{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T13:24:00Z","timestamp":1772717040129,"version":"3.50.1"},"reference-count":30,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2017,4,1]],"date-time":"2017-04-01T00:00:00Z","timestamp":1491004800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.jp","scandinavianjournalpain.com","clinicalkey.com","clinicalkey.es","clinicalkey.com.au","clinicalkey.fr","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_j.sjpain.2017.01.006_s_001\">\n                    <jats:title>Background and aim<\/jats:title>\n                    <jats:p>Opioid analgesics are often effective for pain management, but may cause constipation. The aim of this study was to determine healthcare resource use and costs in non-cancer and cancer patients with opioid-induced constipation (OIC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2017.01.006_s_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a nationwide register-based cohort study including patients \u226518years of age initiating \u22654 weeks opioid therapy (1998\u20132012) in Denmark. Ameasure of OIC was constructed based on data from Danish national health registries, and defined as \u22651 diagnosis of constipation, diverticulitis, mega colon, ileus\/subileus, abdominal pain\/acute abdomen or haemorrhoids and\/or \u22652 subsequent prescription issues of laxatives. Total healthcare resource utilization and costs (including pharmacy dispense, inpatient-, outpatient-, emergency room- and primary care) were estimated according to OIC status, opioid treatment dosage and length, gender, age, marital status, and comorbidities using Generalised Linear Model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2017.01.006_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 97 169 eligible opioid users (77 568 non-cancer and 19 601 patients with a cancer diagnosis). Among non-cancer patients,15% were classified with OIC,10% had previous constipation, and 75% were without OIC. Patients characteristics of non-cancer OIC patients showed a higher frequency of strong opioid treatment (69% versus 41%), long-term opioid treatment (1189 days versus 584 days), advanced age (73 years versus 61 years), and cardiovascular disease (31%versus 19%) compared to those without OIC (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001 for all comparisons). Non-cancer patients with OIC had 34% higher total healthcare costs compared to those without OIC (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) after adjusting for age, gender, opioid usage, marital status and comorbidities. Among cancer patients, 35% were classified with OIC,14% had previous constipation, and 51% were without OIC. A higher proportion of cancer patients with OIC were continuous opioid users (85% versus 83%) and strong opioid users (97% versus 85%), compared to those without OIC (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001 for both comparisons). Further, the mean number of days on opioids were higher for cancer patients with versus without OIC (329 days versus 238 days,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). Total healthcare costs were 25% higher for cancer patients with versus without OIC (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) after adjusting for age, gender, opioid usage, marital status and comorbidities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2017.01.006_s_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this nationwide study based on real life data suggested that both non-cancer patients and cancer patients suffering from opioid-induced constipation (OIC) may have higher healthcare resource utilization and higher associated costs compared to those without OIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2017.01.006_s_005\">\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Reducing the number of OIC patients has potential cost savings for the health care system. Special attention should be on patients at potential high risk of OIC, such as strong and long-term opioid treatment, advanced age, and concomitant cardiovascular disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.sjpain.2017.01.006","type":"journal-article","created":{"date-parts":[[2017,2,20]],"date-time":"2017-02-20T09:48:10Z","timestamp":1487584090000},"page":"83-90","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":12,"title":["Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy: A nationwide register-based cohort study in Denmark"],"prefix":"10.1515","volume":"15","author":[{"given":"Jens","family":"S\u00f8ndergaard","sequence":"first","affiliation":[{"name":"Research Unit of General Practice, Institute of Public Health , University of Southern Denmark , Odense , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helene Nordahl","family":"Christensen","sequence":"additional","affiliation":[{"name":"AstraZeneca Nordic-Baltic , S\u00f6dert\u00e4lje , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rikke","family":"Ibsen","sequence":"additional","affiliation":[{"name":"i2minds , \u00c5rhus , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorte Ejg","family":"Jarb\u00f8l","sequence":"additional","affiliation":[{"name":"Research Unit of General Practice, Institute of Public Health , University of Southern Denmark , Odense , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob","family":"Kjellberg","sequence":"additional","affiliation":[{"name":"KORA, Danish Institute for Local and Regional Government Research , Copenhagen , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2017,4,1]]},"reference":[{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_001","unstructured":"Jarlbaek L, Kehlet H, Sj\u00f8gren P. [The licit opioid consumption in Denmark]. Ugeskr Laeger 2010;172:3173\u20138 [in Danish]."