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Interactive Exchange

Opioid-Induced Constipation

Proactive Diagnosis and Targeted Management

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.

Suggested Readings

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 study of lubiprostone for opioid-induced constipation in patients with chronic noncancer pain.

Cryer B, et al. Pain Med. 2014; 15(11):1825-1834.

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.

Patient preference with respect to QoL and reduction in opioid-induced constipation (OIC) after treatment with prolonged-release (PR) oxycodone/naloxone compared with previous analgesic therapy [PREFER study].

van Dongen VCPC, et al. Int J Clin Pract. 2014;68(11):1364-1375.

Interactive Presentation

Scientific Insights Into Opioid-Induced Constipation

Anthony J. Lembo, MD


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

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