Restoring Balance: Advances in the Management of Opioid-Induced Constipation by Integritas Communications

This activity is jointly sponsored by Global Education Group and Integritas Communications. This activity is supported by an educational grant from AstraZeneca. This event is not a part of the official AAFP Assembly. This activity has been reviewed and is accepted for up to 1.5 Prescribed credits by the American Academy of Family Physicians.

CME/MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com

FACULTY FACULTY

Anthony J. Lembo, MD Prerecorded Associate Professor of Medicine Harvard Medical School Beth Israel Deaconess Medical Center Boston, Massachusetts

Jeffrey A. Gudin, MD Director Pain Management and Wellness Center Englewood Hospital and Medical Center Englewood, New Jersey

Bill H. McCarberg, MD Adjunct Assistant Clinical Professor University of California, San Diego Founder, Chronic Pain Management Program Kaiser Permanente San Diego Family Practitioner Neighborhood Health San Diego, California

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RESTORING BALANCE

Advances in the Management of Opioid-Induced Constipation

TARGET AUDIENCE The educational design of this activity addresses the needs of family physicians involved in the treatment of patients with opioid-induced constipation (OIC).

PREAMBLE

STATEMENT OF NEED/PROGRAM OVERVIEW As many as 100 million adults in the United States suffer from chronic pain.1 Among the multitude of available treatment modalities, opioids are generally regarded as the cornerstone for cancer pain treatment and palliative care, and have gained increasing acceptance as an important therapeutic option for carefully selected patients with chronic noncancer pain.2,3 Yet the side effects of opioid therapy often create significant barriers to good patient outcomes.4,5 Constipation is the most common opioid-related adverse effect, affecting up to 50% of patients on long-term therapy.6-10 OIC is especially burdensome because—unlike for many other adverse effects of opioids— patients do not develop tolerance to treatment-related reductions in bowel motility and increases in gastrointestinal fluid absorption.5 Thus, clinicians who manage patients on opioid therapy must be prepared to integrate approaches that target adequate analgesia and reduce risks of aberrant prescription drug use with efforts to proactively consider and appropriately manage opioid-related side effects—most notably constipation. During this Interactive Exchange™ program, expert faculty will provide practical insights into structured evaluation of bowel habits, prophylactic bowel regimens, and newer pharmacologic approaches that antagonize opioid receptor activation in the gastrointestinal tract.

REFERENCES 1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011. 2. Chou R, Fanciullo GJ, Fine PG, et al. J Pain. 2009;10(2):113-130. 3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. 2010;2010. 4. Daniell HW. Am J Med. 2007;120(9):e21. 5. McNicol E, Horowicz-Mehler N, Fisk RA, et al. J Pain. 2003;4(5):231-256. 6. Bell TJ, Panchal SJ, Miaskowski C, et al. Pain Med. 2009;10(1):35-42. 7. Cook SF, Lanza L, Zhou X, et al. Aliment Pharmacol Ther. 2008;27(12):1224-1232. 8. Panchal SJ, Muller-Schwefe P, Wurzelmann JI. Int J Clin Pract. 2007;61(7):1181-1187. 9. Villars P, Dodd M, West C, et al. J Pain Symptom Manage. 2007;33(1):67-77. 10. Benyamin R, Trescot AM, Datta S, et al. Pain Physician. 2008;11(suppl 2):S105-S120.

EDUCATIONAL OBJECTIVES After completing this activity, the participant should be better able to: • Discuss the fundamentals of opioid pharmacology with an emphasis on clinical effects of opioid receptor activation in the gastrointestinal tract • Proactively implement plans to address OIC in patients who have been selected for long-term opioid therapy • Longitudinally assess opioid-treated patients for problematic bowel function

• Individualize multimodal bowel regimens based on the degree of symptoms, treatment responses, and patient preferences • Counsel patients who have been selected for chronic opioid therapy about the risks of OIC, dietary recommendations, and potential benefits and drawbacks of various treatment approaches

PHYSICIAN ACCREDITATION STATEMENT This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Global Education Group (Global) and Integritas Communications, LLC. Global is accredited by the ACCME to provide continuing medical education for physicians.

