Achieving Balance: Practical Management Strategies for Opioid-Induced Constipation
Meeting Slides
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)
This 12-item questionnaire of patient-reported symptoms assesses 3 subscales of symptoms (bowel movements, rectal symptoms, and abdominal symptoms) over the prior 2 weeks.
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 mitigate opioid-induced constipation and includes a list of questions about constipation for patients to ask their doctors or clinics.
Practice Guidelines
The Functional Gastrointestinal Disorders and the Rome III Process, 2006.
Drossman DA. Gastroenterology. 2006;130(5):1377-1390.
Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain, 2009.
Chou R, et al. J Pain. 2009;10(2):113-130.
VA/DoD Clinical Practice Guideline: Management of Opioid Therapy for Chronic Pain, 2010.
Department of Veterans Affairs, Department of Defense.
Other Resources
A Clinical Guide to Opioid Analgesia. 2nd edition.
Fine PG, Portenoy RK. New York, NY: Vendome Group, LLC; 2007.
Responsible Opioid Prescribing: A Clinician’s Guide. 2nd edition, revised and expanded.
Fishman SM. Washington, DC: Waterford Life Sciences; 2012.
Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation.
Camilleri M, et al. Neurogastroenterol Motil. 2014;26:1386-1395.
Suggested Readings
Chronic opioid induced constipation in patients with nonmalignant pain: challenges and opportunities.
Nelson AD, Camilleri, M. Therapy Adv Gastroenterol. 2015;8(4):206-220.
The impact of opioid-induced constipation among chronic pain patients with sufficient laxative use.
LoCasale RJ, et al. Int J Clin Pract. 2015;Epub ahead of print.
Opioid-induced bowel dysfunction: epidemiology, pathophysiology, diagnosis, and initial therapeutic approach.
Dorn S, et al. Am J Gastroenterol. 2014;2(1):31-37.
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.
Coyne KS, et al. Clinicoecon Outcomes Res. 2014;6:269-281.
Constipation in people prescribed opioids.
Ahmedzai SH, Boland J. BMJ Clin Evid (Online). 2010;pii:2407
The narcotic bowel syndrome: a recent update.
Drossman D, Szigethy E. Am J Gastroenterol. 2014;2(1):22-30.
Opioids in chronic non-cancer pain: systematic review of efficacy and safety.
Kalso E, et al. Pain. 2004;112(3):372-380.
A multi-institutional study analyzing effect of prophylactic medication for prevention of opioid-induced gastrointestinal dysfunction.
Ishihara M, et al. Clin J Pain. 2012;28(5):373-381.
A volunteer model for the comparison of laxatives in opioid-related constipation.
Sykes NP. J Pain Symptom Manage. 1996;11(6):363-369.
Establishing "best practices" for opioid rotation: conclusions of an expert panel.
Fine PG, et al. J Pain Symptom Manage. 2009;38(3):418-425.
Naloxegol for opioid-induced constipation in patients with noncancer pain.
Chey WD, et al. N Engl J Med. 2014;370(25):2387-2396.
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.
Clinical evaluation of the efficacy of methylnaltrexone in resolving constipation induced by different opioid subtypes combined with laboratory analysis of immunomodulatory and antiangiogenic effects of methylnaltrexone.
Neefjes ECW, et al. BMC Palliative Care. 2014;13:42.
Interactive PresentationScientific Insights Into Opioid-Induced Constipation
Anthony J. Lembo, MD
Practical Management Strategies for 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
Evidence-Based Strategies for Improved Patient Outcomes
Proactive Diagnosis and Targeted Management
Differential Diagnosis and Comprehensive Management Strategies
Optimizing Maintenance Therapy Across Healthcare Settings
Evolving Strategies for Diagnosis and Long-Term Management
Consensus and Controversies for Responsible Opioid Prescribing
Best Practices in Combination Therapy
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Clinical Updates in LDL-C Management
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Identifying Patients and Tailoring Therapy
Collaborative Approaches to Guideline-Concordant Patient Care
New Strategies for Individualizing Long-term Care
A Focus on Patients With Opioid-Induced Constipation
Consensus and Controversies Across the Spectrum of Patient Presentations
Evolving Treatment Algorithms and Expert Perspectives on Biosimilars
Patient Selection, Treatment Initiation, and Ongoing Monitoring
Engaging With Patients About Opioid-Induced Constipation
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Expanding the Conversation on Opioid-Induced Constipation
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