Opioid-related bowel dysfunction: prevalence and identification of predictive factors in a large sample of Italian patients on chronic treatment

G. Rosti, A. Gatti*, A. Costantini**, A.F. Sabato*, F. Zucco§

Medicina Oncologica, Ospedale Ca’ Focello, Treviso (Italy) *Anestesiologia e Terapia del Dolore, Università Tor Vergata, Rome (Italy) **Terapia del Dolore e Cure Palliative, Ospedale SS. Annunziata, Chieti (Italy); §Unità di Terapia del Dolore e Cure Palliative, Ospedale G. Salvini, Garbagnate Milanese, Milano (Italy)

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• Anesthesiology

Abstract. – Background and Objectives: Opioid-bowel dysfunction (OBD) is a broad range of symptoms potentially associated with opioid therapy. This prospective, multicentric study assesses the prevalence of OBD in patients on analgesic therapy for the treatment of pain from any cause and identifies the factors associated with the onset of this side effect.
Materials and Methods: Consecutive patients aged >18 years, on analgesic treatment with opioids, non-steroidal anti-inflammatory drugs (NSAIDs) or other therapies for chronic pain of any aetiology were included in the study. The association of OBD with gender, age, pain aetiology and analgesic treatment was analyzed by multivariate analysis and logistic analysis.
Results: In total, 2324 patients were included in the study. The prevalence of OBD symptoms was 63.5%, despite that the wide majority of patients (89.5%) were receiving laxatives. OBD symptoms were judged as directly correlated with analgesic therapy in 85.1% of cases. The highest prevalence of constipation was reported with morphine, whereas the lowest was observed in patients on oxycodone CR and buprenorphine TTS. Statistical analysis showed that patients on opioids have a higher likelihood of experiencing OBD symptoms than those on NSAIDs or other treatments (66.2% vs 37.0%), and this probability is even higher in those with cancer-related pain (69.3%). Female gender and age >70 years also appeared as risk factors. The logistic analysis indicated that cancer-related pain, increased age and the use of fentanyl are positive predictors of the presence of OBD, whereas the administration of oxicodone CR was associated with a decreased incidence of these symptoms.
Discussion: Even with the limitation of any observational experience, this study suggests, for the first time, the existence of some factors predictive of the onset of OBD symptoms in patients on analgesic treatment. Moreover, different opioids seem to be associated with a different risk of experiencing these symptoms.

Corresponding Author: Giovanni Rosti, MD; e-mail: rosti.giovanni@gmail.com

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