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  • Overview
  • Pre-Assessment
  • Activity
    • Chapter 1
    • Chapter 2
    • Chapter 3
    • Chapter 4
  • Post-Test
  • Evaluation
  • Claim Credit
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Treatment Strategies for OIC in Patients with Chronic Pain

Treatment Strategies for OIC in Patients with Chronic Pain



Time to Complete

1 hour


October 2, 2017


October 2, 2018
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Maximum Credits

1.00 / AMA PRA Category 1 CreditTM

Accredited Provider

Provided by Integrity Continuing Education, Inc.

Commercial Supporter

Supported by an educational grant from Salix Pharmaceuticals, Inc., a division of Valeant Pharmaceuticals North America LLC

Program Description

Opioid analgesics represent the cornerstone of chronic pain therapy with approximately 250 million prescriptions filled annually in the United States. There has been a sharp increase in opioid use in the last decade, with nearly 149 million prescriptions in 2003 to 207 million in 2013. It is currently estimated that 3% of adults in the US are receiving long-term opioid therapy for noncancer pain and 90% of patients experiencing moderate-to-severe chronic pain are treated with opioids. While opioids alleviate pain by acting on opioid receptors in the central nervous system and the peripheral nervous system, their action on µ-receptors in the gastrointestinal (GI) tract is known to result in GI dysfunction. The symptoms of GI dysfunction include nausea, vomiting, abdominal cramping, bloating, abdominal pain, and constipation, which are experienced by most patients taking opioids. However, unlike other side effects of opioids such as sedation and respiratory depression, GI dysfunction does not resolve over time and can result in treatment discontinuation or voluntary dose reduction.

Opioid-induced constipation (OIC) is the most commonly reported and debilitating adverse effect associated with opioid therapy. Its prevalence ranges from 40% to 95% and is associated with increased healthcare utilization and costs, as well as decreased patient QOL. OIC has been associated with hemorrhoids, rectal pain and burning, bowel obstruction, bowel rupture, fecal impaction, and death. Additionally, persistent OIC among patients is known to increase medical services, hospital admissions, and inpatient stays while decreasing work productivity and activity. Indeed, these direct and indirect costs significantly burden the healthcare system. There has therefore been an unmet need to reduce the healthcare burden of OIC and improve the QOL of patients.

Intended Audience

This educational initiative has been designed for primary care physicians involved in the care of patients with OIC.

Educational Objectives

Upon completion of this educational activity, participants should be able to:

  • Describe the prevalence of opioid-induced constipation (OIC) and its effect on patient health, quality of life, and adequacy of pain management
  • Identify clinical barriers to accurate assessment and diagnosis of OIC
  • Describe the recommended assessment of patients with OIC and indications for initiation of treatment
  • Compare the relative efficacy and safety of currently available therapies for OIC

Conflict Of Interest Disclosure Policy

Integrity Continuing Education, Inc. requires instructors, planners, managers, and other individuals 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 Integrity Continuing Education for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. Integrity Continuing Education is committed to providing learners with high-quality CME/CE activities and related materials that promote improvement or quality in healthcare and not a specific proprietary business interest or a commercial interest.

The faculty/planners listed under the Faculty heading below reported their 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.


Anthony Lembo, MD
Associate Professor of Medicine
Harvard University Medical School
Beth Israel Deaconess Medical Center
Boston, MA

Dr. Lembo discloses the following:
Consultant: Ardelyx, Ironwood, Prometheus, Salix, Takeda
Research: Prometheus

Jeffrey Gudin, MD
Pain Management and Palliative Care
Englewood Hospital and Medical Center
Englewood, NJ

Dr. Gudin discloses the following:
Consultant: Collegium, Daiichi, Depomed, Kaleo, Kempharm, Inspirion, Insys, Iroko, Nektar, Purdue, Quest, Salix, Shionogi, Teva, Zogenix
Speaker: Collegium, Daiichi, Depomed, Endo, Inspirion, Purdue, Salix

Accredited Provider Disclosure

Patima Tanapat, PhD, has no real or apparent conflicts of interest to disclose.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

Integrity Continuing Education, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians.

Designation Statement

Integrity Continuing Education designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)TM  . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Integrity Continuing Education and Salix Pharmaceuticals, Inc., a division of Valeant Pharmaceuticals North America LLC, 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 Integrity Continuing Education and Salix Pharmaceuticals, Inc., a division of Valeant Pharmaceuticals North America LLC. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.


There are no fees for participating and receiving CME credit for this activity. During the period of October 2, 2017 through October 2, 2018, participants must:

  • Read the learning objectives and faculty disclosures
  • Complete the pre-test
  • Study the educational activity
  • Complete the post-test and the evaluation form
A statement of credit will be issued only upon receipt of a completed activity evaluation form and a completed post-test with a score of 70%.

For information about ACCME accreditation of this activity, please contact Integrity Continuing Education at (855) 835-4004 or

If you have any questions relating to your certificate or other issues with this activity, please contact

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