{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:33:04Z","timestamp":1790289184106,"version":"4.1.0"},"reference-count":62,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Agenas Sciterion S.r.l."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Opioid-induced constipation (OIC) is a very common and troublesome gastrointestinal side effect following the use of opioids. Despite existing international guidelines, OIC is largely underdiagnosed and undertreated. ECHO OIC is a European project designed to improve the diagnosis and management of OIC at the primary care level. The next phase of the ECHO OIC project is to review and adapt the proposed European pathway at national level, considering the local patient journey and clinical practice. A multidisciplinary group of 12 Italian experts reviewed and discussed the European path and formulated a seven-step guide for the practical management of OIC that is also easily applicable in primary care: 1. When prescribing long-term opioids, the physician should inform the patient of the possibility of the onset of OIC; 2. At opioid prescription, doctors should also prescribe a treatment for constipation, preferably macrogol or stimulant laxatives; 3. The patient should be evaluated for OIC within the second week of initiating opioid treatment, by clinical history and Rome IV criteria; 4. In the presence of constipation despite laxatives, prescription of a PAMORA (Peripherally Acting Mu Opioid Receptor Antagonist) should be considered; 5. When prescribing a PAMORA, prescribing information should be carefully reviewed, and patients should be accurately instructed for appropriate use; 6. Efficacy and tolerability of the PAMORA should be monitored regularly by Bowel Function Index, considering a cut-off of 30 for the possible step-up of OIC treatment; 7. After 4 weeks of treatment, if the efficacy of PAMORA is deemed inadequate, discontinuation of the PAMORA, addition of an anti-constipation drugs, change of opioid type, or referral to a specialist should be considered. Spreading knowledge about the OIC problem as much as possible to the health community is crucial to obtain not only an early treatment of the condition but also to promote its prevention.<\/jats:p>","DOI":"10.3390\/jcm13226689","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T07:47:16Z","timestamp":1730965636000},"page":"6689","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Improving Diagnosis and Management of Opioid-Induced Constipation (OIC) in Clinical Practice: An Italian Expert Opinion"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3822-2923","authenticated-orcid":false,"given":"Giustino","family":"Varrassi","sequence":"first","affiliation":[{"name":"Fondazione Paolo Procacci, 00193 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Casale","sequence":"additional","affiliation":[{"name":"Fondazione Antea, 00135 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Grazia","family":"De Marinis","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Campus Bio-Medico, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Dentali","sequence":"additional","affiliation":[{"name":"Dipartimento di Area Medica, Asst Sette Laghi, SC Medicina Generale, Universit\u00e0 dell\u2019Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Evangelista","sequence":"additional","affiliation":[{"name":"School of Medicine, L\u2019Aquila University, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gino","family":"Gobber","sequence":"additional","affiliation":[{"name":"Italian Palliative Care Society, 38100 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Lanzetta","sequence":"additional","affiliation":[{"name":"INI UniCamillus, Saint Camillus International University of Health and Medical Sciences, 00046 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierangelo","family":"Lora Aprile","sequence":"additional","affiliation":[{"name":"Italian College of General Practitioners and Primary Care, 50100 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Caterina","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Luigi Vanvitelli University, 80133 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5359-1471","authenticated-orcid":false,"given":"Piero","family":"Portincasa","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine \u201cA. Murri\u201d, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari \u201cAldo Moro\u201d, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Radaelli","sequence":"additional","affiliation":[{"name":"Internal Medicine, Valduce Hospital, 22100 Como, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ungar","sequence":"additional","affiliation":[{"name":"University of Florence and Azienda Ospedaliero-Universitaria Careggi, 50100 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s40122-022-00446-1","article-title":"Chronic Non-cancer Pain Management in a Tertiary Pain Clinic Network: A Retrospective Study","volume":"12","author":"Latina","year":"2023","journal-title":"Pain Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/SPC.0000000000000640","article-title":"Opioid use disorder in cancer patients","volume":"17","author":"Lewis","year":"2023","journal-title":"Curr. 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