Common Clinical Practice for Opioid-Induced Constipation: A Physician Survey.

BACKGROUND

Opioid-induced constipation (OIC) remains an important clinical obstacle despite the availability of several guidelines and pharmacological options for its management. Here, we surveyed common practices and perceptions about OIC among physicians who prescribe opioids in Italy.

METHODS

The online survey included 26 questions about OIC. Responses were analyzed descriptively and aggregated by physician specialty.

RESULTS

A total of 501 physicians completed the survey. Most respondents (67%) did not feel adequately educated about OIC despite general consensus regarding interest in the topic. Overall, 62-75% of physicians regularly evaluated intestinal function or OIC symptoms in patients receiving opioid therapy. The most common method for assessment was patient diary; few physicians used a validated instrument such as the Rome IV criteria. Psychiatrists and addiction specialists showed the lowest interest and poorest practices. Most respondents (78%) preferred macrogol prophylaxis followed by macrogol plus another laxative for first-line treatment of OIC symptoms. Peripheral-acting mu opioid receptor antagonists (PAMORAs) were not widely used among physicians; 61% had never prescribed a PAMORA for OIC.

CONCLUSION

Our findings reveal important differences in clinical practice for OIC across physician specialties. Additional formative efforts are necessary to improve awareness about best practices in OIC.

Informations de copyright

© 2021 Coluzzi et al.

Déclaration de conflit d'intérêts

FC is a speaker and consultant for Angelini, Grunenthal, Malesci, Molteni, Pfizer, and Shionogi. DA has received research grants and consultant fees from Intercept Pharma, Molteni, Shionogi, and Vesta, and is a consultant for Aboca. ATC has received research grants from Molteni, Gruenenthal GmbH, Prostrakan, Amgen, and Ipsen and is a consultant for Kyowa Kirin, Gruenenthal GmbH, Pfizer, Helsinn Healthcare, Molteni, Shionogi, Italfarmaco, Sandoz International GmbH, Angelini Holding S.p.A., Mundipharma, and the Institute de Recherche “Pierre Fabre.” WG has received research grants and other funding from Molteni and Shionogi. FM has received research grants and other funding from Molteni and Shionogi. GM has received research grants and other funding from Molteni and Shionogi. CP has received research grants and other funding from Molteni and Shionogi. GV is Member of the Advisor Boards of Abbott, Dompé, Malesci, Menarini International, Molteni, Mundipharma, Shionogi. Also, he is Member of the Speakers’ Bureau of Berlin-Chemie, Dompé, MAP, Menarini International, MCAC, Molteni, Takeda. He has received funds for research by Dompé, Fondazione Maugeri and Pfizer. He is a Member of the Editorial Board of several scientific journals, and is Editor in Chief of Pain and Therapy. FL has received research grants and other funding from Molteni and Shionogi. The authors report no other conflicts of interest in this work.