Table 9.

Initial management of patients with an indication for, or already receiving, chronic opioid therapy

Indication for chronic opioid therapy	Already receiving chronic opioid therapya
1. Inform the patient that opioid use may cause or worsen constipation, necessitating the use of laxatives	1. Administer a validated measurement scale before opioid therapy (baseline) and at regular intervals (e.g. once weekly) to facilitate the early detection of worsening bowel function
2. Assess bowel function before starting opioid therapy (baseline) using a validated measurement scale	2. If constipation is diagnosed, assess severity and possible causes
3. If bowel function is found to be abnormal, initiate appropriate treatment. The aim of such treatment is to avoid discontinuation of opioid treatment or a reduction in dosage that could lead to recurrence of pain	3. Initiate laxative treatment in patients not currently receiving it. In the case of worsening bowel function in patients already on laxative treatment, review and, if necessary, gradually intensify it. If possible, increase the dose of the medication(s) already in use. If necessary, add an additional agent with a complementary mechanism of action

^aWith or without concomitant laxatives