“Before beginning any form of treatment of OIC, it is important to take a complete history, because not all patients taking opioids and experiencing constipation necessarily have OIC,” Dr. Chey advises. “The development of constipation temporally associated with opioid treatment initiation is likely caused by opioids.”

“If lifestyle changes, osmotics, or stimulants are ineffective, I would advise considering treatment with a PAMORA sooner rather than later,” he adds.

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At present, there are no consensus guidelines for management of OIC. The American Academy of Pain Medicine has convened a panel of experts who are currently drafting guidelines, says Dr. Fudin, who is a member of the panel.

Dr. Fudin notes that the absence of guidelines means “it is difficult to get managed care to pay for PAMORAs, since they are not currently regarded as standard of care.” It is to be hoped that this will change once guidelines have been established.


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