Clinical Issues in Chronic Pain Debates and Discussions About Therapeutically Targeting Nerve Growth Factor Signaling

Charles E. Argoff, MD, Alfonso E. Bello, MD, Jeffrey A. Gudin, MD, Egilius L.H. Spierings, MD, PhD


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


This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc. and Teva Branded Pharmaceutical Products R&D, Inc.

Target Audience

The educational design of this activity addresses the needs of pain specialists and other clinicians involved in the management of patients with chronic osteoarthritic or low back pain.

Statement of Need/Program Overview

Chronic pain affects 100 million Americans and has significant health and socioeconomic repercussions.1 Appropriate pain management can improve patient quality of life and overall outcomes and also reduce health care costs.1 Although nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are often prescribed to manage chronic pain, both analgesic classes are associated with risks and are not appropriate for all patients.2-4 The search for additional treatment options with novel mechanisms of action has resulted in some focus on nerve growth factor (NGF) as a potential therapeutic target.5 In this Clinical Issues™ program, an expert panel will examine the pathophysiologic roles of NGF in osteoarthritis and low back pain, and clinical trial data for emerging anti-NGF therapies.6,7 Learners will leave this engaging discussion with an increased understanding of current and future techniques for pain management.


  1. Institute of Medicine Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011. Accessed March 21, 2018.
  2. Dowell D, et al. CDC [Centers for Disease Control and Prevention] Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49.
  3. Johnsen SP, et al. Risk of hospitalization for myocardial infarction among users of rofecoxib, celecoxib, and other NSAIDs: a population-based case-control study. Arch Intern Med. 2005;165(9):978-984.
  4. Whelton A. Renal and related cardiovascular effects of conventional and COX-2-specific NSAIDs and non-NSAID analgesics. Am J Ther. 2000;7(2):63-74.
  5. Malfait AM, Miller RJ. Emerging targets for the management of osteoarthritis pain. Curr Osteoporos Rep. 2016;14(6):260-268.
  6. Denk F, et al. Nerve growth factor and pain mechanisms. Annu Rev Neurosci. 2017;40:307-325.
  7. Miller RE, et al. Current status of nerve growth factor antibodies for the treatment of osteoarthritis pain. Clin Exp Rheumatol. 2017;35 (suppl 107[5]):85-87.

Educational Objectives

Upon completion of this activity, participants will be able to:

  • Discuss the pathophysiologic underpinnings of chronic osteoarthritic and low back pain with a focus on contributions from NGF
  • Educate patients about limitations in efficacy, and personal and public risks associated with currently available pharmacologic treatment options for chronic osteoarthritic or low back pain
  • Describe the mechanistic rationales and clinical evidence for emerging analgesic strategies designed to inhibit NGF signaling


Charles E. Argoff, MD
Professor of Neurology
Albany Medical College
Director, Comprehensive Pain Center
Albany Medical Center
Albany, New York

Alfonso E. Bello, MD
Clinical Associate Professor of Medicine
University of Illinois College of Medicine at Chicago
Physician, Rheumatology and Interventional Pain Management
Director of Rheumatology Research
Illinois Bone & Joint Institute
Glenview, Illinois

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

Egilius L. H. Spierings, MD, PhD
Clinical Professor of Neurology & Craniofacial Pain
Tufts University Schools of Medicine & Dental Medicine
Boston, Massachusetts
Medical Director & Principal Investigator
MedVadis Research Corporation
Watertown, Massachusetts

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 Communications. 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.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score at least 70% on the posttest and complete the program evaluation.

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:

Charles E. Argoff, MD: Consultant: Eli Lilly and Company, Pfizer Inc.; Stock Shareholder: Pfizer Inc.

Alfonso E. Bello, MD: Consultant: Horizon Pharma plc; Honoraria: Celgene Corporation, Horizon Pharma plc, Mallinckrodt Pharmaceuticals plc, Pfizer Inc.; Speakers Bureau: Celgene Corporation, Horizon Pharma plc, Mallinckrodt Pharmaceuticals plc, Pfizer Inc.

Jeffrey A. Gudin, MD: Consultant: BioDelivery Sciences International, Inc., Daiichi-Sankyo, Inc., Inspirion Delivery Sciences LLC, Nektar Therapeutics, Pernix Therapeutic Holdings, Inc., Quest; Speakers Bureau: Collegium Pharmaceutical, Inc., Daiichi-Sankyo, Inc., Purdue Pharma L.P., Salix Pharmaceuticals

Egilius L. H. Spierings, MD, PhD: Consultant: Alder BioPharmaceuticals, Inc., Amgen Inc., Eli Lilly and Company; Grant/Research: Alder BioPharmaceuticals, Inc., Amgen Inc., Pfizer Inc., Teva Pharmaceuticals USA; Speakers Bureau: Amgen Inc.; Stock Shareholder: Zosano Pharma Corporation

The 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:

Lindsay Borvansky, Andrea Funk, Ashley Marostica, RN, MSN, Jim Kappler, PhD, Liddy Knight, hereby state that neither they nor their spouses/life partners have any financial relationships to products or devices with any commercial interest related to the content of these activities of any amount during the past 12 months.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. 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.


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.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

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expiration 07/26/2019

type Webcast