Managing Opioid-Induced Constipation

Target Audience

The educational design of this activity addresses the needs of physiatrists, pain specialists, and other clinicians involved in the identification and multidisciplinary management of patients with opioid-induced constipation.

Statement of Need/Program Overview

Constipation, the most common side effect of chronic opioid therapy, is a constellation of symptoms that includes infrequent or incomplete bowel movements, abdominal pain or bloating, and the need to strain when having a bowel movement.^1,2 In addition to constipation-related discomfort, opioid-induced constipation (OIC) produces significant health and quality-of-life burdens.^3,4 Poorly managed OIC can lead patients to reduce or skip opioid doses, thereby decreasing adherence, increasing pain-related biopsychosocial complications, diminishing functional gains, and compromising overall outcomes.^4-6

During this online Interactive Professor™ program, the expert faculty will present practical approaches to multimodal management of OIC. Presenting faculty will discuss initiation and escalation of appropriate therapies, including pharmacologic treatment modalities that have been specifically approved for OIC by the US Food and Drug Administration (FDA).^7,8 This program will review the most recent evidence-based guidelines for management of OIC,⁹ as well as effective patient communication strategies for discussing opioid-related bowel issues and available treatment options. Participants will gain experience in a hands-on approach to bowel assessment, management strategies, and implementation of individualized treatment plans for patients with OIC.

1. Coyne KS, LoCasale RJ, Datto CJ, Sexton CC, Yeomans K, Tack J. 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. Clinicoecon Outcomes Res. 2014;6:269-281.
2. Camillieri M, Drossman DA, Becker G, Webster LR, Davies AN, Mawe GM. Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol Motil. 2014;26(10):1386-1395.
3. LoCasale RJ, Datto C, Wilson H, Yeomans K, Coyne KS. The burden of opioid-induced constipation: discordance between patient and health care provider reports. J Manag Care Spec Pharm. 2016;22(3):236-245.
4. Andresen V, Banerji V, Hall G, Lass A, Emmanuel AV. The patient burden of opioid-induced constipation: new insights from a large, multinational survey in five European countries. United European Gastroenterol J. 2018;6(8):1254-1266.
5. Harris JD. Management of expected and unexpected opioid-related side effects. Clin J Pain. 2008;24(suppl 10):S8-S13.
6. Gupta SH, Patel H, Scopel J, Mody RR. Impact of constipation on opioid therapy management among long-term opioid users, based on a patient survey. J Opioid Manag. 2015;11(4):325-338.
7. Chey WD, Webster L, Sostek M, Lappalainen J, Barker PN, Tack J. Naloxegol for opioid-induced constipation in patients with noncancer pain. N Engl J Med. 2014;370(25):2387-2396.
8. Argoff CE, Brennan MJ, Camilleri M, et al. Consensus recommendations on initiating prescription therapies for opioid-induced constipation. Pain Med. 2015;16(12):2324-2337.
9. Crockett SD, Greer KB, Heidelbaugh JJ, Falck-Ytter Y, Hanson BJ, Sultan S; American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology. 2019;156(1):218-226.

Educational Objectives

After completing this activity, the participant should be better able to:

• Describe the clinical profiles and prescribing recommendations for FDA-approved treatment options for OIC
• Discuss recent updates to national evidence-based guidelines on the management of OIC
• Tailor bowel regimens for patients with opioid-treated chronic pain who do not respond adequately to traditional laxative therapy

Faculty

Jeffrey A. Gudin, MD
Attending Physician, Englewood Hospital and Medical Center
Clinical Associate Professor, Anesthesiology and Perioperative Medicine, Rutgers New Jersey Medical School
Board Certified in Pain Management, Anesthesiology, Palliative Care and Addiction Medicine
Englewood, New Jersey

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM MOC Recognition Statement

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.5 medical knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Nursing Continuing Education

Global Education Group is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This educational activity for 0.5 contact hours is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score 70% or better on the posttest and complete the program evaluation.

Disclosure of Conflicts of Interest

Global requires instructors, planners, managers, and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Jeffrey A. Gudin, MD: Consultant/Independent Contractor: AcelRx Pharmaceuticals, Inc., BioDelivery Sciences International, Inc., Daiichi-Sankyo, Inc., GlaxoSmithKline, Mallinckrodt, Nektar Therapeutics, Purdue Pharma L.P., Quest, Salix Pharmaceuticals, Scilex Pharmaceuticals, Inc., Semnur Pharmaceuticals. Speakers Bureau: BioDelivery Sciences International, Inc., Daiichi-Sankyo, Inc., Scilex Pharmaceuticals, Inc.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Planner or Manager:
Lindsay Borvansky: Nothing to disclose
Andrea Funk: Nothing to disclose
Liddy Knight: Nothing to disclose
Ashley Cann: Nothing to disclose
Ashley Marostica, RN, MSN: Nothing to disclose
Stacey Ullman, MHS: Nothing to disclose
Rose O’Connor, PhD, CHCP: Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global and Integritas Communications do not recommend the use of any agent outside of the labeled indication(s).

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Fee Information and Refund/Cancellation Policy

There is no fee for this educational activity.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers of use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.