Opioid-induced constipation in internal medicine: recognition and management pathways

Area of Science:

• Gastroenterology
• Internal Medicine
• Pharmacology

Background:

• Opioid-induced constipation (OIC) is a prevalent and distressing gastrointestinal side effect in patients receiving chronic opioid therapy.
• OIC is often underdiagnosed and inadequately managed, significantly impacting patients' quality of life.
• There is a need to increase awareness and standardize the approach to OIC within internal medicine.

Purpose of the Study:

• To promote awareness of OIC in internal medicine.
• To review and adapt European expert guidelines (ECHO OIC) for OIC diagnosis and management.
• To provide national customization and a multidisciplinary approach through Italian expert consensus.

Main Methods:

• Examination of the EnhanCing Healthcare Outcomes in Opioid-Induced Constipation (ECHO OIC) statement.
• Discussion and adaptation of guidelines by an Italian expert consensus group.
• Implementation of a multi-step clinical pathway for OIC.

Main Results:

• A seven-step diagnostic-therapeutic pathway for OIC prevention, diagnosis, treatment, and long-term management was formulated.
• The pathway emphasizes education, early intervention, monitoring, tailored pharmacologic strategies, and coordinated referrals.
• The approach aims to improve the quality of life for patients experiencing OIC.

Conclusions:

• Increased awareness of OIC is crucial in clinical practice.
• The ECHO OIC seven-step pathway offers a pragmatic and scalable model for improved OIC management.
• A multidisciplinary and tailored approach is essential for effective OIC care.