Evidence-Based Best Practices

Comprehensive Pain Management in Palliative Care and OIC

Relieving the Burden of Opioid-Induced Constipation

This activity is jointly provided by Global Education Group and Integritas Communications.

This activity is supported by an educational grant from AstraZeneca.

Target Audience

The educational design of this activity addresses the needs of palliative care clinicians who manage patients on opioid-based pain regimens.

Statement of Need/Program Overview

As the United States population ages, an increasing number of individuals will suffer from significant pain as they approach end-of-life.1 Despite advances in our understanding of pain physiology and available treatment modalities, pain associated with life-threatening illnesses is often untreated or undertreated.2 This results in part from side effects of commonly prescribed analgesics. For example, opioids have long been the cornerstone treatment for pain associated with cancer or other terminal conditions.3,4 The most frequent side effect of prescription opioids is constipation, which ranks as the third most commonly reported symptom in palliative care.5,6 Unaddressed opioid-induced constipation (OIC) can have markedly deleterious effects on patient function and quality of life.7,8 With an overall goal of improving comprehensive pain management in patients receiving palliative care, this Evidence-Based Best Practices program will examine the pathophysiology of opioid-induced bowel dysfunction, prophylactic treatment regimens for OIC, assessment strategies to identify and monitor affected patients, and new therapeutic approaches that mitigate OIC effectively and safely.


  1. Robinson CL. Health Prog. 2007;88(1):48-53.
  2. Deandrea S, et al. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. 2008;19(12):1985-1991.
  3. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Version 2.2016.
  4. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatr Soc. 2009;57(8):1331-1346.
  5. Coyne KS, et al. Clinicoecon Outcomes Res. 2014;6:269-281.
  6. Gatti A, Sabato AF. Clin Drug Investig. 2012;32(5):293-301.
  7. Holzer P. Expert Opin Investig Drugs. 2007;16(2):181-194.
  8. Rao SS. Gastroenterol Clin North Am. 2007;36(3):687-711.

Educational Objectives

After completing this activity, the participant should be better able to:

  • Evaluate baseline and ongoing bowel function in palliative care patients who need opioid-based pain management
  • Describe the mechanisms of action, published evidence, and prescribing considerations for FDA-approved medications in the treatment of OIC
  • Incorporate prophylactic bowel regimens and newer OIC therapies into comprehensive palliative care plans
  • Communicate with opioid-treated palliative care patients and their caregivers to facilitate bowel assessment efforts and shared decision-making about OIC treatment options


Anthony J. Lembo, MD (Prerecorded)
Associate Professor of Medicine
Director, GI Motility Laboratory
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Michael J. Brennan, MD
The Pain Center of Fairfield
Fairfield, Connecticut
Senior Attending Physician
Department of Medicine
Bridgeport Hospital
Bridgeport, Connecticut

April M. Zehm, MD
Instructor, Harvard Medical School
Assistant in Medicine
Division of Palliative Care
Massachusetts General Hospital
Boston, Massachusetts

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation

Global Education Group designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education

Global Education Group is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

This educational activity for 1.0 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is accredited for 1.0 contact hour which includes 0.0 hour of pharmacology.

Activity ID #2306L.

This activity was planned in accordance with AANP CE Standards and Policies.


Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

Americans with Disabilities Act

Event staff will be glad to assist you with any special needs (ie, physical, dietary, etc). Please contact Mike Remsen prior to the live event at

For information about the accreditation of this program, please contact Global at 303-395-1782 or


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