Managing Opioid-Induced Constipation
Translating Guidelines Into Patient Care
Pathophysiology of OIC
OIC Assessment and Initial Management
Management of Laxative-Refractory OIC
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.
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.
Comprehensive Cancer Pain Management
Let’s Talk Constipation
| Faculty: | Mihir M. Kamdar, MD; Kathleen Madden, FNP, MSN, AOCNP, APHN; Bill H. McCarberg, MD |
| Release: | 07/12/2019 |
| Expiration: | 07/12/2020 |
Managing Opioid-Induced Constipation
Translating Guidelines Into Patient Care
| Faculty: | Jeffrey A. Gudin, MD |
| Release: | 01/03/2020 |
| Expiration: | 01/03/2021 |
