Constipation is a topic most people would try to avoid. But the two people who should be talking about it — doctors and their patients — appear to be avoiding it as well.
Nearly 4 out of 10 doctors whose patients have opioid induced constipation (OIC) don’t know that their patients are constipated, according to a new study being presented at PAINWeek, a national conference of practitioners in the field of pain management.
OIC is a common side-effect of opioid painkillers, with 40% to 80% of patients taking opioids for chronic non-cancer pain suffering some degree of constipation.
Researchers followed nearly 500 patients with OIC in the United States, Canada, Germany and the United Kingdom for six months. Most of the patients were female (62%); with lower back pain (77%) and joint pain (51%) the most frequently reported pain condition. The most common opioids prescribed to them were oxycodone, hydrocodone, morphine and tramadal.
What set this study apart from others is that the patients’ physicians were also questioned about their treatment and interaction with patients.
Only 61% of the doctors knew that their patients were constipated and 25% didn’t know their patients were taking laxatives.
Clearly, there’s a communication problem between doctors and patients when it comes to OIC.
“Patients are either too embarrassed to talk to their physicians about it or physicians aren’t listening or aware,” said Hilary Wilson, co-author and research scientist for Evidera, which conducted the study. “My guess is the conversation isn’t happening. Patients aren’t bringing it up and doctors aren’t asking about it.”
“If the physician isn’t asking about constipation, the patient may not feel empowered enough to bring that up with the provider. They may want to prioritize their pain medication refill or pain medication treatment over the constipation issue. The patient may also feel that they can manage their constipation on their own.”
Over-the-counter laxatives, as well as increased fluid and dietary fiber intake, can often be used to relieve OIC, but even when those treatments fail — many doctors remain in the dark about what their patients are going through or that its interfering with their pain management.
Nearly one in four patients (23%) said they were “very dissatisfied” with their OIC treatment. But only about 3% of doctors thought their patients were unhappy with their treatment.
Nearly half (49%) of patients with constipation reported moderate or complete interference with the ability of their opioid medication to control pain; but only 27% of doctors knew that. That knowledge is important because many patients reduce how often they take pain medication in an attempt to self-manage their OIC symptoms.
“The thing that surprised me most was the lack of awareness. The doctors didn’t even know,” said Wilson. “Clearly there needs to be education for patients and clinicians to have this conversation. There are adequate treatments out there. There are thing that can be used to treat constipation and this does impact patients and so that conversation needs to happen. Physicians need to ask and patients need to feel comfortable bringing it up with their doctors.”