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However, it is frequently under\u2010recognised and thus effective management is often not instituted despite a number of treatment options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The central objective of this study is to provide a summary of the pathophysiology and clinical evaluation of opioid\u2010induced constipation and to provide a pragmatic management algorithm for day\u2010to\u2010day clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This summary and the treatment algorithm is based on the opinion of a European expert panel evaluating current evidence in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The pathophysiology of opioid\u2010induced constipation is multi\u2010faceted. The key aspect of managing opioid\u2010induced constipation is early recognition. Specific management includes increasing fluid intake, exercise and standard laxatives as well as addressing exacerbating factors. The Bowel Function Index is a useful way of objectively evaluating severity of opioid\u2010induced constipation and monitoring response. Second\u2010line treatments can be considered in those with recalcitrant symptoms, which include gut\u2010restricted or peripherally acting mu\u2010opioid receptor antagonists. However, a combination of interventions may be needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Opioid\u2010induced constipation is a common, yet under\u2010recognised and undertreated, complication of opioid therapy. We provide a pragmatic step\u2010wise approach to opioid\u2010induced constipation, which should simplify management for clinicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/2050640618818305","type":"journal-article","created":{"date-parts":[[2018,12,14]],"date-time":"2018-12-14T20:26:31Z","timestamp":1544819191000},"page":"7-20","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":145,"title":["Pathophysiology and management of opioid\u2010induced constipation: European expert consensus statement"],"prefix":"10.1002","volume":"7","author":[{"given":"Adam D","family":"Farmer","sequence":"first","affiliation":[{"name":"Institute of Applied Clinical Science<!--<institution-id institution-id-type=\"Ringgold\">4212<\/institution-id>--> Keele University Keele UK"},{"name":"Department of Gastroenterology Aalborg University Hospital Aalborg Denmark"},{"name":"Centre for Trauma and Neuroscience Queen Mary 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