Prevalence of drug-induced constipation and severity of associated biopsychosocial effects in patients with nonmalignant pain: a cross-sectional review of depersonalized data from the German Pain e-Registry

Abstract

Background Drug-induced constipation (DIC) is a well-known comorbidity of cancer pain, however, data on its prevalence in nonmalignant pain (NMP) and its biopsychosocial effects are few. Objective To assess prevalence and impact of DIC in patients with NMP. Methods Exploratory noninterventional, retrospective, cross-sectional analysis of depersonalized routine data of the German Pain e-Registry on 150,488 NMP patients (EUPAS identifier: 42286). Results DIC affects 33.5% of NMP patients. Most prevalent risk factors were the use of strong opioid analgesics and analgesic polymedication. Patients with DIC presented with significantly worse biopsychosocial scores as well as significantly higher percentages of individuals with severe deterioration of pain, daily life activities, physical and mental quality-of-life, mood, and overall wellbeing. Among patients with DIC those who reported constipation as clinical symptom and who documented bowel-function index (BFI) scores above the reference range were significantly more affected compared to those who either reported only constipation as adverse event or elevated BFI scores. 55.9% of patients with DIC reported the use of laxatives, mostly over-the counter preparations (43.6%), whereas prescription laxatives were taken by only 29.3%. Conclusions DIC is a frequent comorbidity of pain management and affects around one third of patients with NMP. It interferes significantly with pain-related biopsychosocial effects and has to be addressed specifically to improve the overall burden in affected patients. However, use of laxatives was significantly less frequent than recommended indicating significant room for improvement.