title: Satisfaction with Therapy Among Patients with Chronic Noncancer Pain with Opioid-Induced Constipation.
abstract: BACKGROUND
  Greater satisfaction with medication is associated with better adherence; however, specific to opioid-induced constipation (OIC), data on the relationship between medication satisfaction and efficacy are lacking.
  
  
  OBJECTIVE
  To understand satisfaction with therapy among patients with chronic noncancer pain and OIC.
  
  
  METHODS
  A prospective longitudinal study was conducted in the United States, Canada, Germany, and the United Kingdom using web-based patient surveys. Patients on daily opioid therapy for ≥ 74 weeks for the treatment of chronic noncancer pain with OIC were recruited from physician offices and completed a web-based survey at baseline and weeks 2, 4, 6, 8, 12, 16, 20, and 24. When completing each survey, patients selected the remedies used in the previous 2 weeks to relieve constipation; options included natural/behavioral therapies, over-the-counter (OTC) therapies, and prescription laxatives. Patients selected the amount of relief and satisfaction with each selected therapy. Descriptive statistics were calculated; Spearman's correlations were calculated for symptom relief and satisfaction.
  
  
  RESULTS
  Mean age of the 489 patients who met the criteria for OIC and completed the baseline survey was 52.6 ± 11.6 years; 62% were female; 85% were white. Increasing levels of relief from constipation were associated with increasing levels of satisfaction for all agents; correlations were > 0.55 and statistically significant (P < 0.001). Among the patients who had used OTC therapies in the 2 weeks prior to baseline, 54% to 73% reported that they were somewhat or very satisfied with the therapy. Yet, of these satisfied patients, 28% to 63% experienced no or only slight relief from the therapy. Twenty percent to 79% of the patients who had used prescription laxatives in the 2 weeks prior to baseline reported being at least somewhat satisfied with the therapy.
  
  
  CONCLUSIONS
  These results indicate that there is a high rate of inadequate response to laxatives for patients with OIC that persisted for the 6 months of this study. While increased relief from constipation was associated with increased satisfaction for all therapies, there remains a substantial number of patients who report satisfaction despite having only inadequate relief from OIC that merits further investigation.
authors.affiliation: 1 Director, Quality, Design & Analytics, Medical Evidence and Observational Research, AstraZeneca Pharmaceuticals, Wilmington, Delaware.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: LoCasale
authors.affiliation: 2 U.S. Medical Affairs Medical Lead, AstraZeneca Pharmaceuticals, Wilmington, Delaware.
authors.forename: Catherine
authors.initials: C
authors.lastname: Datto
authors.affiliation: 3 Senior Program Officer, Science, Patient-Centered Outcomes Research Institute (PCORI), Washington, DC.
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Margolis
authors.affiliation: 4 Vice President, Research, Evidera, Bethesda, Maryland.
authors.forename: Karin S
authors.initials: KS
authors.lastname: Coyne
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D003248:Constipation / Q000139:chemically induced*; D005260:Female; D006801:Humans; D054368:Laxatives / Q000009:adverse effects / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D054368:Laxatives