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Engaging the Patient™

Overcoming Challenges in Cancer Pain Management

Engaging With Patients About Opioid-Induced Constipation

Meeting Slides

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.

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.

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

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Dowell D, et al. MMWR Recomm Rep. 2016;65 (1):1-49.

The management of constipation in palliative care: clinical practice recommendations.

Larkin PJ, et al. Palliat Med. 2008;22(7):796-807.

NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain.

National Comphrensive 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

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.

Other Resources

Consensus recommendations on initiating prescription therapies for opioid-induced constipation.

Argoff CE, et al. Pain Med. 2015;16(12):2324-2337

A Clinical Guide to Opioid Analgesia. 2nd edition.

Fine PG, Portenoy RK. New York, NY: Vendome Group, LLC; 2007.

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.

Responsible Opioid Prescribing. A Clinician’s Guide. 2nd Edition, revised and expanded.

Wilson PR. Pain Med. 2015;16(5):1027-1028.

Suggested Readings

Constipation in people prescribed opioids.

Ahmedzai SH, Boland J. BMJ Clin Evid (Online). 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

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.

Opioid-induced bowel dysfunction: epidemiology, pathophysiology, diagnosis, and initial therapeutic approach.

Dorn S, et al. Am J Gastroenterol Suppl. 2014;2(1):31-37.

Establishing "best practices" for opioid rotation: conclusions of an expert panel.

Fine PG, et al. J Pain Symptom Manage. 2009;38(3):418-425

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 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 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.

The impact of opioid-induced constipation among chronic pain patients with sufficient laxative use.

LoCasale RJ, et al. Int J Clin Pract. 2015;69(12):1448-1456.

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.

Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients.

Tarumi Y, et al. J Pain Symptom Manage. 2013;45(1):2-13.

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. November 2016. [Epub Ahead of Print].

RA 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. March 2017. [Epub Ahead of Print].

Interactive Presentation

Scientific Insights Into Opioid-Induced Constipation

Narrated by Anthony J. Lembo, MD


Patient Interview

Narrated by Jeffrey A. Gudin, MD


Mary: Uncovering Opioid-Induced Constipation

Narrated by Nicole M. Ross MSN CRNP AOCNP


Mary: Inadequate Response to Laxative Therapy

Narrated by Nicole M. Ross MSN CRNP AOCNP


Activity
Comprehensive Pain Management in Palliative Care

Relieving the Burden of Opioid-Induced Constipation

Activity
Overcoming Challenges in Cancer Pain Management

Engaging With Patients About 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

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

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