Encouraging conversation around constipation

Prescribing opioid-based therapy for pain management can be a complex undertaking. Doctors need to raise a number of precautions at the initial point of prescription to ensure patient safety, such as risk of addiction and abuse. These conversations tend to take precedence over discussions around the “lower priority”, yet equally painful side effects of opioid therapy.

The Challenge

With their pending entry into the opioid-induced constipation (OIC) category, our client raised concern that the commercialization strategy provided by their global team wasn’t optimized for the local market. It was heavily reliant on the GP proactively carrying the constipation conversation forward with patients, when the reality was that they had other issues to prioritize.

Using the PatientConsumer™ Framework, we sought to determine where and how we could bring the issue of severe OIC-induced pain to the forefront.

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Persona work and influencer mapping revealed some critical truths that global strategy had overlooked:

  • The relationship between the HCP and the PatientConsumer™ was anchored in pain, not GI – the “constipation conversation” was not taking place at point of prescription or beyond.
  • When constipation symptoms arose, the PatientConsumer™ was not making the connection back to their opioid therapy. They were also too embarrassed to bring it up.
  • The PatientConsumer™ mainly deferred to Web searches and pharmacist advice to guide their constipation relief decisions, where OIC education seemed to have no presence.
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Journey mapping revealed that the PatientConsumer™ was getting trapped in a vicious cycle of ineffective self-management.

Relying heavily on online resources and the pharmacist for guidance, they moved from bulking agents to stool softeners, to laxatives and other remedies – anything to help relieve their constipation pains.

While these treatments temporarily masked the pain by helping to improve stool quality, they did nothing to addressing the root cause of the issue – intestinal motility.

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Insights from profiles and journeys prompted a necessary step-change from global’s approach.


Stop assuming that the constipation conversation unfolds in primary care. The GP has competing priorities, and the PatientConsumer™ is too self-conscious.


Start engaging other touch points along the journey to help the PatientConsumer™ and non-GP influencers properly diagnose the issue, and secure the right treatment.


Change the approach with the GP. Take a firmer position in forcing the dialogue at the point of prescription as a proactive measure.

The Solution

To connect with the PatientConsumer™, our communications plan targeted multiple stakeholders on their journey: pharmacists, nurses, and chronic pain associations. Digital tools were recommended to help the PatientConsumer™ recognize the severity of their symptoms and gain the confidence they need to seek the right treatment. These aligned with HCP tools to ensure that they are well enough informed to “talk OIC”.