A Case-Based Approach to the Safe and Effective Use of Opioid Therapy in Primary Care

Release date: August 31, 2010
Expiration date: August 31, 2011
Estimated time to complete activity: 1.5 hours

This CME/CE-certified activity is based on a roundtable discussion held on January 19, 2010.

This educational initiative is co-provided by Curatio CME Institute, Penn State College of Medicine, the University of Tennessee College of Pharmacy, and EduPro Resources LLC. This activity has been created in collaboration with the American Pain Foundation and Friends Research Institute and in consultation with the National Institute on Drug Abuse.

This activity is supported by educational grants from Endo Pharmaceuticals and Pricara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC.

Hardware/Software Requirements

Javascript-enabled browser
Active high-speed Internet connection
Adobe Acrobat Reader
Adobe Flash Player 7.0+

Activity Overview
The use of opioid analgesics for the treatment of chronic pain can present a challenge to clinicians. The most significant hindrance to effective treatment is a lack of long-term efficacy and safety data regarding the use of opioids to treat chronic pain. Several guidelines and review articles have been published that are designed to advise clinicians on how to best use opioid therapy for the treatment of chronic pain. This activity uses a case-based approach to demonstrate how these published recommendations can be implemented in daily practice.

Target Audience
This activity has been designed to meet the educational needs of primary care physicians, nurses, nurse practitioners, physician assistants, and pharmacists who treat chronic pain patients.

Learning Objectives
Upon completion of this activity, participants should be able to:

Select the most appropriate analgesic agents for each patient based on their medical condition, personal characteristics, medical history, drug abuse history, and any other information that has bearing on how his or her pain can be best treated
Educate patients/caregivers on the proper use of analgesic agents, the use of self-assessment tools to track pain relief, and other pain-reducing strategies
Assess patients for the risk of drug misuse, abuse, and addiction, and develop strategies to mitigate those risks
Formulate treatment plans to select, dose, and monitor opioid therapy; evaluate opioid therapy outcomes; and transition from opioids when they are not effective or become problematic
List the social and regulatory factors that affect provider prescribing habits
Recognize the need to eliminate prescribing patterns that are not based on scientific evidence and best clinical practices

Faculty
Paul Arnstein, RN, PhD
Clinical Nurse Specialist for Pain Relief
Massachusetts General Hospital
Associate Professor
MGH Institute for Health Professions
Boston, Massachusetts

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

Mary Lynn McPherson, PharmD, BCPS, CPE
Professor, Vice Chair
Department of Pharmacy Practice and Science
University of Maryland School of Pharmacy
Baltimore, Maryland

Steering Committee
Russell Portenoy, MD—Chair
Chairman and Gerald J. Friedman Chair in Pain Medicine and Palliative Care
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center
Professor of Neurology and Anesthesiology
Albert Einstein College of Medicine
Chief Medical Officer
Metropolitan Jewish Hospice and Palliative Care/Jacob Perlow Hospice
New York, New York

Paul Arnstein, RN, PhD

Bonnie J. Bixler, MEd
Director of Special Projects and Physician Programs
Penn State Hershey College of Medicine
Hershey, Pennsylvania

Dorothy Caputo, MA, APRN, BC-ADM, CDE
Lead Nurse Planner
EduPro Resources LLC
West Keansburg, New Jersey

Glen E. Farr, PharmD
Professor of Clinical Pharmacy and Associate Dean
University of Tennessee College of Pharmacy
Knoxville, Tennessee
Paul Arnstein, RN, PhD

Perry G. Fine, MD
Professor of Anesthesiology
University of Utah
Salt Lake City, Utah

Thomas Finnegan, PhD
Associate Medical Director
Curatio CME Institute

Matthew Horn, MD
Medical Director
Curatio CME Institute

Arthur G. Lipman, PharmD, FASHP
University Professor, Department of Pharmacotherapy, College of Pharmacy
Adjunct Professor of Anesthesiology, School of Medicine
Director of Clinical Pharmacology, Pain Management Center
University of Utah Health Sciences Center
Salt Lake City, Utah

Bill H. McCarberg, MD

Mary Lynn McPherson, PharmD, BCPS, CPE

Steven D. Passik, PhD
Clinical Psychologist
Department of Psychiatry and Behavioral Sciences
Memorial Sloan-Kettering Cancer Center
New York, New York

Micke A. Brown, BSN, RN
Director of Communications
American Pain Foundation
Baltimore, Maryland

Samantha Libby-Cap
Director, PainSAFE Program
American Pain Foundation
Baltimore, Maryland

