Overcoming Challenges in Cancer Pain Management
Engaging With Patients About Opioid-Induced Constipation
Scientific Insights Into Opioid-Induced Constipation
Patient Interview
Mary: Uncovering Opioid-Induced Constipation
Mary: Inadequate Response to Laxative Therapy
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].
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.
Comprehensive Pain Management in Palliative Care
Relieving the Burden of Opioid-Induced Constipation
| Faculty: | Anthony J. Lembo, MD; Michael J. Brennan, MD; April M. Zehm, MD |
| Release: | 04/11/2017 |
| Expiration: | 04/11/2018 |
Overcoming Challenges in Cancer Pain Management
Engaging With Patients About Opioid-Induced Constipation
| Faculty: | Anthony J. Lembo, MD; Nicole M. Ross, MSN, CRNP, AOCNP; Michael J. Brennan, MD; Mihir M. Kamdar, MD; Patricia A. Jakel, RN, MN, AOCN |
| Release: | 08/31/2017 |
| Expiration: | 08/31/2018 |
