Caring for Patients With Chronic Pain

Target Audience

The educational design of this activity addresses the needs of primary care providers, pain specialists, and other clinicians involved in opioid-based management of chronic pain

Statement of Need

Affecting an estimated 100 million adults in the United States, chronic pain is one of the most common reasons to seek medical treatment.¹ Importantly, the associated neuroplastic changes are progressive and potentially irreversible, underscoring the need for aggressive treatment.² Yet although relief from chronic pain is a clear medical goal, clinicians are often challenged by pain’s subjective nature and the need to balance the potential benefits and risks associated with certain medication classes. In particular, a broad analgesic spectrum and dosing flexibility have made prescription opioids the cornerstone of cancer pain treatment.³ These medications are also an important therapeutic option for carefully selected patients with moderate to severe chronic noncancer pain.⁴ Unfortunately, however, increased prescribing has been mirrored by growing concerns about opioid abuse and higher rates of overdose deaths.^5-7 Thus, clinicians who provide opioid medications to patients with chronic pain must adopt responsible prescribing strategies, including screening for risk factors associated with aberrant drug use, appropriate monitoring, and meticulous documentation of clinical decision making.⁴ Other tools that can help reduce opioid-related risks for patients, prescribers, and the public include periodic urine drug testing, prescription monitoring programs, and newer long-acting opioid formulations designed to resist or deter some aberrant drug-taking behaviors.^8-10 This Interactive Exchange^™ program will examine each of these strategies as well as published evidence and clinical guidelines for long-term opioid therapy. The goal is to empower clinicians to select patients who may benefit from long-term opioid therapy, assess risk, monitor outcomes, and tailor opioid-based regimens over time.

References

1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011.

2. Woolf CJ. Central sensitization: uncovering the relation between pain and plasticity. Anesthesiology. 2007;106(4):864-867.

3. Swarm RA, Abernethy AP, Anghelescu DL, et al. Adult cancer pain. J Natl Compr Canc Netw. 2013;11(8):992-1022.

4. Chou R, Fanciullo GJ, Fine PG, Miaskowski C, Passik SD, Portenoy RK. Opioids for chronic noncancer pain: prediction and identification of aberrant drug-related behaviors: a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009;10(2):131-146.

5. Starr TD, Rogak LJ, Passik SD. Substance abuse in cancer pain. Curr Pain Headache Rep. 2010;14(4):268-275.

6. Portenoy RK. Treatment of cancer pain. Lancet. 2011;377(9784):2236-2247.

Educational Objectives

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

• Discuss the neurobiologic mechanisms that underlie chronic pain and associated functional disability
• Assess biopsychosocial factors that contribute to chronic pain via patient histories, clinical interviews, and physical exams
• Tailor multimodal opioid-based therapy for patients with chronic pain based on analgesia, functional responses, adverse events, and stratified risk of aberrant behaviors
• Employ opioid prescribing principles for patient monitoring and documentation to comply with medical standards of care, government agencies, and risk evaluation and mitigation strategies
• Educate patients about the safe and appropriate use of prescription opioid analgesics, including common side effects, drug-drug interactions, and the critical need to adhere to the therapeutic plan 

Faculty

Michael J. Brennan, MD
Director, The Pain Center of Fairfield
Fairfield, Connecticut
Senior Attending Physician
Department of Medicine, Physical Medicine, and Rehabilitiation
Bridgeport Hospital
Bridgeport, Connecticut

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

David M. Simpson, MD, FAAN
Professor of Neurology
Mount Sinai School of Medicine
Director, Neuromuscular Division
Director, Neuro-AIDS Program
Mount Sinai Hospital
New York, New York

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.

Physician Credit Designation

Global Education Group designates this live 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.

Instructions for Obtaining Credit

In order to receive credit, participants must complete the pre-activity questionnaire, posttest and program evaluation. Participants must also score at least 70 % on the posttest. Certrificates will be distributed online at the conclusion of the activity.

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

System Requirements

PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Internet Explorer (v8.0 or greater), Chrome, or Firefox

MAC
MAC OS 10+
Flash Player Plugin (v7.0.1.9 or greater)
Safari

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 spouse/life partner 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 spouse/life partner have with commercial interests related to the content of this CME activity:

• Michael J. Brennan, MD Consultant: Depomed, Inc., INSYS Therapeutics, Inc., Mallinckrodt Pharmaceuticals, Purdue Pharma L.P., Teva Pharmaceuticals Industries Ltd.
• David Simpson, MD, FAAN Consultant: Acorda Therapeutics, Inc., Allergan, Inc., Astellas Pharma Inc.; Grant/Research: Acorda Therapeutics, Inc., Allergan, Inc., Astellas Pharma Inc.; Honoraria: Allergan, Inc., Astellas Pharma Inc.; Speaker’s Bureau: Allergan, Inc., Astellas Pharma Inc.
• Bill McCarberg, MD Honoraria: AstraZeneca Pharmaceuticals LP, Collegium Pharmaceutical, Inc., Depomed Inc., Inspirion Pharmaceuticals, Iroko Pharmaceuticals, LLC, Janssen Pharmaceuticals, Inc., Kaléo, Inc., Mallinckrodt Pharmaceuticals, Millennium Laboratories, LLC, Pfizer Inc., Salix Pharmaceuticals, Inc., Takeda Pharmaceuticals U.S.A., Inc., Zogenix, Inc.; Stock Shareholder: BioSpecifics Technologies Corp., Galena Biopharma, Inc., Johnson & Johnson, Nektar Therapeutics, and Protein Design Labs, Inc.

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

• Jim Kappler, PhD Nothing to disclose
• Ashley Marostica, RN, MSN Nothing to disclose
• Amanda Glazar, PhD Nothing to disclose
• Andrea Funk 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.