Will Rowe
Chief Executive Officer
American Pain Foundation
Baltimore, Maryland

Frank Vocci, PhD
President
Friends Research Institute
Baltimore, Maryland

Richard Denisco, MD, MPH
Medical Officer, Services Research Branch
Division of Epidemiology, Services and Prevention Research
National Institute on Drug Abuse
Bethesda, Maryland

Cathrine Sasek, PhD
Office of Science Policy and Communications
Science Policy Branch
National Institute on Drug Abuse
Bethesda, Maryland

David A. Thomas, PhD
Behavioral and Cognitive Research Branch
Division of Neuroscience and Behavioral Research
National Institute on Drug Abuse
Bethesda, Maryland

Accreditation and Credit Designation Statements
Physician
Penn State College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Penn State College of Medicine designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Pharmacist
The University of Tennessee College of Pharmacy (UTCOP) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this knowledge-based educational activity will provide a statement for 1 contact hour credit (0.1 CEUs) and will be available following successful completion of the program. Successful completion includes participating in the program, completing a self-assessment instrument and completing an evaluation instrument. ACPE Program # 064-000-10-220-H01-P

Grievance Statement
A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of a program sponsored or co-sponsored by the UTCOP may contact the Associate Dean for Continuing Education in writing. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level of review.

Nurse
EduPro Resources LLC is an approved provider of continuing nursing education by New Jersey State Nurses Association (NJSNA), an accredited approver by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. Provider number P208-8/08-11.

EduPro Resources LLC is also an approved provider by the California Board of Registered Nursing (CBRN), Provider Number CEP-14387.

This activity is accredited for 1.5 contact hours upon successful completion of the activity. Successful completion includes participating in the program, completing a self-assessment instrument, and completing an evaluation instrument.

Disclaimer
Accreditation refers to educational content only and does not imply endorsement of products by NJSNA, ANCC, CBRN, or EduPro Resources.

Co-Provider Statement
This activity is co-provided by Curatio CME Institute and EduPro Resources LLC.

Nurse Practitioners
This program is approved for 1.5 contact hours of continuing education by the American Academy of Nurse Practitioners (AANP). Program ID 1007233.

This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Physician Assistants
This program has been reviewed and is approved for a maximum of 1.5 hours of American Academy of Physician Assistants (AAPA) Category 1 CME credit by the Physician Assistant Review Panel. Approval is valid for 1.0 year(s) from the issue date of August 2010. Participants may submit the self- assessment at any time during that period.

This program was planned in accordance with AAPA’s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs.

Method of Participation
There are no fees for participating in this CME/CE activity. To receive credit during the period August 2010 to August 31, 2011, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, and (3) complete the online activity posttest and evaluation form.

Medium
The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.

Disclaimer
The information presented in this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a clinician regarding diagnosis and treatment of a specific patient’s medical condition.

Disclosure
In accordance with the ACCME and ACPE Standards for Commercial Support, all CME/CPE providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CE activity content over which the individual has control. Relationship information appears below:

Faculty Disclosure Information—All Contributing Faculty and Partners
The co-providers and educational partners are committed to offering CME/CE programs that promote improvements or quality in health care and are developed free of the control of commercial interests. Reasonable efforts have been taken to ensure that our programs are balanced, independent, objective, scientific, and in compliance with regulatory requirements. Faculty and course directors have disclosed all relevant financial relationships with commercial companies, and the co-providers have a process in place to resolve any conflict of interest. Disclosure of a relationship is not intended to suggest or condone bias but is made to provide participants with information that might be of importance to their evaluation of this educational activity.

Paul Arnstein, RN, PhD, has disclosed the following relevant financial relationships:

Consultant, Advisor

Cephalon, Inflexxion, King Pharmaceuticals, Ortho-McNeil-Janssen

Perry G. Fine, MD, has disclosed the following relevant financial relationships:

Consultant, Advisor	Ameritox, Cephalon, Covidien, Janssen, Meda Pharmaceuticals, Ortho-McNeil-Janssen, PriCara, Purdue Pharma
Medical/Legal Consultant	Johnson & Johnson

Arthur G. Lipman, PharmD, has disclosed the following relevant financial relationships:

Speakers Bureau	Johnson & Johnson, Merck, Wyeth/Pfizer
Consultant, Advisor	Covidien, Johnson & Johnson, NiCox, Wyeth/Pfizer

Bill H. McCarberg, MD, has disclosed the following relevant financial relationships:

Speakers Bureau

Abbott, Cephalon, Endo Pharmaceuticals, Forest Labs, King Pharmaceuticals, Ligand, Lilly, Merck, Mylan, Pfizer, PriCara, Purdue Pharma

