The impact of opioid and laxative prescribing habits on constipation in the primary care setting before and after the introduction of SIGN 44: Control of pain in patients with cancer

Abstract

The constipating effect of opioids used in cancer pain is widely acknowledged. Opioids account for about a half of constipation in cancer patients, making constipation one of the most prevalent side effects of cancer analgesia. Scottish Intercollegiate Guidelines Network (SIGN) guideline 44 (7.4.1) states explicitly that the appropriate intervention for opioid-induced constipation is a combination of softening and stimulating prophylactic laxatives. Previous literature suggests such practice is not commonplace, implicating a knock-on negative effect to patients' quality of life and highlighting the need for audit in this area. An audit of bowel management in Fife primary care was carried out comparing laxative prescribing practice before and after the publication of SIGN 44: Control of pain in patients with cancer. The data for the audit included all opioid prescriptions including both cancer and non-cancer patients. It was found that publication of SIGN 44 had no significant effect on adherence to the guideline by general practitioners in Fife, at six-, 12- and 18-months post-publication. Implications for quality of life and improving bowel management are discussed.