Open Access Open Access  Restricted Access Subscription or Fee Access

Opioid-induced constipation in chronic pain: Experience with 180 patients

Ignacio Velázquez Rivera, MD, Lourdes Velázquez Clavarana, BSc, Pilar García Velasco, BSc, Carmen Melero Ramos, BSc

Abstract


Background: Opioid-induced constipation (OIC) is a common adverse effect of opioid analgesic therapy that significantly affects the patient's quality of life and may lead to poor adherence and treatment failure. Tapentadol, oxycodone/naloxone, and some transcutaneous opioids were associated with less frequent OIC than morphine or oxycodone in controlled clinical trials. However, few studies compare these newer opioids with each other in terms of OIC.

Methods and patients: We performed a cross-sectional observational study that evaluated the degree of OIC and risk factors in patients receiving long-term treatment (>1 year) at a tertiary care pain unit with tapentadol, oxycodone/naloxone, hydromorphone, fentanyl, or buprenorphine. The degree of constipation was evaluated using the Bowel Function Index (BFI).

Results: Out of 180 enrolled patients (median age: 61.5 years, 66.7 percent women, mean treatment duration: 3 years), 57.2 percent suffered from nociceptive pain, 33.9 percent from mixed pain, and 8.9 percent from neuropathic pain. The most commonly prescribed opioids were oxycodone/naloxone (44.4 percent) and tapentadol (37.8 percent). At the time of the study, 73.9 percent of patients had constipation (BFI > 29), and 21.7 percent had severe constipation (BFI > 69). In a multiple linear regression analysis, previous constipation, morphine equivalent dose, treatment with fentanyl and interaction between morphine equivalent dose and hydromorphone were associated with more severe constipation.

Conclusions: Most patients receiving long-term treatment with opioids present symptoms of constipation. The bowel function profile was more favorable for tapentadol and oxycodone, with no differences between them, even though morphine equivalent doses were on average higher in the tapentadol group.


Keywords


opioid-induced constipation, tapentadol, oxycodone, naloxone, hydromorphone, fentanyl, chronic pain

Full Text:

PDF

References


Gálvez R, Provencio M, Sanz-Ortiz J, et al.: Análisis económico de oxicodona LP/naloxona LP en el manejo del dolor intense y el estreñimiento asociado al tratamiento con opioides en España. PharmacoEcon Span Res Artic. 2012; 9: 23-34.

Gatchel RJ, Peng YB, Peters ML, et al.: The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychol Bull. 2007; 133(4): 581-624.

Morlion B: Chronic low back pain: Pharmacological, interventional, and surgical strategies. Nat Rev Neurol. 2013; 9(8): 462-473.

American Society of Anesthesiologists Task Force on Chronic Pain Management, American Society of Regional Anesthesia and Pain Management: Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010; 112(4): 810-833.

De Leon-Casasola OA: Opioids for chronic pain: New evidence, new strategies, safe prescribing. Am J Med. 2013; 126(3) (suppl 1): S3-S11.

Galvez R, Provencio M, Cobo M, et al.: [Observational and cross-sectional study of prevalence and severity of the opioid-induced bowel dysfunction]. Aten Primaria. 2014; 46(1): 32-39.

Kalso E, Allan L, Dellemijn PL, et al.: Recommendations for using opioids in chronic non-cancer pain. Eur J Pain. 2003; 7(5): 381-386.

Kalso E, Edwards JE, Moore RA, et al.: Opioids in chronic non-cancer pain: Systematic review of efficacy and safety. Pain. 2004; 112(3): 372-380.

Casati A, Sedefov R, Pfeiffer-Gerschel T: Misuse of medicines in the European Union: A systematic review of the literature. Eur Addict Res. 2012; 18(5): 228-245.

Noble M, Treadwell JR, Tregear SJ, et al.: Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010; 20(1): CD006605.

Chou R, Fanciullo G, Fine P, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.

Argoff CE, Brennan MJ, Camilleri M, et al.: Consensus recommendations on initiating prescription therapies for opioid-induced constipation. Pain Med. 2015; 16(12): 2324-2237.

Breivik H, Collett B, Ventafridda V, et al.: Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006; 10(4): 287-333.

Panchal SJ, Muller-Schwefe P, Wurzelmann JI: Opioid-induced bowel dysfunction: Prevalence, pathophysiology and burden. Int J Clin Pract. 2007; 61(7): 1181-1187.

Thorpe DM: Management of opioid-induced constipation. Curr Pain Headache Rep. 2001; 5(3): 237-240.

Bell TJ, Panchal SJ, Miaskowski C, et al.: The prevalence, severity, and impact of opioid-induced bowel dysfunction: Results of a US and European Patient Survey (PROBE 1). Pain Med. 2009; 10(1): 35-42.

Oosten AW, Oldenmenger WH, Mathijssen RH, et al.: A systematic review of prospective studies reporting adverse events of commonly used opioids for cancer-related pain: A call for the use of standardized outcome measures. J Pain. 2015; 16(10): 935-946.

Poulsen JL, Brock C, Olesen AE, et al.: Evolving paradigms in the treatment of opioid-induced bowel dysfunction. Therap Adv Gastroenterol. 2015; 8(6): 360-372.

Doyle D, Hanks G, MacDonald N: Oxford Textbook of Palliative Medicine. Oxford, UK: Oxford University Press, 1999.

