Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation

Abstract

Background: Opioids are effective for acute and chronic pain conditions, but their use is associated with often difficult-to-manage constipation and other gastrointestinal (GI) effects due to effects on peripheral μ-opioid receptors in the gut. The mechanism of opioid-induced constipation (OIC) differs from that of functional constipation (FC), and OIC may not respond as well to most first-line treatments for FC. The impact of OIC on quality of life (QoL) induces some patients to decrease or stop their opioid therapy to relieve or avoid constipation.

Purpose: At a roundtable meeting on OIC, a working group developed a consensus definition for OIC diagnosis across disciplines and reviewed current OIC treatments and the potential of treatments in development. By consensus, OIC is defined as follows: 'A change when initiating opioid therapy from baseline bowel habits that is characterized by any of the following: reduced bowel movement frequency, development or worsening of straining to pass bowel movements, a sense of incomplete rectal evacuation, or harder stool consistency'. The working group noted the prior validation of a patient response outcome and end point for clinical trials and recommended future efforts to create treatment guidelines and QoL measures specific for OIC. Details from the working group's discussion and consensus recommendations for patient care and research are presented in this article.

Keywords: opioid-induced constipation; pain; palliative care; quality of life; μ-opioid receptor.

Conflict of interest statement

CONFLICTS OF INTEREST

MC has served as an advisory board member and a consultant for AstraZeneca and Theravance, and as an adjudication committee member for AstraZeneca. MC’s institution has received fees for his participation as an editorial board member for AstraZeneca and as a consultant for Theravance.

DAD has served as an advisory board member for Ironwood Pharmaceuticals, Lexicon Pharmaceuticals, and Synergy Pharmaceuticals; a consultant for AstraZeneca, Ironwood Pharmaceuticals, Ono Pharmaceuticals, and Takeda; has received grant support from AstraZeneca and Ironwood Pharmaceuticals; and currently is President of the Rome Foundation.

GB has served as an advisory board member for AstraZeneca, has received speaking fees from Cephalon, Grunenthal, Mundipharma, and Pfizer, and has received clinical research grants from Grunenthal, Mundipharma, Pfizer, and Roche. GB is supported by grants from the Federal Ministry of Education and Research in Germany, the German Cancer Aid and the Ministry of Science and Arts in the federal state of Baden-Wuerttemberg.

LRW has served as an advisory board member for AcelRx Pharmaceuticals, AstraZeneca, Boehringer Ingelheim, Collegium Pharmaceuticals, Inspirion Therapeutics, Insys Therapeutics, Iroko Pharmaceuticals, Mallinckrodt Pharmaceuticals, Nektar Therapeutics, Orexo Pharmaceuticals, Pfizer (formerly King), Salix Pharmaceuticals, and Teva; as a consultant for Acura Pharmaceuticals, AstraZeneca, Biodelivery Sciences International, Boston Scientific, CVS Caremark, Jazz Pharmaceuticals, Mallinckrodt Pharmaceuticals, Medtronic, Nektar Therapeutics, Neura Therapeutik, Nevro Corporation, Pharmacofore, Quintiles, Shionogi, and Theravance; and has received travel support from AcelRx Pharmaceuticals, Acura Pharmaceuticals, AstraZeneca, Biodelivery Sciences International, Boehringer Ingelheim, Boston Scientific, Collegium Pharmaceuticals, Inspirion Therapeutics, Insys Therapeutics, Iroko Pharmaceuticals, Mallinckrodt Pharmaceuticals, Medtronic, Nektar Therapeutics, Nevro Corporation, Orexo Pharmaceuticals, QRx Pharma, Teva, and Theravance.

AND has served as an advisory board member and has received speaking fees from AstraZeneca and Wyeth Pharmaceuticals.

GMM has served as an advisory board member for Shire Pharmaceuticals, and is supported by NIH grant DK62267.

Medical writing services were provided by Stephanie Leinbach, PhD, and Judy Fallon, PharmD, CMPP (Complete Healthcare Communications, Inc., Chadds Ford, PA), with funding from AstraZeneca LP (Wilmington, DE).

© 2014 John Wiley & Sons Ltd.