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Comprehensive Pain Management in Palliative Care: Relieving the Burden of Opioid-Induced Constipation

As the United States population ages, an increasing number of individuals will suffer from significant pain as they approach end of life.1 Despite ...

Available credits: 0.50

Time to complete: 30 minutes


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  • Overview

    As the United States population ages, an increasing number of individuals will suffer from significant pain as they approach end of life.1 Despite advances in our understanding of pain physiology and available treatment modalities, pain associated with life-threatening illnesses is often untreated or undertreated.2 This results in part from side effects of commonly prescribed analgesics. For example, opioids have long been the cornerstone treatment for pain associated with cancer or other terminal conditions.3,4 The most frequent side effect of prescription opioids is constipation, which ranks as the third most commonly reported symptom in palliative care.5,6 Unaddressed opioid-induced constipation (OIC) can have markedly deleterious effects on patient function and quality of life.7,8 With an overall goal of improving comprehensive pain management in patients receiving palliative care, this Evidence-Based Best Practices program will examine the pathophysiology of opioid-induced bowel dysfunction, prophylactic treatment regimens for OIC, assessment strategies to identify and monitor affected patients, and new therapeutic approaches that mitigate OIC effectively and safely.


    1. Robinson CL. Health Prog. 2007;88(1):48-53.
    2. Deandrea S, et al. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. 2008;19(12):1985-1991.
    3. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Version 2.2016.
    4. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatr Soc. 2009;57(8):1331-1346.
    5. Coyne KS, et al. Clinicoecon Outcomes Res. 2014;6:269-281.
    6. Gatti A, Sabato AF. Clin Drug Investig. 2012;32(5):293-301.
    7. Holzer P. Expert Opin Investig Drugs. 2007;16(2):181-194.
    8. Rao SS. Gastroenterol Clin North Am. 2007;36(3):687-711.

    Fee Information & Refund/Cancellation Policy 

    There is no fee for this educational activity.

  • Learning Objectives

    After completing this activity, the participant should be better able to:

    • Evaluate baseline and ongoing bowel function in palliative care patients who need opioid-based pain management
    • Describe the mechanisms of action, published evidence, and prescribing considerations for FDA-approved medications in the treatment of OIC
    • Incorporate prophylactic bowel regimens and newer OIC therapies into comprehensive palliative care plans
    • Communicate with opioid-treated palliative care patients and their caregivers to facilitate bowel assessment efforts and shared decision-making about OIC treatment options
  • Target Audience

    The educational design of this activity addresses the needs of palliative care clinicians who manage patients on opioid-based pain regimens.

  • Disclosure of Conflicts of Interest

    Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

    The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

    Anthony J. Lembo, MD
    Consultant/Independent Contractor: Alkermes plc, Ardelyx, Inc., Forest Laboratories, Inc., Ironwood Pharmaceuticals, Inc., Prometheus Laboratories Inc., Salix Pharmaceuticals, Inc.; Grant/Research Support: Prometheus Laboratories Inc.

    Michael J. Brennan, MD
    Consultant/Independent Contractor: AstraZeneca, Cara Therapeutics Inc., Collegium Pharmaceutical Inc., Depomed,Inc., Progenics Pharmaceuticals, Inc., Purdue Pharma L.P., Teva Pharmaceuticals USA Inc.; Honoraria: AstraZeneca, Collegium Pharmaceutical Inc., Depomed, Inc.,Progenics Pharmaceuticals, Inc., Purdue Pharma L.P., Teva Pharmaceuticals USA Inc.; Stockholder: Cara Therapeutics Inc.

    April M. Zehm, MD
    Nothing to disclose

    The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
    Kristen Delisi -Nothing to disclose
    Andrea Funk - Nothing to disclose
    Laura Gilsdorf - Nothing to disclose
    Ashley Marostica, RN, MSN - Nothing to disclose
    Rose O’Connor, PhD - Nothing to disclose
    Jim Kappler, PhD - Nothing to disclose

    Disclosure of Unlabeled Use

    This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas do not recommend the use of any agent outside of the labeled indications.  

    The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


    Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

  • Accreditation and Credit Designation Statements

    Physician Accreditation Statement
    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

    Physician Credit Designation
    Global Education Group designates this enduring activity for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Nursing Continuing Education
    Global Education Group is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

    This educational activity for 0.50 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

    Nurse Practitioner Continuing Education

    Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is accredited for 0.50 contact hour(s) which includes 0.1 hour(s) of pharmacology. 
    Activity ID #2306E.
    This activity was planned in accordance with AANP CE Standards and Policies.

    Global Contact Information
    For information about the accreditation of this program, please contact Global at 303-395-1782 or

  • Instructions to Receive Credit

    In order to receive credit for this activity, the participant must: 

    1. Read the CME information, including the learning objectives and faculty disclosures
    2. Listen to the full content of the activity and reflect upon its teachings
    3. Successfully complete the post-test with a passing score and the evaluation at the end of the activity

    Participants who successfully complete the activity, post test and evaluation will have a statement of credit made available immediately.

  • Provider(s)/Educational Partner(s)

    This activity is jointly provided by Global Education Group and Integritas Communications.

  • Commercial Support

    This activity is supported by an educational grant from AstraZeneca.

  • System Requirements

    Our site requires a computer, tablet or mobile device and a connection to the Internet. For best results, a high-speed Internet connection is recommended (DSL/cable). We also recommend using the latest version of your favorite browser to ensure compliance with W3C standards, such as Internet Explorer, Microsoft Edge, Chrome, Firefox or Safari. Users accustomed to IE8, IE9 IE10 are advised to update their browsers for the best experience.

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