Image
Interactive Professor

Managing Opioid-Induced Constipation

Translating Guidelines Into Patient Care

Meeting Slides

Guidelines

NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain.

National Comprehensive Cancer Network.

American Gastroenterological Association Institute Guideline on the Medical Management of Opioid-Induced Constipation.

Crockett SD, et al. Gastroenterology. 2019;156(1):218-226

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.

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

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.

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.

Insights into the role of opioid receptors in the GI tract: experimental evidence and therapeutic relevance.

Galligan JJ, et al. Handb Exp Pharmacol. 2017; 239: 363–378.

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.

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.

Randomized phase III and extension studies of naldemedine in patients with opioid-induced constipation and cancer.

Katakami N, et al. J Clin Oncol. 2017;35(34):3859-3866.

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer.

Janku F, et al. Ann Oncol. 2016;27(11):2032-2038.

Interactive Presentation

Pathophysiology of OIC

Narrated by Anthony J. Lembo, MD


OIC Assessment and Initial Management

Presented by Lorrain Drapek, DNP, FNP-BC, AOCNP


Management of Laxative-Refractory OIC

Presented by Mihir M. Kamdar, MD


Activity
Comprehensive Cancer Pain Management

Let’s Talk Constipation

Activity
Managing Opioid-Induced Constipation

Translating Guidelines Into Patient Care

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

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

Clinical Issues in Chronic Pain

Consensus and Controversies for Responsible Opioid Prescribing

Intrathecal Drug Delivery for Chronic Pain

The Role of Nurses in Optimizing Long-term Outcomes

Intrathecal Drug Therapy for Chronic Pain

Evolving Best-Practice Strategies to Maximize Efficacy and Safety

Comprehensive Chronic Pain Management

A Focus on Patients With Opioid-Induced Constipation

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

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

Comprehensive Relief from Cancer Pain

Expanding the Conversation on Opioid-Induced Constipation

Finding Relief in Osteoarthritis

New Paths to Chronic Pain Management

What’s New in Systemic Lupus Erythematosus?

Unlocking Novel Paths to Patient Care

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# Query Time (s)
0
select id, status from activities where FIND_IN_SET(:shortAddress, shortAddress)
0.000887
1
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0.000255
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SHOW COLUMNS FROM `resources`
0.001475
5
SHOW CREATE TABLE `resources`
0.000346
6
SELECT * FROM `resources` `t` WHERE `t`.`id`=111 LIMIT 1
0.000460
7
SHOW COLUMNS FROM `interactions`
0.001040
8
SHOW CREATE TABLE `interactions`
0.000272
9
SHOW COLUMNS FROM `resource_videos`
0.001014
10
SHOW CREATE TABLE `resource_videos`
0.000276
11
SELECT `videos`.`id` AS `t1_c0`, `videos`.`vzaar_id` AS `t1_c1`, `videos`.`title` AS `t1_c2`, `videos`.`description` AS `t1_c3`, `videos`.`resource_id` AS `t1_c4`, `videos`.`type` AS `t1_c5` FROM `resource_videos` `videos` WHERE (`videos`.`resource_id`=:ypl0)
0.000467
12
SHOW COLUMNS FROM `activities`
0.001234
13
SHOW CREATE TABLE `activities`
0.000302
14
SHOW COLUMNS FROM `users`
0.001303
15
SHOW CREATE TABLE `users`
0.000288
16
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000437
17
INSERT INTO `users` (`role`, `sendEmails`, `sendSms`, `source`, `session`, `lastLogin`, `phone`, `createDate`) VALUES (:yp0, :yp1, :yp2, :yp3, :yp4, :yp5, :yp6, :yp7)
0.003911
18
SELECT * FROM `users` `t` WHERE session=:session LIMIT 1
0.000414
19
UPDATE `users` SET `lastLogin`=:yp0 WHERE `users`.`id`=2539980
0.003054
20
SELECT `activities`.`id` AS `t1_c0`, `activities`.`group_id` AS `t1_c1`, `activities`.`resource_id` AS `t1_c2`, `activities`.`title` AS `t1_c3`, `activities`.`type` AS `t1_c4`, `activities`.`facultyNames` AS `t1_c5`, `activities`.`shortDescription` AS `t1_c6`, `activities`.`fullDescription` AS `t1_c7`, `activities`.`creditAmount` AS `t1_c8`, `activities`.`shortAddress` AS `t1_c9`, `activities`.`creditType` AS `t1_c10`, `activities`.`startDate` AS `t1_c11`, `activities`.`finishDate` AS `t1_c12`, `activities`.`sponsors` AS `t1_c13`, `activities`.`status` AS `t1_c14`, `activities`.`createDate` AS `t1_c15`, `activities`.`image` AS `t1_c16`, `activities`.`image_featured` AS `t1_c17`, `activities`.`archived` AS `t1_c18`, `activities`.`managers_list` AS `t1_c19`, `activities`.`is_send_pp_email` AS `t1_c20`, `activities`.`muvi_sync_date` AS `t1_c21`, `activities`.`expert_questions` AS `t1_c22` FROM `activities` `activities` WHERE (`activities`.`resource_id`=:ypl0)
0.001664
21
SELECT r.id, COUNT(r.id) relevance FROM resources r join `resource_topics` rtj on rtj.`resource_id`=r.id WHERE rtj.`topic_id` in (SELECT topic_id from `resource_topics` rt where rt.`resource_id`=:rid AND rt.topic_id>0) AND r.id <> :rid AND r.status = 'active' Group by r.id order by relevance DESC, r.`createDate` DESC
0.003369
22
SELECT * FROM `resources` `t` WHERE `t`.`id` IN (149, 145, 94, 83, 69, 61, 59, 55, 44, 41, 40, 39, 36, 31, 26, 25, 23, 21, 17, 12, 10, 7)
0.001147
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