title: Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation.
abstract: OBJECTIVE
  Aims of this consensus panel were to determine (1) an optimal symptom-based method for assessing opioid-induced constipation in clinical practice and (2) a threshold of symptom severity to prompt consideration of prescription therapy.
  
  
  METHODS
  A multidisciplinary panel of 10 experts with extensive knowledge/experience with opioid-associated adverse events convened to discuss the literature on assessment methods used for opioid-induced constipation and reach consensus on each objective using the nominal group technique.
  
  
  RESULTS
  Five validated assessment tools were evaluated: the Patient Assessment of Constipation-Symptoms (PAC-SYM), Patient Assessment of Constipation-Quality of Life (PAC-QOL), Stool Symptom Screener (SSS), Bowel Function Index (BFI), and Bowel Function Diary (BF-Diary). The 3-item BFI and 4-item SSS, both clinician administered, are the shortest tools. In published trials, the BFI and 12-item PAC-SYM are most commonly used. The 11-item BF-Diary is highly relevant in opioid-induced constipation and was developed and validated in accordance with US Food and Drug Administration guidelines. However, the panel believes that the complex scoring for this tool and the SSS, PAC-SYM, and 28-item PAC-QOL may be unfeasible for clinical practice. The BFI is psychometrically validated and responsive to changes in symptom severity; scores range from 0 to 100, with higher scores indicating greater severity and scores >28.8 points indicating constipation.
  
  
  CONCLUSIONS
  The BFI is a simple assessment tool with a validated threshold of clinically significant constipation. Prescription treatments for opioid-induced constipation should be considered for patients who have a BFI score of ≥30 points and an inadequate response to first-line interventions.
authors.affiliation: The American Academy of Pain Medicine Foundation and Comprehensive Pain Center, Albany Medical Center, Albany, New York, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Argoff
authors.affiliation: The Pain Center of Fairfield, Fairfield, Connecticut, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Brennan
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Camilleri
authors.affiliation: Supportive and Palliative Care, Royal Surrey County Hospital and St. Luke's Cancer Centre, Surrey, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
authors.affiliation: Remitigate, LLC, and Department of Pharmacy, Stratton Veterans Affairs Medical Center, Albany, New York, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fudin
authors.affiliation: Department of Geriatrics, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Galluzzi
authors.affiliation: Pain Management and Palliative Care, Englewood Hospital and Medical Center, Englewood, New Jersey, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gudin
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lembo
authors.affiliation: Pain and Headache Center, Swedish Medical Center, Seattle, Washington, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Stanos
authors.affiliation: Scientific Affairs, PRA Health Sciences, Salt Lake City, Utah, USA.
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Webster
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires / Q000592:standards*; D014481:United States
chemical_list: D000701:Analgesics, Opioid
keywords: Bowel Function Index; Chronic Pain; Lubiprostone; Methylnaltrexone; Naloxegol; PAMORAs