Opioid-Induced Constipation Impacts Nearly 40% of Patients Prescribed Opioids for Cancer Pain

Results of the European Pain in Cancer survey (EPIC) have shown that cancer pain and the side effects associated with cancer treatment have a “significant impact on the quality of life” of many patients in Europe and Israel who are suffering from the disease.

When asked about pain relief, nearly two-thirds of patients, or 63%, taking prescribed medication reported breakthrough pain or inadequate pain relief. Patients taking opioids for pain relief reported even more problems. Side effects from the opioids were cited by 74% of respondents, with constipation, cited by 37% of those who experienced opioid side effects, being the most common problem. For those patients experiencing opioid-induced constipation, 25% were not co-prescribed laxatives by their doctors. Additional side effects included nausea and vomiting (33%) and sedation (20%).

Other findings of the EPIC survey focused on the impact of pain on quality of life. Nearly a third of patients, or 30%, said that they were “in too much pain to care sufficiently for themselves or others,” while 43% of respondents felt that their pain made them “an increased burden to others.” Pain that prevented patients’ ability for thinking and concentrating was reported by 51% of survey participants, and, for those patients still employed, 52% said that “their pain impacts on their work performance.”

The EPIC survey was completed in 12 countries between 2006 and early 2007 and “aimed to explore the burden of cancer pain, current pain treatment practices across Europe and Israel and their effects in all cancer types and cancer stages,” according to the researchers. Initially, 5,084 adult patients were contacted about screening interviews, with 2,864 who actually completed the interview. The patients who were interviewed “rated their pain to be 5 or above on a pain scale and had experienced recurrent pain several times a month or more in the last month.” According to the researchers, following that phase, “573 patients were then randomly selected to complete in-depth attitudinal questionnaires.”

Professor Harald Breivik, a member of the Faculty of Medicine at the University of Oslo, commented on the results of the survey:

“The results of the EPIC study underline the impact of cancer pain on the day-to-day lives of patients but also strongly highlight that side effects of pain treatments can cause further problems. Many patients must choose between endure their pain, or suffer the side effects from their pain medication,” said Breivik. “Clinicians need to adhere to pain management guidelines, specifically the World Health Organisation’s pain relief ladder2, in order to improve access to the appropriate level of pain medication for patients. Keeping a close track of the pain relief obtained and the side effects of these medications, and adjusting therapy to both aspects, are mandatory in order to improve pain patients’ quality of life.”