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Interactive Professor

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 Presentation

Scientific Insights Into Opioid-Induced Constipation

Anthony J. Lembo, MD


Activity
Achieving Balance

Practical Management Strategies for Opioid-Induced Constipation

Relevant Resources

Persistent and Breakthrough Pain

Balancing the Benefits and Risk of Opioid-Based Therapy

Improving the Care of Patients With Chronic Pain

Individualized Assessment and Mechanism-Based Multimodal Treatment

Caring For Patients With Chronic Pain

Responsible Opioid Prescribing to Achieve Individualized Functional Goals

Acute Management of Migraine Attacks

Overcoming Pain and Gastrointestinal Distress to Improve Patient Outcomes

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

Intrathecal Drug Delivery for Chronic Pain

Selecting Patients and Optimizing Long-Term Outcomes

Clinical Updates on the Management of Gout

Evidence-Based Strategies for Improved Patient Outcomes

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

Chronic Obstructive Pulmonary Disease, Asthma, or Both

Differential Diagnosis and Comprehensive Management Strategies

Improving Outcomes in Chronic Obstructive Pulmonary Disease

Optimizing Maintenance Therapy Across Healthcare Settings

Managing Gout in Primary Care

Evolving Strategies for Diagnosis and Long-Term Management

Clinical Issues in Chronic Pain

Consensus and Controversies for Responsible Opioid Prescribing

Noninsulin Approaches to Managing Type 2 Diabetes

Best Practices in Combination Therapy

Intrathecal Drug Delivery for Chronic Pain

The Role of Nurses in Optimizing Long-term Outcomes

Hitting the Target in Type 2 Diabetes

Evolving Approaches to Insulin Based Therapy

Intrathecal Drug Therapy for Chronic Pain

Evolving Best-Practice Strategies to Maximize Efficacy and Safety

Clearing the Air

Improving Outcomes for Patients with COPD

Clinical Updates in Type 2 Diabetes

New Strategies for Insulin Replacement Therapy

How Low Do You Go?

Clinical Updates in LDL-C Management

Incretin-Based Therapies For Type 2 Diabetes

Improving Comprehensive Patient Care

Improving Outcomes in Non–24-Hour Sleep-Wake Disorder

Identifying Patients and Tailoring Therapy

Comprehensive Management of Chronic Obstructive Pulmonary Disease

Collaborative Approaches to Guideline-Concordant Patient Care

Clinical Updates in the Management of Severe Asthma

New Strategies for Individualizing Long-term Care

Comprehensive Chronic Pain Management

A Focus on Patients With Opioid-Induced Constipation

Clinical Issues in Bipolar Depression

Consensus and Controversies Across the Spectrum of Patient Presentations

Clinical Updates in Rheumatoid Arthritis

Evolving Treatment Algorithms and Expert Perspectives on Biosimilars

Best Practices in Intrathecal Therapy for Chronic Pain

Patient Selection, Treatment Initiation, and Ongoing Monitoring

Overcoming Challenges in Cancer Pain Management

Engaging With Patients About Opioid-Induced Constipation

Caring for Patients with Severe Asthma

Evolving Best Practices to Optimize Outcomes

Can You Spot Axial Spondyloarthritis?

The PCP’s Role in Timely Recognition and Referral

Clinical Issues in Chronic Pain

Debates and Discussions About Therapeutically Targeting Nerve Growth Factor Signaling

Advancing the Care of Severe Asthma

Differential Diagnosis, Multidisciplinary Management, and Patient Engagement

Updates in HCV Screening and Treatment

Key Issues Impacting OB/GYN Practice

Comprehensive Relief from Cancer Pain

Expanding the Conversation on Opioid-Induced Constipation

Evolving Models of HIV Care

Volume II: Expanding Evidence for the Role of Rapid ART Initiation in HIV Practice