Galligan JJ, Akbarali HI: Molecular physiology of enteric opioid receptors. Am J Gastroenterol Suppl. 2014; 2(1): 17-21.

Rose S (ed.): A Practical Approach to Diagnosis and Treatment. New York: Springer, 2014: 182.

Yuan CS, Pappagallo M: Opioid bowel dysfunction. In Yuan CS (ed.): Handbook of Opioid Bowel Syndrome. New York: Haworth Medical Press, 2005.

Kurz A, Sessler DI: Opioid-induced bowel dysfunction: Pathophysiology and potential new therapies. Drugs. 2003; 63(7): 649-671.

Simpson K, Leyendecker P, Hopp M, et al.: Fixed-ratio combination oxycodone/naloxone compared with oxycodone alone for the relief of opioid-induced constipation in moderate- to-severe noncancer pain. Curr Med Res Opin. 2008; 24(12): 3503-3512.

Wade WE, Spruill WJ: Tapentadol hydrochloride: A centrally acting oral analgesic. Clin Ther. 2009; 31(12): 2804-2818.

Targin 5/2.5mg, 10mg/5mg, 20mg/10mg and 40/20mg prolonged release tablets. Summary of Product Characteristics. January 31, 2017. Available at http://www.medicines.ie/medicine/14383/SPC/Targin+10mg+5mg+and+20mg+10mg+prolonged+release+tablets-PHARMACOLOGICAL_PROPS. Accessed February 2017.

Rentz AM, Yu R, Muller-Lissner S, et al.: Validation of the Bowel Function Index to detect clinically meaningful changes in opioid-induced constipation. J Med Econ. 2009; 12(4): 371-383.

Mercadante S, Porzio G, Ferrera P, et al.: Tapentadol in cancer pain management: A prospective open-label study. Curr Med Res Opin. 2012; 28(11): 1775-1779.

Gonzalez-Barboteo J, Trelis-Navarro J, Tuca-Rodríguez A, et al.: Rotación de opioides: una alternativa en el tratamiento del dolor refractario en pacientes con cáncer. Med Clin. 2010; 135(13): 617-622.

Jurnista [package insert]: Ficha técnica [Summary of product characteristics]. October 2017. Available at https://www.aemps.gob.es/cima/pdfs/es/ft/68019/68019_ft.pdf. Accessed October 2017.

Durigesic [package insert]: Ficha técnica [Summary of product characteristics]. November 2016. Available at https://www.aemps.gob.es/cima/pdfs/es/ft/61959/FichaTecnica_61959.html.pdf. Accessed February 2017.

Trasntec [package insert]: Ficha técnica [Summary of product characteristics]. September 2014. Available at https://www.aemps.gob.es/cima/pdfs/es/ft/64685/FichaTecnica_64685.html. pdf. Accessed February 2017.

Sittl R, Likar R, Nautrup BP: Equipotent doses of transdermal fentanyl and transdermal buprenorphine in patients with cancer and noncancer pain: Results of a retrospective cohort study. Clin Ther. 2005; 27(2): 225-237.

Galvez R, Schafer M, Hans G, et al.: Tapentadol prolonged release versus strong opioids for severe, chronic low back pain: Results of an open-label, phase 3b study. Adv Ther. 2013; 30(3): 229-259.

Kwong WJ, Hammond G, Upmalis D, et al.: Bowel function after tapentadol and oxycodone immediate release (IR) treatment in patients with low back or osteoarthritis pain. Clin J Pain. 2013; 29(8): 664-672.

Steigerwald I, Schenk M, Lahne U, et al.: Effectiveness and tolerability of tapentadol prolonged release compared with prior opioid therapy for the management of severe, chronic osteoarthritis pain. Clin Drug Investig. 2013; 33(9): 607-619.

Lowenstein O, Leyendecker P, Hopp M, et al.: Combined prolonged-release oxycodone and naloxone improves bowel function in patients receiving opioids for moderate-to-severe non-malignant chronic pain: A randomised controlled trial. Expert Opin Pharmacother. 2009; 10(4): 531-543.

Ueberall MA, Mueller-Schwefe GH: Development of opioid-induced constipation: Post hoc analysis of data from a 12-week prospective, open-label, blinded-endpoint streamlined study in low-back pain patients treated with prolonged-release WHO step III opioids. J Pain Res. 2015; 8: 459-475.

Baron R, Jansen JP, Binder A, et al.: Tolerability, safety, and quality of life with tapentadol prolonged release (PR) compared with oxycodone/naloxone PR in patients with severe chronic low back pain with a neuropathic component: A randomized, controlled, open-label, phase 3b/4 trial. Pain Pract. 2016; 16(5): 600-619.

Wirz S, Wittmann M, Schenk M, et al.: Gastrointestinal symptoms under opioid therapy: A prospective comparison of oral sustained-release hydromorphone, transdermal fentanyl, and transdermal buprenorphine. Eur J Pain. 2009; 13(7): 737-743.

Kuo A, Wyse BD, Meutermans W, et al.: In vivo profiling of seven common opioids for antinociception, constipation and respiratory depression: No two opioids have the same profile. Br J Pharmacol. 2015; 172(2): 532-548.




DOI: http://dx.doi.org/10.5055/jom.2019.0487

Refbacks

  • There are currently no refbacks.
This site uses cookies to maintain session information critical to the user's experience and environment on this system. Click "Accept Cookies" to continue.
For more details please visit our privacy statement at: Privacy & GDPR