Opioid-Induced Adverse Effects Hit Social Media

Pauline Anderson

September 10, 2014

LAS VEGAS, Nevada — Patients are tweeting and using other social media outlets to vent about their negative experiences with constipation and other opioid-related adverse effects, and about the lack of discussions with their doctor about such gastrointestinal (GI) symptoms.

"Our results from this social media platform reveal a need for doctor-patient communication regarding opioid-use GI side effects," said Justin Scopel, MD, MBA, associate medical director, medical affairs, Takeda Pharmaceuticals Inc.

Dr. Scopel discussed the study, funded by Takeda Pharmaceuticals, during a poster presentation session at the PAINWeek meeting here. Takeda Pharmaceuticals/Sucampo Pharmaceuticals Inc have a product called lubiprostone (Amitiza) that is approved by the US Food and Drug Administration for the treatment of opioid-induced constipation, as well as chronic idiopathic constipation and irritable bowel syndrome with constipation.

"Free-Range" Survey

Opioids are used to treat both chronic and acute pain, but they often cause nausea, bloating, and constipation. For example, more than 40% of opioid users experience constipation. In some cases, these GI adverse effects are so severe that patients discontinue the opioid, said Dr. Scopel.

Researchers carried out a structured review of social media platforms, using an "unfiltered free-range method rather than a formal survey" to determine how patients balance pain relief with some of the adverse effects that opioids can cause, said Dr. Scopel.

The study involved 2 types of analysis. The first used a qualitative method where researchers reviewed Twitter posts during a 3-week period as well as posts on e-forums on health-related networking sites such as www.PatientsLikeMe.com. The e-forum posts were not in a particular time frame because, as Dr. Scopel pointed out, there are far fewer posts than tweets. They looked for key words related to GI adverse effects.

The second method involved a computer-driven quantitative approach that used different statistical models to determine the most frequent themes based on key words.

Of the 264,040 Tweets and 217,199 e-forum posts extracted by the data collection algorithms, 4% of the Tweets and 2% of the posts were relevant to opioid-induced constipation. These formed the data sets and were the basis of the qualitative analysis.

From this analysis, 1214 people endorsed GI adverse effects. The top 3 concerns were constipation, which was mentioned by 70%; nausea, by 21%; and vomiting, by 10%. "This goes along with some of the epidemiologic formal studies we've seen with constipation certainly being the most relevant and the highest reported by patients," said Dr. Scopel.

Forty patients questioned their opioid regimens because of the severity of the GI adverse effects, and 48 mentioned reducing or stopping altogether their opioid treatment because of adverse effects or that their doctor changed their drug regimen for this reason.

Thirty-two patients mentioned communicating or wanting to communicate with their doctor about opioid-induced GI adverse effects.

The most common themes from the quotes, said Dr. Scopel, were balancing opioid use with adverse effects, the GI adverse effects themselves, and doctor-patient communications.

Unprompted Reporting

Within the doctor-patient communication quotes, patients were concerned about the difficulty talking to their physician, rotating or altering an opioid prescription, and seeking further health information. "So there was a real gamut of patients reporting this in a completely unprompted manner, sharing it on social media platforms, so it's obviously important to them," said Dr. Scopel.

With the quantitative model, the researchers let the computer "dig" through the original pool of quotes to find the most common themes, said Dr. Scopel. Only quotes that had a minimum weighting, meaning they had relevance to a given topic, were included. Of the 50 topics fitted to the constipation content model, 7 "rose to the top" as having a higher than average proportion of relevant social media tweets and posts, he said. As well, 13 of 50 topics related to patient-doctor communications contained higher than average percentages of relevant quotes.

The study showed a convergence between the 2 methods of analysis. Of the 7 constipation topics picked up by the computer model, 5 were also the most common in the manual process. Of the 13 patient-doctor topics from the computer-driven model, 12 overlapped as being most common from the hand-sorted method.

"Both methods reveal that patients are modifying their treatment regimen, with or without medical advice, that they're unprepared to treat their opioid side effects," and although they want to talk to their doctor about these adverse effects they feel unable to do so, said Dr. Scopel.

"This type of discussion often falls by the wayside, but it's clearly important, especially when it affects the patient medication adherence."

The posts and tweets were "expressed by patients in their own words" and reveal what they are experiencing "when nobody else is listening," said Dr. Scopel.

Frustrated Patients

Addressing a query from an attendee, Dr. Scopel said the study shows just how frustrated some patients are about experiencing adverse effects and not getting the information they want. "They are left feeling in a real bind."

He suggested that physicians may want to think about taking an extra 30 seconds or however long it takes to tell patients what to expect and perhaps arrange to discuss any concerns at a future meeting. Dr. Scopel said he expects the research will be published in the near future.

The poster session co-chair, Joseph Pergolizzi Jr, MD, assistant professor, medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, found the study "interesting" because it "used cutting-edge social media to help provide insight into a very common side effect of opioids."

The study, agreed Dr. Pergolizzi, "showed there is a need for increased doctor-patient communication regarding opioid-induced GI side effects."

The study was funded by Takeda Pharmaceuticals. Dr. Scopel is an employee of Takeda Pharmaceuticals. Dr. Pergolizzi is a consultant with Iroko Pharmaceuticals; receives grant or research support from Inspirion Pharmaceuticals, INSYS Therapeutics Inc, Johnson & Johnson Services Inc, Mundipharma International, and Purdue Pharma LP; and is on the speakers bureau for AstraZeneca, Grünenthal USA Inc, Iroko Pharmaceuticals, Janssen Pharmaceuticals Inc, and Purdue Pharma LP.

PAINWeek 2014. Poster 113. Presented September 4, 2014.

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