Comprehensive Relief from Cancer Pain
Expanding the Conversation on Opioid-Induced Constipation
Clinical Practice Guidelines
Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation.
Camilleri M, et al. Neurogastroenterol Motil. 2014;26(10):1386-1395.
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Dowell D, et al. MMWR Recomm Rep. 2016;65(No. RR 1):1-49.
NCCN Guidelines & Clinical Resources. NCCN Guidelines for Supportive Care: Adult Cancer Pain.
National Comprehensive Cancer Network.
Patient Resources
Patient Conversation Guide
This patient tool can be completed prior to the visit with the health care provider to guide a meaningful conversation about bowel habits and constipation symptoms.
Patient Education Handout
This leaflet provides patients with approaches to mitigating opioid-induced constipation and includes a list of questions about constipation for patients to ask their doctors or clinics.
Other Resources
Consensus recommendations on initiating prescription therapies for opioid-induced constipation.
Argoff CE, et al. Pain Med. 2015;16(12):2324-2337.
Consensus recommendations for the management of constipation in patients with advanced, progressive illness.
Librach SL, et al. J Pain Symptom Manage. 2010;40(5):761-773.
Clinical Assessment Tools
Bowel Function Index (BFI)
The BFI provides a numerical score for the prior 7 days based on ease of defecation, feeling of incomplete evacuation, and personal judgment of constipation.
Bristol Stool Form Scale
This visual scale is used to help patients characterize their stool. It classifies the most commonly passed stool forms into 7 types.
Patient Assessment of Constipation (PAC-SYM)
The PAC-SYM is a 12-item questionnaire of patient-reported symptoms during the 2 prior weeks with 3 subscales tracking bowel movements, rectal symptoms and abdominal symptoms.
Suggested Readings
Suggested Readings
Constipation in people prescribed opioids.
Ahmedzai SH, Boland J. BMJ Clin Evid. 2010;pii:2407.
Naloxegol for opioid-induced constipation in patients with noncancer pain.
Chey WD, et al. N Engl J Med. 2014;370(25):2387-2396.
Pharmacologic profile of naloxegol, a peripherally acting µ-opioid receptor antagonist, for the treatment of opioid-induced constipation.
Floettmann E, et al. J Pharmacol Exp Ther. 2017;361(2):280-291.
Impact of constipation on opioid therapy management among long-term opioid users, based on a patient survey.
Gupta S, et al. J Opioid Manag. 2015;11(4):325-338.
A randomized, placebo-controlled trial of lubiprostone for opioid-induced constipation in chronic noncancer pain.
Jamal MM, et al. Am J Gastroenterol. 2015;110(5):725-732.
Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer.
Janku F, et al. Ann Oncol. 2016;27(11):2032-2038.
Randomized phase 3 and extension studies: efficacy and impacts on quality of life of naldemedine in subjects with opioid-induced constipation and cancer.
Katakami N, et al. Ann Oncol. April 18, 2018; doi: 10.1093/annonc/mdy118. [Epub ahead of print].
Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction.
Leppert W. Drug Des Devel Ther. 2015;9:2215-2231.
Efficacy of treatments for opioid-induced constipation: a systematic review and meta-analysis.
Nee J, et al. Clin Gastroenterol Hepatol. 2018;16(10):1569-1584.
Randomized, double-blind trial of oral methylnaltrexone for the treatment of opioid-induced constipation in patients with chronic noncancer pain.
Rauck R, et al. Pain Pract. 2017;17(6):820-828.
Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement.
Tai S-Y, et al. BMC Palliat Care. 2016;15:32.
A phase 2b, randomized, double-blind placebo-controlled study to evaluate the efficacy and safety of naldemedine for the treatment of opioid-induced constipation in patients with chronic noncancer pain.
Webster LR, et al. Pain Med. 2017;18(12):2350-2360.
Expanding the Conversation on Opioid-Induced Constipation
Relevant Resources
Balancing the Benefits and Risk of Opioid-Based Therapy
Individualized Assessment and Mechanism-Based Multimodal Treatment
Responsible Opioid Prescribing to Achieve Individualized Functional Goals
Overcoming Pain and Gastrointestinal Distress to Improve Patient Outcomes
Proactive Diagnosis and Targeted Management
Selecting Patients and Optimizing Long-Term Outcomes
Proactive Diagnosis and Targeted Management
Consensus and Controversies for Responsible Opioid Prescribing
The Role of Nurses in Optimizing Long-term Outcomes
Evolving Best-Practice Strategies to Maximize Efficacy and Safety
A Focus on Patients With Opioid-Induced Constipation
Patient Selection, Treatment Initiation, and Ongoing Monitoring
Engaging With Patients About Opioid-Induced Constipation
The PCP’s Role in Timely Recognition and Referral
Debates and Discussions About Therapeutically Targeting Nerve Growth Factor Signaling
Translating Guidelines Into Patient Care
