What to Do and What Not to Do in the Management of Opioid-Induced Constipation: A Choosing Wisely Report

• Main Authors: Domenico Alvaro, Augusto Tommaso Caraceni, Flaminia Coluzzi, Walter Gianni, Fabio Lugoboni, Franco Marinangeli, Giuseppe Massazza, Carmine Pinto, Giustino Varrassi
• Format: Article
• Language: English
• Published: Adis, Springer Healthcare 2020-09-01
• Series: Pain and Therapy
• Subjects: Bristol Stool Scale; Chronic constipation; Opioid-induced constipation; Peripheral mu-opioid receptor antagonist; Rome IV criteria
• Online Access: https://doi.org/10.1007/s40122-020-00195-z
• ISSN: 2193-8237; 2193-651X

Abstract Introduction Despite the essential utility of opioids for the clinical management of pain, opioid-induced constipation (OIC) remains an important obstacle in clinical practice. In patients, OIC hinders treatment compliance and has negative effects on quality of life. From a clinician perspective, the diagnosis and management of OIC are hampered by the absence of a clear, universal diagnostic definition across disciplines and a lack of standardization in OIC treatment and assessment. Methods A multidisciplinary panel of physician experts who treat OIC was assembled to identify a list of ten corrective actions—five “things to do” and five “things not to do”—for the diagnosis and management of OIC, utilizing the Choosing Wisely methodology. Results The final list of corrective actions to improve the diagnosis and clinical management of OIC emphasized a need for: (i) better physician and patient education regarding OIC; (ii) systematic use of diagnostically validated approaches to OIC diagnosis and assessment (i.e., Rome IV criteria and Bristol Stool Scale, respectively) across various medical contexts; and (iii) awareness about appropriate, evidence-based treatments for OIC including available peripheral mu-opioid receptor antagonists (PAMORAs). Conclusions Physicians who prescribe long-term opioids should be forthcoming with patients about the possibility of OIC and be adequately versed in the most recent guideline recommendations for its management.