},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_002","doi-asserted-by":"crossref","unstructured":"Drewes AM, Munkholm P, Simr\u00e9n M, Breivik H, Kongsgaard UE, Hatlebakk JG, Agreus L, Friedrichsen M, Christrup LL. Definition, diagnosis and treatment strategies for opioid-induced bowel dysfunction\u2014Recommendations of the Nordic Working Group. Scand J Pain 2016;11:111\u201322.","DOI":"10.1016\/j.sjpain.2015.12.005"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_003","doi-asserted-by":"crossref","unstructured":"Boswell K, Kwong WJ, Kavanagh S. Burden of opioid-associated gastrointestinal side effects from clinical and economic perspectives: a systematic literature review. J Opioid Manag 2010;6:269\u201389.","DOI":"10.5055\/jom.2010.0025"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_004","doi-asserted-by":"crossref","unstructured":"Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 2004;112:372\u201380.","DOI":"10.1016\/j.pain.2004.09.019"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_005","doi-asserted-by":"crossref","unstructured":"Cook SF, Lanza L, Zhou X, Sweeney CT, Goss D, Hollis K, Mangel AW, Fehnel SE. Gastrointestinal side effects in chronic opioid users: results from a population-based survey. Aliment Pharmacol Ther 2008;27:1224\u201332.","DOI":"10.1111\/j.1365-2036.2008.03689.x"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_006","doi-asserted-by":"crossref","unstructured":"Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med 2009;10:35\u201342.","DOI":"10.1111\/j.1526-4637.2008.00495.x"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_007","doi-asserted-by":"crossref","unstructured":"Hjalte F, Berggren AC, Bergendahl H, Hjortsberg C. The direct and indirect costs of opioid-induced constipation. J Pain Symptom Manage 2010;40:696\u2013703.","DOI":"10.1016\/j.jpainsymman.2010.02.019"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_008","doi-asserted-by":"crossref","unstructured":"Bell T, Annunziata K, Leslie JB. Opioid-induced constipation negatively impacts pain management, productivity, and health-related quality of life: findings from the National Health and Wellness Survey. J Opioid Manag 2009;5:137\u201344.","DOI":"10.5055\/jom.2009.0014"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_009","doi-asserted-by":"crossref","unstructured":"Reimer K, Hopp M, Zenz M, Maier C, Holzer P, Mikus G, Bosse B, Smith K, Buschmann-Kramm C, Leyendecker P. Meeting the challenges of opioid-induced constipation in chronic pain management \u2013 a novel approach. Pharmacology 2009;83:10\u20137.","DOI":"10.1159\/000165778"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_010","doi-asserted-by":"crossref","unstructured":"Coyne KS, LoCasale RJ, Datto CJ, Sexton CC, Yeomans K, Tack J. Opioid-induced constipation in patients with chronic noncancer pain in the USA, Canada, Germany, and the UK: descriptive analysis of baseline patient-reported outcomes and retrospective chart review. Clinicoecon Outcomes Res 2014;6:269\u201381.","DOI":"10.2147\/CEOR.S61602"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_011","doi-asserted-by":"crossref","unstructured":"Candrilli SD, Davis KL, Iyer S. Impact of constipation on opioid use patterns, health care resource utilization, and costs in cancer patients on opioid therapy. J Pain Palliat Care Pharmacother 2009;23:231\u201341.","DOI":"10.1080\/15360280903098440"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_012","doi-asserted-by":"crossref","unstructured":"Takemoto ML, Fernandes RA, Almeida GR, Monteiro RD, Colombini-Neto M, Bertola-Neto A. Health care resource use and costs in opioid-treated patients with and without constipation in Brazil. Value Health 2011;14:S78\u201381.","DOI":"10.1016\/j.jval.2011.05.019"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_013","unstructured":"Iyer S, Davis KL, Candrilli S. Opioid use patterns and health care resource utilization in patients prescribed opioid therapy with and without constipation. Manag Care 2010;19:44\u201351."},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_014","unstructured":"Wan Y, Corman S, Gao X, Liu S, Patel H, Mody R. Economic burden of opioid-induced constipation among long-term opioid users with noncancer pain. Am Health Drug Benefits 2015;8:93\u2013102."},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_015","doi-asserted-by":"crossref","unstructured":"Kwong WJ, Diels J, Kavanagh S. Costs of gastrointestinal events after outpatient opioid treatment for non-cancer pain. Ann Pharmacother 2010;44:630\u201340.","DOI":"10.1345\/aph.1M520"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_016","doi-asserted-by":"crossref","unstructured":"Pedersen KM, Andersen JS, Sondergaard J. General practice and primary health care in Denmark. J Am Board Fam Med 2012;25:S34\u20138.","DOI":"10.3122\/jabfm.2012.02.110216"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_017","doi-asserted-by":"crossref","unstructured":"Lynge E, Sandegaard JL, Rebolj M. The Danish national patient register. Scand J Public Health 2011;39:30\u20133.","DOI":"10.1177\/1403494811401482"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_018","doi-asserted-by":"crossref","unstructured":"Kildemoes HW, Sorensen HT, Hallas J. The Danish national prescription registry. Scand J Public Health 2011;39:38\u201341.","DOI":"10.1177\/1403494810394717"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_019","unstructured":"WHO Collaborating Centre for Drug and Statistics Methodology. Guidelines for ATC classification DDD assignment 2013, Oslo; 2012, ISBN 978-82-8082-525-4."