Talking about bowel habits may help prevent misuse of opioids

One of my chronic pain patients recently requested an appointment, complaining of increased pain. I asked him to bring him an opioid prescription so that the office could count the tablets. The count eventually dropped – not because she was increasing her dose, but because she was taking less of her opioid medications than those prescribed. So, I started asking myself: why would a patient with chronic pain taking opioids reduce her medications and complain about an increase in pain? In addition, why did not she address this issue during her previous appointment?

After an exchange with the patient, I determined that this patient was suffering from opioid-induced constipation, which affects 40 to 80% of patients receiving long-term opioid therapy. The burden of OIC often has an impact on the lives of patients because they can experience distress and discomfort, an increase in the number of doctor visits, absences from work and a productivity scaled down.

[See: How Often Should I Poop, and Other Toilet Topics.]

This patient reported having changed her opioid dosage after her constipation, in the hope of relieving the discomfort of her responsible physician. Although it helped relieve his officer, taking fewer opioids than those prescribed compromised the relief of his pain. It is important to note that the patient eventually returned to taking the appropriate amount of opioids that had been prescribed to her. However, changing the dose of a prescription drug is actually misusing it. And this is of particular concern for patients who rely on opioid therapy to relieve their chronic pain.

A recent survey found that some patients had used a modification of their opioid regimen to relieve the ozone syndrome. According to a one-week national online survey sponsored by Salix Pharmaceuticals and the US Pain Foundation and conducted by Wakefield Research, which evaluated the responses of 441 American adults aged 18 or older living with chronic pain, a treatment opioid and OIC sufferers – 37% reported having changed the dosage of their opioid medications to try to relieve the pain or discomfort of OIC.

In my experience and contrary to popular belief, conventional laxatives are not a reliable treatment for OIC. Generally, for the responsible physician, the treatment plan includes stool monitoring and lifestyle adjustment in conjunction with conventional laxatives. Over-the-counter therapies, such as laxatives, do not target the opioid receptor-mediated OIC mechanism. Although I think opioids are necessary for some patients with chronic pain, it is my job to help prevent patients from abusing these drugs.

[See: What to Eat, Drink and Do to Relieve Constipation.]

Health care providers must remember that patients may feel uncomfortable when talking about their bowel movements. We must do more to facilitate this dialogue. I encourage patients to adopt a "Ask them, tell them" policy by ensuring that we ask them the appropriate questions about their bowel habits and discussing the OIC as a potential side effect of treatment by opioids.

Unfortunately, this policy is not the norm. The survey found that while most of the patients surveyed (58%) thought their doctor wanted to help them get faster relief for their problem, only 50% remembered being told by their doctor before taking their opioid medications that constipation posed a potential risk. effect. As a doctor specializing in the treatment of pain, that worries me a lot.

By setting up an open discussion policy and taking into account the other problems that patients are exposed to, doctors will be more effective in identifying appropriate treatment options to help people with chronic pain, while potentially reducing the risk that the patient will not follow his opioid regime. /therapy. As health care providers, we can begin this dialogue by asking questions such as, "How have your bowel habits changed since taking the opioid?" If you or a family member is suffering For chronic pain and opioid treatment, I encourage you to talk with your health care provider about OIC symptoms and treatment options that may be right for you.

[See: Foods That Cause Bloating.]

Joseph Pergolizzi, M.D., Senior Partner and Director of Research at Naples Anesthesia and Pain Associates in Naples, Florida, and paid consultant for Salix Pharmaceuticals.

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