Boaz Gedaliahu Samolsky Dekel1, Maria Cristina Sorella1, Alessio Vasarri2, Alberto Gori3, Rita Maria Melotti1. 1. Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Department of Emergency-Urgency, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medicine and Surgery Sciences, Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy. 2. Department of Emergency-Urgency, Azienda Ospedaliera-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy. 3. Department of Medicine and Surgery Sciences, Post Graduate School of Anaesthesia and Intensive Care, University of Bologna, Bologna, Italy.
Abstract
OBJECTIVES: Assessment of opioid-induced constipation (OIC) prevalence and relationship with demographic, clinical, and drug predictors in our daily practice. DESIGN: Observational and retrospective study. SETTING: Chronic pain (CP) center of Bologna's Teaching Hospital, Italy. SUBJECTS: Mixed consecutive CP opioid-user outpatients (n = 128). MAIN OUTCOME MEASURE(S): OIC was assessed with the Bowel Function Index (BFI) in three consecutive visits. Absolute difference and Student's t-test were used to compare BFI scores. Predictors (opioid compound and type, morphine-equivalent daily-dose [MEDD], and laxatives) were retrieved from the patients' charts. BFI and predictors relationships were checked by multinomial logistic regression (MLR); independent predictors of BFI scores were assessed with χ2 analysis. RESULTS: Of the 384 evaluations, 85 percent were on strong opioids with a MEDD range of 11-50 mg per day in the majority (60 percent) and 64 percent showed moderate constipation; 42 percent did not use laxatives while 24 percent used macrogol with significant decrease in the BFI. MLR showed that oxycodone was associated with a risk for moderate constipation. Lactulose and glycerin suppositories were associated with severe constipation. Non-opioid users and cancer patients were associated with normal bowel function and severe constipation, respectively. CONCLUSIONS: OIC was found in almost all evaluations of weak or strong opioidusers (97 percent); moderate to severe OIC was found in 72 percent of the evaluations. Cancer patients were associated with severe constipation. Macrogol was superior to other laxatives. In our experience, macrogol relieved constipation in those on the combination of oxycodone and naloxone and in those on fentanyl patches. Lactulose and glycerol suppositories were associated with severe constipation.
OBJECTIVES: Assessment of opioid-induced constipation (OIC) prevalence and relationship with demographic, clinical, and drug predictors in our daily practice. DESIGN: Observational and retrospective study. SETTING:Chronic pain (CP) center of Bologna's Teaching Hospital, Italy. SUBJECTS: Mixed consecutive CP opioid-user outpatients (n = 128). MAIN OUTCOME MEASURE(S): OIC was assessed with the Bowel Function Index (BFI) in three consecutive visits. Absolute difference and Student's t-test were used to compare BFI scores. Predictors (opioid compound and type, morphine-equivalent daily-dose [MEDD], and laxatives) were retrieved from the patients' charts. BFI and predictors relationships were checked by multinomial logistic regression (MLR); independent predictors of BFI scores were assessed with χ2 analysis. RESULTS: Of the 384 evaluations, 85 percent were on strong opioids with a MEDD range of 11-50 mg per day in the majority (60 percent) and 64 percent showed moderate constipation; 42 percent did not use laxatives while 24 percent used macrogol with significant decrease in the BFI. MLR showed that oxycodone was associated with a risk for moderate constipation. Lactulose and glycerin suppositories were associated with severe constipation. Non-opioid users and cancerpatients were associated with normal bowel function and severe constipation, respectively. CONCLUSIONS: OIC was found in almost all evaluations of weak or strong opioidusers (97 percent); moderate to severe OIC was found in 72 percent of the evaluations. Cancerpatients were associated with severe constipation. Macrogol was superior to other laxatives. In our experience, macrogol relieved constipation in those on the combination of oxycodone and naloxone and in those on fentanyl patches. Lactulose and glycerol suppositories were associated with severe constipation.
Authors: Matthew A Spiegel; Grant H Chen; Antonio C Solla; Lee P Hingula; Aron Legler; Amitabh Gulati Journal: J Palliat Med Date: 2020-07-08 Impact factor: 2.947