Treatment Strategies for OIC in Patients with Chronic Pain

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Haymarket Medical Education

1 hour

PROGRAM DESCRIPTION
Opioid analgesics represent the cornerstone of chronic pain therapy with approximately 250 million prescriptions filled annually in the United States. There has been a sharp increase in opioid use in the last decade, with nearly 149 million prescriptions in 2003 to 207 million in 2013. It is currently estimated that 3% of adults in the US are receiving long-term opioid therapy for noncancer pain and 90% of patients experiencing moderate-to-severe chronic pain are treated with opioids. While opioids alleviate pain by acting on opioid receptors in the central nervous system and the peripheral nervous system, their action on µ-receptors in the gastrointestinal (GI) tract is known to result in GI dysfunction. The symptoms of GI dysfunction include nausea, vomiting, abdominal cramping, bloating, abdominal pain, and constipation, which are experienced by most patients taking opioids. However, unlike other side effects of opioids such as sedation and respiratory depression, GI dysfunction does not resolve over time and can result in treatment discontinuation or voluntary dose reduction. Opioid-induced constipation (OIC) is the most commonly reported and debilitating adverse effect associated with opioid therapy. Its prevalence ranges from 40% to 95% and is associated with increased healthcare utilization and costs, as well as decreased patient QOL. OIC has been associated with hemorrhoids, rectal pain and burning, bowel obstruction, bowel rupture, fecal impaction, and death. Additionally, persistent OIC among patients is known to increase medical services, hospital admissions, and inpatient stays while decreasing work productivity and activity. Indeed, these direct and indirect costs significantly burden the healthcare system. There has therefore been an unmet need to reduce the healthcare burden of OIC and improve the QOL of patients.

EDUCATIONAL OBJECTIVES
Upon completion of this educational activity, participants should be able to:Describe the prevalence of opioid-induced constipation (OIC) and its effect on patient health, quality of life, and adequacy of pain managementIdentify clinical barriers to accurate assessment and diagnosis of OICDescribe the recommended assessment of patients with OIC and indications for initiation of treatmentCompare the relative efficacy and safety of currently available therapies for OIC