Interactive Exchange

Restoring Balance: Advances in the Management of Opioid-Induced Constipation

Meeting Slides

Clinical Tools

Bowel Function Index

The BFI provides a numerical assessment score for prior 7 days based on ease of defecation, feeling of incomplete evacuation, and personal judgment of constipation.

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 2 prior weeks.

Bristol Stool Form Scale

This visual scale is used to classify the type of stools passed.

Patient Education Tool

This patient education tool list items that patients can do at home to help ease their opioid-induced constipation and includes a list of questions to ask the doctor or clinic about constipation.


The functional gastrointestinal disorders and the Rome III process, 2006.

Drossman DA. Gastroenterology. 2006;130:1377-1390.

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

Chou R, et al. Pain. 2009;10(2):113-130.

Clinical practice guidelines: Management of Opioid Therapy for Chronic Pain, 2010

Department of Veterans Affairs. VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.

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

Fecal incontinence in the elderly.

Leung FW, et al. Gastroenterol Clin North Am. 2009

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. 

Opioids in chronic non-cancer pain: systematic review of efficacy and safety.

Kalso E, et al. Pain. 2004;112(3):372-380

Constipation in people prescribed opioids.

Ahmedzai SH, Boland J. Clin Evid (Online). 2010;pii:2407

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.

A Randomized Study of Lubiprostone for Opioid-Induced Constipation in Patients with Chronic Noncancer Pain.

Cryer B, et al. Pain Med. 2014; Epublished ahead of print.

Naloxegol for opioid-induced constipation in patients with noncancer pain.

Chey WD, et al. N Engl J Med. 2014;370:2387-2396.

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 VC, et al. Int J Clin Pract. 2014. Epublished ahead of print.

Interactive Presentation

Introduction to Opioid-Induced Constipation

Anthony Lembo, MD

Advances in the Management of Opioid-Induced Constipation

Restoring Balance

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

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

Managing Opioid-Induced Constipation

Translating Guidelines Into Patient Care

Finding Relief in Osteoarthritis

New Paths to Chronic Pain Management

What’s New in Systemic Lupus Erythematosus?

Unlocking Novel Paths to Patient Care