Comprehensive Cancer Pain Management
Let’s Talk Constipation
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 PresentationPathophysiology 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
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
Expanding the Conversation on Opioid-Induced Constipation
