Persistent and Breakthrough Pain

Faculty

Michael J. Brennan, MD
Medical Director, Pain Center of Fairfield
Fairfield, Connecticut
Senior Attending Physician, Department of Medicine, Physical Medicine, and Rehabilitation
Bridgeport Hospital
Bridgeport, Connecticut
Associate Director, Chronic Pain and Rehabilitation Center
Silver Hill Hospital
New Canaan, Connecticut

Steven P. Stanos, DO
Assistant Professor
Assistant Program Director
Multidisciplinary Pain Fellowship
Northwestern University Feinberg School of Medicine
National Director, Corporate Pain Services
Attending Physician, Center for Pain Management
Rehabilitation Institute of Chicago
Chicago, Illinois

Mark S. Wallace, MD
Professor of Clinical Anesthesiology
Director, Center for Pain and Palliative Medicine
University of California at San Diego
San Diego, California

Target Audience

The educational design of this activity addresses the needs of pain specialists, oncologists, pain management nurses, pharmacists, and other health care providers involved in the opioid-based management of patients with persistent and breakthrough pain (BTP).

Statement of Need/ Program Overview

Chronic pain is a dynamic condition in which biologic and psychosocial factors markedly influence clinical presentation.¹ As a result, most patients experience daily fluctuations in pain, even when the persistent baseline component of their pain is relatively well controlled. These episodes of BTP—first described more than two decades ago in patients with cancer—negatively affect patient mood, function, and/or quality of life, highlighting the need for targeted assessment and tailored management.^2-5 Yet, although aggressive pain treatment is a clear medical goal, clinicians are challenged by the subjective nature of pain and public health consequences associated with some analgesic medications. For instance, whereas prescription opioids have long been the cornerstone of cancer pain treatment, increased use of these agents in the large, heterogeneous patient population with chronic noncancer pain has been mirrored by higher rates of opioid abuse and overdose.^6,7 Moreover, therapeutic advances have led to improved survival rates for cancer and other previously terminal diseases, often leaving survivors with disabling chronic pain syndromes as a result of surgery, radiation, chemotherapy, or other medical interventions.^8,9 Thus, many patients will require long-term symptomatic management, including, at times, opioid therapy for persistent pain and BTP. Pain specialists and other clinicians must adopt responsible prescribing strategies.³ This eHealthSource program will provide attendees with practical approaches to persistent pain and BTP assessment, risk stratification related to aberrant opioid use, patient education, and long-term monitoring of outcomes.

References  

1. Gatchel RJ, et al. Psychol Bull. 2007;133(4):581-624.
2. Bennett DS, et al. J Opioid  Manag. 2007;3(2):101-106.
3. Chou R, et al. J Pain. 2009;10(2):113-130.
4. Davies AN, et al. Eur J Pain. 2009;13(4):331-338.
5. Portenoy RK, Hagen NA. Pain. 1990;41(3):273-281.
6. Hall AJ, et al. JAMA. 2008;300(22):2613-2620.
7. Portenoy RK. Lancet. 2011;377(9784):2236-2247.
8. Lage A, Crombet T. Int J Environ Res Public Health. 2011;8(3):683-697.
9. Levy MH, et al. Cancer J. 2008;14(6):401-409.

Educational Objectives

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

• Describe the diagnostic criteria for BTP and clinical characteristics of various episode subtypes
• Differentially diagnose transient increases in pain levels and functional compromise in patients with chronic pain
• Discuss the respective roles and prescribing considerations for long-acting opioids, short-acting opioids, and transmucosal immediate-release fentanyl products
• Individualize multimodal opioid-based treatment regimens for persistent pain and BTP to reflect the temporal profile of pain, functional impairment, treatment side effects, and risks related to aberrant medication use
• Prescribe opioid therapy for persistent pain and BTP in a manner consistent with medical standards of care and Risk Evaluation and Mitigation Strategies

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 sponsorship 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.

Instructions for Obtaining Credit

In order to receive credit, participants must complete the preactivity questionnaire, postactivity questionnaire, and program evaluation. Participants must also score at least a 70% on the posttest.

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

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

System Requirements

Kindle App, iBooks App, or Nook App or device.

Disclosure of Conflicts of Interest

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:

Michael J. Brennan, MD—Consultant/Independent Contractor to Covidien, Endo Pharmaceuticals Inc., Purdue Pharma L.P., and Teva Pharmaceuticals;   receives honoraria  from Covidien, Endo Pharmaceuticals Inc., INSYS Therapeutics Inc., Pfizer Inc., Purdue Pharma L.P., and Teva Pharmaceuticals.

Steven P. Stanos, DO—Advisory Board/Consultant to Endo Pharmaceuticals Inc., Mallinckrodt Pharmaceuticals, Matrix Healthcare Services, Inc., and Pfizer Inc.

Mark S. Wallace, MD—Consultant/Independent Contractor to INSYS Therapeutics Inc.

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:

Ashley Marostica, RN, MSN—Nothing to disclose
Amanda Glazar, PhD—Nothing to disclose
Jim Kappler, PhD—Nothing to disclose
Stacey Hansen—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 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.