PHYSICIAN CREDIT DESIGNATION Global Education Group designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAFP ACCREDITATION STATEMENT This live activity, Restoring Balance: Advances in the Management of Opioid-Induced Constipation, with a beginning date of 10/21/2014, has been reviewed and is acceptable for up to 1.50 Prescribed credit(s) by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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PREAMBLE

• Describe the clinical profiles of current and emerging opioid receptor antagonists for the management of OIC

RESTORING BALANCE

Advances in the Management of Opioid-Induced Constipation

INSTRUCTIONS TO RECEIVE CREDIT In order to receive credit for this activity, the participant must complete the evaluation form and return it to a staff member at the end of the program.

FEE INFORMATION & REFUND/CANCELLATION POLICY There is no fee for this educational activity.

PREAMBLE

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: Jeffrey Gudin, MD Consultant/Independent Contractor to Nektar Therapeutics; Speakerâ&#x20AC;&#x2122;s Bureau for AstraZeneca plc and Salix Pharmaceuticals, Inc. Anthony Lembo, MD Consultant/Independent Contractor to AstraZeneca plc, GlaxoSmithKline, Ironwood Pharmaceuticals, Inc., Prometheus Laboratories Inc., and Salix Pharmaceuticals, Inc.; Grant/Research Support from Prometheus Laboratories Inc. Bill McCarberg, MD Consultant/Independent Contractor to AstraZeneca plc, Collegium Pharmaceutical, Inc., Depomed, Inc., Inspirion Pharmaceuticals, LLC, Iroko Pharmaceuticals, LLC, Janssen Pharmaceuticals, Inc., KalĂŠo, Inc., Mallinckrodt Pharmaceuticals, Inc., Millennium Pharmaceuticals, Inc., Pfizer, Inc., Salix Pharmaceuticals, Inc.,Takeda Pharmaceuticals U.S.A., Inc., and Zogenix, Inc.; Stockholder of Biospecifics Technologies Corp., Galena Biopharma, Inc., Johnson & Johnson, Nektar Therapeutics, Protein Design Labs, Inc.

The planners and managers 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: Ashley Marostica, RN, MSN Nothing to disclose Amanda Glazar, PhD

Nothing to disclose

Andrea Funk

Nothing to disclose

Rose Oâ&#x20AC;&#x2122;Connor, PhD

Nothing to disclose

PREAMBLE

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 Communications, 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 any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER 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 manufacturerâ&#x20AC;&#x2122;s product information, and comparison with recommendations of other authorities.

GLOBAL CONTACT INFORMATION For information about the accreditation of this program, please contact Global at 303-395-1782 or inquire@globaleducationgroup.com.

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SLIDES

Advances in the Management of Opioid-Induced Constipation

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RESTORING BALANCE

SLIDES

Advances in the Management of Opioid-Induced Constipation

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SLIDES

RESTORING BALANCE

SLIDES

Advances in the Management of Opioid-Induced Constipation

For additional CME activities log on to

SLIDES

RESTORING BALANCE

SLIDES

Advances in the Management of Opioid-Induced Constipation

For additional CME activities log on to

SLIDES

RESTORING BALANCE

SLIDES

Advances in the Management of Opioid-Induced Constipation

For additional CME activities log on to

SLIDES

RESTORING BALANCE

SLIDES

Advances in the Management of Opioid-Induced Constipation

For additional CME activities log on to

SLIDES

RESTORING BALANCE

SLIDES

Advances in the Management of Opioid-Induced Constipation

SLIDES

For additional CME activities log on to

RESTORING BALANCE

Advances in the Management of Opioid-Induced Constipation

CLINICAL TOOLS »» Bowel Function Index The BFI provides a numerical assessment score for prior 7 days based on ease of defecation, feeling of incomplete evacuation, and personal judgment of constipation.

»» Patient Assessment of Constipation (PAC-SYM) This 12-item questionnaire of patient-reported symptoms assesses 3 subscales of symptoms (bowel movements, rectal symptoms, and abdominal symptoms) over the 2 prior weeks.

»» Bristol Stool Form Scale This visual scale is used to classify the type of stools passed.

PATIENT EDUCATION TOOL