Comprehensive Chronic Pain Management

Faculty

Brooks D. Cash, MD
Professor of Medicine
Division of Gastroenterology
University of South Alabama Health System
Mobile, Alabama

Jeffrey A. Gudin, MD
Director Pain Management and Wellness Center
Englewood Hospital and Medical Center
Englewood, New Jersey

Bill H. McCarberg, MD, FABPM
Adjunct Assistant Clinical Professor
University of California, San Diego
Founder, Chronic Pain Management Program
Kaiser Permanente San Diego
Family Practitioner
Neighborhood Health
San Diego, California 

Target Audience

The educational design of this activity addresses the needs of pain specialists, primary care providers (PCPs), and other clinicians involved in the management of patients with opioid-treated chronic pain.

Statement of Need/Program Overview

Constipation, the most common side effect of chronic opioid therapy, is a constellation of symptoms that include infrequent or incomplete bowel movements, abdominal pain or bloating, and the need to strain when having a bowel movement.^1,2 In clinical trials examining the benefits and risks of chronic opioid therapy, opioid-induced constipation often affects up to 50% of study subjects, and is likely even more common when opioids are used to treat chronic pain outside of structured trial protocols.^3,4 In this Clinical Research Updates™ program, a multidisciplinary panel of expert clinicians discusses best practices for identifying patients with opioid-induced constipation—for example, how to initiate conversations with patients about this potentially uncomfortable topic and advice on incorporating easy-to-use bowel assessment tools into daily practice. The panel also reviews nonpharmacologic and pharmacologic treatment modalities, including agents that have been specifically approved for opioid-induced constipation by the US Food and Drug Administration.^5,6

References

1. Coyne KS, et al. Opioid-induced constipation in patients with chronic noncancer pain in the USA, Canada, Germany, and the UK: descriptive analysis of baseline patient-reported outcomes and retrospective chart review. Clinicoecon Outcomes Res. 2014;6:269-281.

2. Camillieri M, et al. Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol Motil. 2014;26(10):1386-1395.

3. Cook SF, et al. Gastrointestinal side effects in chronic opioid users: results from a population-based survey. Aliment Pharmacol Ther. 2008;27(12):1224-1232.

4. Ueberall M, Mueller-Schwefe GH. Development of opioid-induced constipation: post hoc analysis of data from a 12-week prospective, open-label, blinded-endpoint streamlined study in low-back pain patients treated with prolonged-release WHO step III opioids. J Pain Res. 2015;8:459-475.

5. Chey WD, et al. Naloxegol for opioid-induced constipation in patients with noncancer pain. N Engl J Med. 2014;370(25):2387-2396.

6. Argoff CE, et al. Consensus recommendations on initiating prescription therapies for opioid-induced constipation. Pain Med. 2015;16(12):2324-2337.

Educational Objectives

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

• Evaluate baseline bowel patterns and subsequent changes in bowel function in patients initiating opioid-based therapy for chronic pain
• Prescribe initial prophylactic strategies to reduce the chances of OIC development in opioid-treated patients
• Discuss the mechanisms of action, evidence for efficacy and safety, and other prescribing considerations for medications that have been FDA-approved for the treatment of OIC
• Personalize longitudinal management plans for OIC patients to address persistent bowel symptoms, prior treatment response, and patient preferences
• Engage patients on chronic opioid therapy to facilitate bowel assessment efforts and shared decision-making on potential OIC treatment options

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is accredited for 1.0 contact hour(s) which includes 0.0 hour(s) of pharmacology.

Activity ID #2094E.

This activity was planned in accordance with AANP CE Standards and Policies.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or
cme@globaleducationgroup.com

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score a 70% or better on the posttest.

System Requirements

PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Adobe Acrobat Reader

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Safari
Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

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.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: 

Brooks D. Cash, MD  Consultant: Allergan plc, Valeant Pharmaceuticals International, Inc.; Speakers Bureau: Allergan plc, AstraZeneca plc, Takeda Pharmaceuticals U.S.A., Inc., Valeant Pharmaceuticals International, Inc.

Jeffrey A. Gudin, MD  Consultant: AstraZeneca plc, Daiichi Sankyo Company, Limited, Depomed, Inc., Endo Pharmaceuticals Inc., Insys Therapeutics, Inc., Kaléo, Inc., KemPharm, Inc., Quest Diagnostics Inc., SCILEX Pharmaceuticals, Inc., Teva Pharmaceuticals USA, Inc.; Speakers Bureau: AstraZeneca plc, Iroko Pharmaceuticals, LLC, Purdue Pharma L.P., Salix Pharmaceuticals, Inc.

Bill H. McCarberg, MD, FABPM  Consultant: AstraZeneca plc, Collegium Pharmaceutical, Inc., Depomed, Inc., Janssen Pharmaceuticals, Inc., Kaléo, Inc., Millenium Pharmaceuticals, Inc., Pfizer Inc., Salix Pharmaceuticals, Inc., Takeda Pharmaceuticals U.S.A., Inc.; Stock Shareholder: BioSpecifics Technologies Corp., Collegium Pharmaceutical, Inc., Galena Biopharma, Inc., Johnson & Johnson Services, Inc., Nektar Therapeutics, Protein Design Labs, Inc.

The following planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Kristen Delisi, NP      Nothing to disclose
Amanda Glazar, PhD      Nothing to disclose
Andrea Funk      Nothing to disclose
Laura Gilsdorf      Nothing to disclose
Rose O’Connor, PhD      Nothing to disclose
Jim Kappler, PhD      Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.