Comprehensive Pain Management

This activity is jointly provided by Global Education Group and Integritas Communications.

This activity is supported by an educational grant from AstraZeneca.

This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standard.

Target Audience

The educational design of this activity addresses the needs of pain specialists and other health care providers involved in the treatment of patients with opioid-induced constipation (OIC).

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 the cornerstone for cancer pain treatment and palliative care, and they have gained increasing acceptance as an important therapeutic option for carefully selected patients with chronic noncancer pain.^2,3 Yet, opioid side effects 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 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 Clinicians must proactively consider and appropriately manage opioid-related side effects—most notably, constipation. By pre-emptively explaining the risk for OIC, clinicians can prepare patients to discuss changes in their bowel habits and adopt prophylactic or additional management strategies that can ease this burdensome side effect. During this Interactive Exchange™ program, expert faculty will provide practical insights into structured evaluations of bowel habits, prophylactic bowel regimens, and newer pharmacologic approaches that antagonize opioid receptor activation in the gastrointestinal tract, thereby targeting the underlying cause of OIC. 

References

1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011. https://www.iom.edu/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx. Accessed June 2015.
2. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. 2010;2010. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed June 2015.
4. Daniell HW. Opioid-induced androgen deficiency discussion in opioid contracts. Am J Med. 2007;120(9):e21.
5. McNicol E, Horowicz-Mehler N, Fisk RA, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003;4(5):231-256.
6. Bell TJ, Panchal SJ, Miaskowski C, et al. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med. 2009;10(1):35-42.
7. Cook SF, Lanza L, Zhou X, et al. Gastrointestinal side effects in chronic opioid users: results from a population-based survey. Aliment Pharmacol Ther. 2008;27(12):1224-1232.
8. Panchal SJ, Muller-Schwefe P, Wurzelmann JI. Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden. Int J Clin Pract. 2007;61(7):1181-1187.
9. Villars P, Dodd M, West C, et al. Differences in the prevalence and severity of side effects based on type of analgesic prescription in patients with chronic cancer pain. J Pain Symptom Manage. 2007;33(1):67-77.
10. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(suppl 2):S105-S120.

Educational Objectives

After completing this activity, the participant should be better able to:

• Evaluate baseline bowel habits, risk factors for OIC development, and ongoing changes in bowel function in patients on long-term opioid therapy
• Implement a prophylactic treatment plan to address OIC concurrent with the initiation of opioid therapy
• Analyze current pharmacotherapies for OIC based on mechanisms of action and data on efficacy and safety
• Tailor treatment regimens for patients experiencing OIC according to symptom severity, past treatment responses, and patient preferences
• Collaborate with primary care and other providers to ensure that opioid-treated patients are routinely assessed for changes in bowel habits

Program Agenda

11:30 AM - 12:00 PM   Registration and Lunch
12:00 PM – 12:05 PM   Preactivity Questionnaire
12:05 PM – 12:20 PM   Disease Management Primer
12:20 PM – 12:55 PM   Case Series in Opioid-Induced Constipation
12:55 PM – 1:15 PM     Build-a-Case Collaboration™
1:15 PM – 1:30 PM       Postactivity Questionnaire and Question and Answer Session

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 providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

*This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

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.

Pharmacist Continuing Education

Accreditation Statement
Global Education Group is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Credit Designation
Global Education Group designates this continuing education activity for 1.5 contact hour(s) (0.15 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number - 0530-9999-15-058-L01) This is a knowledge-based activity.

Nursing Continuing Education

Global Education Group is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

This educational activity for 1.5 contact hours is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Instructions to Receive Credit*(ACPE Only)

In order to receive credit for this activity, the participant must complete the Global Education Group evaluation form.

Nurse Practitioner Continuing Education

Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 1101021. This program has been approved for 1.5 contact hours of continuing education (which includes TBD hours of pharmacology).

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.