Opioid Induced Constipation

Faculty

Charles E. Argoff, MD
Professor of Neurology
Albany Medical College
Director, Comprehensive Pain Center
Albany Medical Center
Albany, New York

Brooks Cash, MD
Professor of Medicine
University of South Alabama
Health System Digestive Health Center
Mobile, Alabama

Anthony J. Lembo, MD
Associate Professor of Medicine
Director, GI Motility Laboratory
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Target Audience

The educational design of this activity addresses the needs of primary care physicians and other health care providers involved in the treatment of patients with opioid-induced constipation.

Statement of Need/Program Overview

As many as 100 million adults in the United States suffer from chronic pain.¹ Among the multitude of available treatment modalities, opioids are the cornerstone for cancer pain treatment and palliative care, and they have gained increasing acceptance as an important therapeutic option for carefully selected patients with chronic noncancer pain.^2,3 Yet, opioid side effects often create significant barriers to good patient outcomes.^4,5 Constipation is the most common opioid-related adverse effect, affecting up to 50% of patients on long-term therapy.^6-10 Opioid-induced constipation (OIC) is especially burdensome because—unlike many other adverse effects of opioids—patients do not develop tolerance to treatment-related reductions in bowel motility and increases in gastrointestinal fluid absorption.⁵ Clinicians must proactively consider and appropriately manage opioid-related side effects—most notably, constipation. By pre-emptively explaining the risk for OIC, clinicians can prepare patients to discuss changes in their bowel habits and adopt prophylactic or additional management strategies that can ease this burdensome side effect. During this program, expert faculty will provide practical insights into structured evaluations of bowel habits, prophylactic bowel regimens, and newer pharmacologic approaches that antagonize opioid receptor activation in the gastrointestinal tract, thereby targeting the underlying cause of OIC.

References

1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011. http://www.iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx. Accessed March 2015.
2. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. 2010;2010. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed March 2015.
4. Daniell HW. Opioid-induced androgen deficiency discussion in opioid contracts. Am J Med. 2007;120(9):e21.
5. McNicol E, Horowicz-Mehler N, Fisk RA, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003;4(5):231-256.
6. Bell TJ, Panchal SJ, Miaskowski C, et al. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med. 2009;10(1):35-42.
7. Cook SF, Lanza L, Zhou X, et al. Gastrointestinal side effects in chronic opioid users: results from a population-based survey. Aliment Pharmacol Ther. 2008;27(12):1224-1232.
8. Panchal SJ, Muller-Schwefe P, Wurzelmann JI. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract. 2007;61(7):1181-1187.
9. Villars P, Dodd M, West C, et al. Differences in the prevalence and severity of side effects based on type of analgesic prescription in patients with chronic cancer pain. J Pain Symptom Manage. 2007;33(1):67-77.
10. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(suppl 2):S105-S120.

Educational Objectives

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

• Evaluate baseline bowel habits, risk factors for OIC development, and ongoing changes in bowel function in patients on long-term opioid therapy
• Implement a prophylactic treatment plan to address OIC concurrent with the initiation of opioid therapy
• Analyze current pharmacotherapies for OIC based on mechanisms of action and data on efficacy and safety
• Tailor treatment regimens for patients experiencing OIC according to symptom severity, past treatment responses, and patient preferences
• Discuss the essential elements of opioid pharmacology with specific focus on the effects of opioid receptor activation in the gastrointestinal tract
• Communicate with opioid-treated patients about treatment-emergent adverse events through open, patient-centered dialogue throughout the course of therapy

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas 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 material for a maximum of 1.0 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. Term of Offering This activity was released on June 26, 2015 and is valid for 1 year. Requests for credit must be made no later than June 26, 2016.

Global Contact Information

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

Instructions to Receive Credit

In order to receive credit for this activity, the participant must complete the preactivity questionnaire, view the activity, and complete the posttest and evaluation form.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners 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 spouses/life partners have with commercial interests related to the content of this CME activity:

Charles E. Argoff, MD: Speakers Bureau for Allergan, Inc., AstraZeneca plc, Depomed Inc., Iroko Pharmaceuticals LLC, Janssen Pharmaceuticals, Inc., Millenium Laboratories, and Xenoport Inc. Grant/Research Support from Endo Pharmaceuticals Inc., Forest Laboratories, and Eli Lilly and Company.  Consultant/Independent Contractor to AstraZeneca plc, Depomed Inc., Endo Pharmaceuticals, Nektar Therapeutics, Pfizer, Inc., Xenoport Inc., and Zogenix, Inc. Stock Shareholder of Depomed Inc. and Pfizer Inc. Royalties from Elsevier B.V.

Brooks Cash, MD: Speakers Bureau for AstraZeneca plc, Salix Pharmaceuticals, Inc., and Takeda Pharmaceutical Company Limited.

Anthony J. Lembo, MD: Consultant/Independent Contractor to AstraZeneca plc, Ironwood Pharmaceuticals, Inc., Prometheus Laboratories Inc., and Salix Pharmaceuticals, Inc. Grant/Research Support from Prometheus Laboratories Inc.

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

Amanda Glazar, PhD: Nothing to disclose

Andrea Funk: Nothing to disclose

Rose O’Connor, PhD: 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 Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications. 

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.

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 in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.