First ever consensus on the management of opioid-induced constipation published in UEG Journal

Feb 6, 2019

Kyowa Kirin International PLC has announced the publication of Pathophysiology and Management of Opioid-Induced Constipation: European Expert Consensus Statement in United European Gastroenterology (UEG) Journal.

The European Consensus Statement was initiated to address the barriers to Opioid-Induced Constipation (OIC) diagnosis and to develop a pragmatic, stepwise approach to OIC management. OIC is currently an under-recognised and undertreated complication of opioid therapy, occurring in 51-87% of patients receiving opioids for cancer and around half (41-57%) of patients receiving opioids for chronic non-cancer pain.

Effective management of OIC requires early recognition but patients’ reluctance to report symptoms means the condition often goes unrecognised. OIC is specifically caused by opioids binding to mu-receptors in the bowel and requires different treatment to other types of constipation as over half (54%) of patients with OIC don’t respond to laxatives. Despite the availability of other treatment options, effective management is often not instituted and as a result, almost 60% of patients with OIC reduce their pain medication due to constipation.

The European Consensus Statement and development of an Opioid-Induced Constipation (OIC) management algorithm is the first to address the barriers to OIC diagnosis, including lack of awareness among clinicians about OIC in patients on opioid therapy, low use of universal diagnostic criteria and limited standard protocols for OIC management.

The initiative, supported by Kyowa Kirin International PLC, was driven by a panel of experts from Europe, in the fields of neurogastroenterology, gastroenterology, pain medicine, palliative medicine and oncology, who conducted a focused review of the pathophysiology and clinical evaluation of OIC, which helped form the Consensus Statement.

The Consensus Statement makes specific recommendations for the management of OIC, including educating patients about the side effects of opioids, co-prescription of a laxative, dietary and lifestyle modifications, asking patients about side-effects (including constipation at every clinical review), use of opioid antagonists and evaluation of gastrointestinal physiology.

Dr Adam Farmer, lead author of the report and Consultant Gastroenterologist, University Hospitals of North Midlands NHS Trust said: “The consensus statement is a real step forward in terms of our understanding of opioid-induced constipation. For the first time we have a clinically relevant paper that brings together multiple strands of knowledge and will hopefully change clinical practice in years to come.”

Dr Farmer continued: “The consensus statement is important for three reasons: firstly, for the identification of opioid-induced constipation, secondly for assessing and managing the problem and thirdly to guide appropriate treatment.”

Speaking about what the publication means for patients, Professor Bart Morlion, Anaesthesiologist and President of the European Pain Federation (EFIC) said: “Opioid-induced constipation has a significant impact on a patient’s quality of life, yet in many cases it remains an unreported side-effect.

“As a result, patients often attempt to alleviate their OIC symptoms by decreasing the dose or stopping their pain medication altogether. We hope the consensus statement will lead to better recognition of OIC and make a positive impact on the lives of patients affected by this condition.

“The consensus statement will improve doctors’ knowledge and in turn, their understanding about how best to treat the condition.”