Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation

Charles E. Argoff, Michael J. Brennan, Michael Camilleri, Andrew Davies, Jeffrey Fudin, Katherine E. Galluzzi, Jeffrey Gudin, Anthony Lembo, Steven P. Stanos, Lynn R. Webster

Research output: Contribution to journalReview articlepeer-review

66 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2324-2337
Number of pages14
JournalPain Medicine (United States)
Issue number12
StatePublished - Dec 1 2015


  • Bowel Function Index
  • Chronic Pain
  • Lubiprostone
  • Methylnaltrexone
  • Naloxegol

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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