Mary Lynn McPherson, PharmD, BCPS, CPE, has disclosed the following relevant financial relationships:

Consultant, Advisor

Meda Pharmaceuticals

Steven D. Passik, PhD, has disclosed the following relevant financial relationships:

Speakers Bureau	Cephalon, King Pharmaceuticals, PriCara
Consultant, Advisor	Cephalon, King Pharmaceuticals
Research Grant	Cephalon, King Pharmaceuticals

Russell Portenoy, MD, has disclosed the following relevant financial relationships:

Consultant, Advisor	Afferent Pharmaceuticals, Ameritox, Cephalon, CNSBio, Grupo Ferrer, King Pharmaceuticals, Nicox, ProStrakan Pharmaceuticals, Shire, Solvay, Wyeth, Xenon
Research Grant	Archimedes, Baxter Healthcare Corporation, Calloway Labs, Cephalon, Endo Pharmaceuticals, Flamek Corporation, Fralex, GW Pharmaceuticals, King Pharmaceuticals, Pfizer, Purdue Pharma, Tempur-Pedic Corp, United BioSource Corp, Wyeth

Frank Vocci, PhD, has disclosed the following relevant financial relationships:

Consultant, Advisor

Catalyst Pharmaceutical Partners, Purdue Pharma, Reckitt Benckiser, Roxane Labs, Teva Pharmaceuticals, US WorldMeds

American Pain Foundation representatives indicated that they have no relevant financial relationships to disclose.

The National Institute on Drug Abuse representatives indicated that they have no relevant financial relationships to disclose.

The staff of Penn State College of Medicine, Curatio CME Institute, EduPro Resources, and the University of Tennessee College of Pharmacy involved in the planning of this activity have no financial relationships with any commercial interests relevant to this activity.

Disclaimer
The material was prepared based on a review of multiple sources of information but is not exhaustive of the subject matter. Therefore, health care professionals and other individuals should review and consider other publications and materials about the subject matter rather than relying solely on the information contained in this material.

The information presented in this activity represents the views and opinions of the individual presenters and does not constitute the opinion or endorsement of, or promotion by, Penn State College of Medicine, Curatio CME Institute, the University of Tennessee College of Pharmacy, EduPro Resources, or the program grantors. Reasonable efforts have been made to present educational subject matter in a balanced, unbiased fashion and in compliance with regulatory requirements. Each participant must use his or her personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

Unapproved Product Use
Faculty members are required to inform the audience when they are discussing off-label or unapproved uses of devices or drugs. Devices or drugs that are still undergoing clinical trials are identified as such and should not be portrayed as standard, accepted therapy. Please consult full prescribing information before using any product mentioned in this activity. If using products in an investigational, off-label manner, it is the responsibility of the prescribing physician to monitor the medical literature to determine recommended dosages and uses of the drugs. Penn State College of Medicine, Curatio CME Institute, the University of Tennessee College of Pharmacy, EduPro Resources, the American Pain Foundation, Friends Research Institute, the National Institute on Drug Abuse, Endo Pharmaceuticals and Ortho-McNeil-Janssen Pharmaceuticals do not promote the use of any agent outside of approved labeling.

Generic Name	Trade Name	Approved Use (if any)	Unapproved/Investigational Use
Carbamazepine	Tegretol	Treatment of partial seizures with complex symptomology, generalized tonic-clonic seizures, and mixed seizure patterns that include the above or other partial or generalized seizures Treatment of the pain associated with true trigeminal neuralgia	Treatment of diabetic peripheral neuropathy
Gabapentin	Neurontin	Management of postherpetic neuralgia in adults Adjunctive therapy in the treatment of partial seizures with and without secondary generalization in patients over 12 years of age with epilepsy Also indicated as adjunctive therapy in the treatment of partial seizures in pediatric patients age 3–12 years	Treatment of diabetic peripheral neuropathy Treatment of diabetic peripheral neuropathy
Lidocaine patch	Lidoderm	Indicated for relief of pain associated with postherpetic neuralgia	Treatment of diabetic peripheral neuropathy

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Contact Information
Curatio CME Institute
100 Campbell Boulevard
Suite 103
Exton, PA 19341
Phone: (610) 363-1619

Penn State College of Medicine
Continuing Education, G220
44 East Granada Avenue, Room 1108
PO Box 851
Hershey, PA 17033-0851
Phone: (717) 531-6483
Or ContinuingEd@hmc.psu.edu
Please refer to activity code G4159-11-T.

Curatio CME Institute