Managing Opioid-Induced Constipation

Translating Guidelines Into Patient Care

Clearing the Air in Severe Asthma Management

Improving Patient Outcomes Through Shared Clinical Decision Making

GLP-1 Receptors Agonists in Type 2 Diabetes

Mechanistic Insights and Evolving Treatment Options

Airing It Out

A Case-Based Conversation on Managing Asthma and Chronic Rhinosinusitis With Nasal Polyposis

COPD in Managed Care

The Clinical and Utilization Benefits of Exacerbation Prevention

Assimilating the Evidence in T2DM

Cardiovascular and Renal Outcomes With SGLT2 Inhibitors

Demystifying New Evidence for COPD Management

Best Practices for Primary Care

Finding Relief in Osteoarthritis

New Paths to Chronic Pain Management

The Changing Landscape of HIV Prevention

What the Pharmacist Needs to Know about PrEP

What’s New in Systemic Lupus Erythematosus?

Unlocking Novel Paths to Patient Care

Expert Views on the Changing Landscape in RA

The Increasing Role of JAK Inhibitors

COPD Cases & Conversations

Preventing COPD Exacerbations to Improve Outcomes

Comprehensive Management in COPD

A Whole Patient Case Series

Maybe It’s NOT Mechanical Back Pain

Getting on the Fast Track to Identify AxSpA

Treating Hepatitis C in the Primary Care Setting

Establishing Clinical Readiness Through Mentored Learning

Finding the Path in Eosinophilic Esophagitis

Interdisciplinary Strategies for Adult and Pediatric Patients

Answering the Call

Interdisciplinary Management of Eosinophilic Esophagitis and Hereditary Angioedema

Getting Low in Familial Hypercholesterolemia

Reducing LDL-C and a Lifetime of Cardiovascular Risk

Expert Consult Series in Multiple Sclerosis

Updates, Clinical Scenarios, and Future Directions

Putting a Spotlight on Systemic Mastocytosis

A Multidisciplinary Look at Early Diagnosis and Management

Is It Systemic Mastocytosis?

Best Practices for Diagnosis and Management

Monoclonal Antibodies for COVID-19

An Update on Best Practices

Monoclonal Antibodies for COVID-19

New Avenues to Pre-Exposure Prophylaxis

Early Cancer Detection in Primary Care:

Are You Aware of New Blood-Based Multi-Cancer Screening Tools

Buffing Up on New and Emerging ART

A Look at the Changing HIV Playing Field

Pharmacy PrEP Education

A “How To” Series Spanning Policy to Practice

BRIDGE PrEP

Building Bridges to Reach People who Inject Drugs with the Goal of Employing PrEP for HIV Prevention

Flexing Your Early Cancer Detection Muscles

Strengthening Your Knowledge of Blood-Based Screening Tools

Long-Acting Injectable PrEP:

Bringing HIV Prevention to a New Level

PrEParing to End the Epidemic

Optimizing HIV Prevention in Primary Care

Multi-Cancer Early Detection in Primary Care

What You Need to Know About New Blood-Based Screening Tools

A Call to Action

Monoclonal Antibodies for the Prevention and Treatment of COVID-19

What’s Next

Exploring New Treatment Avenues in Nonadvanced Systemic Mastocytosis

Best Practices in COPD

Practical Updates on the 2023 GOLD Guidelines

Answers to Everyday Practice Challenges in HIV Medicine

A Phone-a-Friend CME Series – Volume 2

Flexing Your Muscles in Familial Hypercholesterolemia

Best Practices for Screening, Diagnosis, and Management

What’s New in the Management of COVID-19

Incorporating New Data and Updated Guidelines Into Daily Practice

Lifting the Bar in Relapsed or Refractory Multiple Myeloma

Capitalizing on BCMA-Directed Therapies

New Horizons in Severe Asthma

From the Airway Epithelium to Improved Patient Outcomes

Strengthening Your COVID-19 Management Technique

Exercising Best Practices for Hospitalized Patients

Making the Rounds on Systemic Mastocytosis

Accelerating Diagnosis and Treatment