},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_020","doi-asserted-by":"crossref","unstructured":"Buntin MB, Zaslavsky AM. Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. J Health Econ 2004;23:525\u201342.","DOI":"10.1016\/j.jhealeco.2003.10.005"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_021","doi-asserted-by":"crossref","unstructured":"Christensen HN, Olsson U, From J, Breivik H. Opioid-induced constipation, use of laxatives, and health-related quality of life. Scand J Pain 2016;11:104\u201310.","DOI":"10.1016\/j.sjpain.2015.12.007"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_022","doi-asserted-by":"crossref","unstructured":"Stubhaug A. Advances in understanding and treatment of opioid-induced-bowel-dysfunction, opioid-induced-constipation in particular Nordic recommendations based on multi-specialist input. Scand J Pain 2016;11:163\u20134.","DOI":"10.1016\/j.sjpain.2016.02.003"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_023","doi-asserted-by":"crossref","unstructured":"Gaertner J, Siemens W, Camilleri M, Davies A, Drossman DA, Webster LR, Becker G. Definitions and outcome measures of clinical trials regarding opioid-induced constipation: a systematic review. J Clin Gastroenterol 2015;49:9\u201316.","DOI":"10.1097\/MCG.0000000000000246"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_024","doi-asserted-by":"crossref","unstructured":"Camilleri M, Drossman DA, Becker G, Webster LR, Davies AN, Mawe GM. Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol Motil 2014;26:1386\u201395.","DOI":"10.1111\/nmo.12417"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_025","doi-asserted-by":"crossref","unstructured":"Kalso E, Allan L, Dellemijn PL, Faura CC, Ilias WK, Jensen TS, Perrot S, Plaghki LH, Zenz M. Recommendations for using opioids in chronic non-cancer pain. Eur J Pain 2003;7:381\u20136.","DOI":"10.1016\/S1090-3801(02)00143-X"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_026","doi-asserted-by":"crossref","unstructured":"Pottegard A, Knudsen TB, van Heesch K, Salmasi H, Schytte-Hansen S, Sondergaard J. Information on risk of constipation for Danish users of opioids, and their laxative use. Int J Clin Pharm 2014;36:291\u20134.","DOI":"10.1007\/s11096-014-9922-0"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_027","doi-asserted-by":"crossref","unstructured":"Coyne KS, Margolis MK, Yeomans K, King FR, Chavoshi S, Payne KA, LoCasale RJ. Opioid-Induced Constipation Among Patients with Chronic Noncancer Pain in the United States, Canada, Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time. Pain Med 2015;16: 1551\u201365.","DOI":"10.1111\/pme.12724"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_028","doi-asserted-by":"crossref","unstructured":"Salmoirago-Blotcher E, Crawford S, Jackson E, Ockene J, Ockene I. Constipation and risk of cardiovascular disease among postmenopausal women. Am J Med 2011;124:714\u201323.","DOI":"10.1016\/j.amjmed.2011.03.026"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_029","doi-asserted-by":"crossref","unstructured":"Olsen J. Who needs selection bias? Scand J Work Environ Health 2014;40:103.","DOI":"10.5271\/sjweh.3405"},{"key":"2025120909570752724_j_j.sjpain.2017.01.006_ref_030","doi-asserted-by":"crossref","unstructured":"Nohr EA, Olsen J. Commentary: epidemiologists have debated representativeness for more than 40 years \u2013 has the time come to move on? Int J Epidemiol 2013;42:1016\u20137.","DOI":"10.1093\/ije\/dyt102"}],"container-title":["Scandinavian Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/sjpain\/15\/1\/article-p83.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S1877886017300149?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S1877886017300149?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2017.01.006\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2017.01.006\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T12:03:03Z","timestamp":1765281783000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2017.01.006\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,1]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,4,1]]},"published-print":{"date-parts":[[2017,4,1]]}},"alternative-id":["10.1016\/j.sjpain.2017.01.006"],"URL":"https:\/\/doi.org\/10.1016\/j.sjpain.2017.01.006","relation":{},"ISSN":["1877-8860","1877-8879"],"issn-type":[{"value":"1877-8860","type":"print"},{"value":"1877-8879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy: A nationwide register-based cohort study in Denmark","name":"articletitle","label":"Article Title"},{"value":"Scandinavian Journal of Pain","name":"journaltitle","label":"Journal Title"},{"value":"http:\/\/dx.doi.org\/10.1016\/j.sjpain.2017.01.006","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"http:\/\/dx.doi.org\/10.1016\/j.sjpain.2017.01.010","name":"associatedlink","label":"CrossRef DOI link to the associated document"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.","name":"copyright","label":"Copyright"}]}}