A Cases and Commentary™ Workshop
September 11, 2009   |  4:30 PM - 8:30 PM
Hyatt Regency Jacksonville Riverfront  |  Jacksonville, Florida


This program is being held in conjunction with the
19th National Conference of the American Society for Pain Management Nursing
Activity Goal
Employing a case-based format that fosters peer-to-peer interaction between participants and thought leaders, this activity aims to disseminate best practices in the assessment, diagnosis, and opioid-based treatment of patients with persistent and breakthrough pain.
Intended Audience

This activity is intended for pain specialists, neurologists, rheumatologists, physical medicine and rehabilitation specialists, family practitioners, oncologists, and internal medicine and general practitioners.

There are no prerequisites for this educational activity.

Statement of Need
Numerous epidemiologic studies have estimated chronic pain syndromes to be responsible for an annual cost of 80 billion dollars in the United States alone, reflecting the more than 50 million people who have chronic pain syndromes.1 Previously regarded as a symptom of underlying disorders, chronic pain is now considered a disease state unto itself. Comprehensive, continual assessment and treatment are needed to address its deleterious effects on multiple functional dimensions, including affective, cognitive, physical, and work-related.2 Further, because daily fluctuations in pain levels are common, health care practitioners need to optimize therapy for persistent baseline pain while independently assessing and treating breakthrough pain. For each patient, clinicians should consider the potential benefits and risks of all available treatment modalities, including behavioral, pharmacologic, and interventional approaches.3-5 Clinical experience and a growing evidence base suggest that opioids are an important analgesic option in appropriately selected patients with functionally impairing persistent and breakthrough pain.6 Treating patients with opioid-based multimodal analgesic strategies necessitates careful collaboration among prescribers and other health care providers to ensure that patients are meeting realistic, individualized treatment goals, to minimize risks related to opioid pharmacology, and to structure therapy to promote adherence to the pain management plan.7,8
Learning Objectives

At the completion of this initiative, participants should be better prepared to:

  • Define, recognize, and independently assess breakthrough and persistent pain in patients with chronic pain syndromes
  • Perform multidimensional and continual assessments of persistent and breakthrough pain based, in part, on the phenomenology and inferred pathophysiology of the pain syndrome as well as patient function and treatment goals
  • Discuss important steps in the implementation, optimization, and long-term monitoring of multimodal opioid-based therapies for persistent and breakthrough pain with patients, families, caregivers, and physicians
  • Explain the respective roles of long-acting, short-acting and rapid-onset opioids in the management of persistent and breakthrough pain
Conflict of Interest Statement

The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present.

Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.

Special Needs

Albert Einstein College of Medicine fully intends to comply with the legal requirements of the Americans with Disabilities Act. Participants in Persistent and Breakthrough Pain: Multidimensional Assessment and Opioid-Based Multimodal Treatment, A Cases and Commentary™ Workshop given by Albert Einstein College of Medicine who require special accommodations should submit written requests to
Philip Compton at pcompton@asanteglobal.com at least 2 weeks prior to the activity.

Learner’s Gap
Chronic pain is prevalent, underdiagnosed, often misdiagnosed, and undertreated.9,10 Evidence-based discussions of chronic pain supported by expert clinical experience enable health care providers to better assess pain, facilitate communication with patients, and improve treatment outcomes.
Faculty

Paul M. Arnstein, RN, PhD

Clinical Nurse Specialist for Pain Relief
Massachusetts General Hospital
Boston, Massachusetts

Patricia Bruckenthal, PhD, RN, ANP-C

Clinical Associate Professor
Stony Brook University School of Nursing
Stony Brook, New York

Deb B. Gordon RN, MS, FAAN

Senior Clinical Nurse Specialist
University of Wisconsin Hospital and Clinics
Madison, Wisconsin

Keela A. Herr, PhD, RN

Professor and Chair
Adult and Gerontology Nursing
The University of Iowa
Iowa City, Iowa

April Hazard Vallerand, PhD, RN, FAAN

Associate Professor
Wayne State University College of Nursing
Detroit, Michigan
CCME Reviewer

David M. Kaufman, MD

Professor of Neurology and Psychiatry
Albert Einstein College of Medicine
of Yeshiva University
Bronx, New York

Mary McLoughlin, RN, MSN, CEN

Division of Education and Organizational
Development Clinical Faculty
Montefiore Medical Center
Bronx, New York
Jointly sponsored by Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications
This activity is supported by an educational grant from Cephalon, Inc.

References

  1. American Pain Society. Pain: Current Understanding of Assessment, Management and Treatments Section I: Background and Significance. Available at: http://www.ampainsoc.org/ce/enduring.htm. Accessed March 2009.
  2. Gatchel RJ, et al. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
  3. Skjutar A, et al. Exploring indicators for pain rehabilitation: A Delphi study using a multidisciplinary expert panel. Musculoskeletal Care. 2009 May 7. [Epub ahead of print]
  4. Scascighini L, et al. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology (Oxford). 2008;47(5):670-8.
  5. Soares LG, Chan VW. The rationale for a multimodal approach in the management of breakthrough cancer pain: a review. Am J Hosp Palliat Care. 2007;24(5):430-9.
  6. Chou R, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):131-46.
  7. Portenoy RK. Appropriate use of opioids for persistent non-cancer pain. Lancet. 2004;364(9436):739-40.
  8. Filoramo MA. Improving goal setting and goal attainment in patients with chronic noncancer pain. Pain Manag Nurs. 2007;8(2):96-101
  9. Walid MS, et al. The Fifth Vital Sign—What Does It Mean? Pain Pract. 2008;8(6):417-22.
  10. Gore M, et al. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J Pain. 2006;7(12):892-900.
Disclaimer

This continuing medical educational activity is designed for physicians, nurses, nurse practitioners, physician assistants, and allied health professionals. Non medical professionals will not be permitted to participate.