CME/CE/CPE Slide Presentations

Utilizing Opioid Therapy for Chronic Pain:
A Case-Based Approach to Optimize Therapeutic Outcomes While Managing Potential Risks

THIS IS NO LONGER AVAILABLE FOR CREDIT

Release Date: October 2008
Expiration Date: October 31, 2009

A web archive of a CME/CE satellite symposium held in conjunction with PAINWeek 2008^TM on September 6, 2008 in Las Vegas Nevada.

This educational activity is jointly sponsored by the Dannemiller Memorial Educational Foundation and
Vital Issues in Medicine, A PDI Company.

Supported by an educational grant from Cephalon, Inc.

FACULTY:
Perry G. Fine, MD
Course Director
Professor of Anesthesiology
Pain Research Center
Department of Anesthesiology
University of Utah
Salt Lake City, Utah

Howard A. Heit, MD, FACP, FASAM
Assistant Clinical Professor
Department of Medicine
Georgetown University School of Medicine
Washington, DC

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

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

Howard S. Smith, MD, FACP
Associate Professor of Anesthesiology, Internal Medicine,
and Physical Medicine and Rehabilitation
Albany Medical College
Academic Director of Pain Management
Department of Anesthesiology
Albany Medical Center Hospital
Albany, New York

Target Audience
This initiative is designed to meet the educational needs of physicians, nurse practitioners, physician assistants, and pharmacists involved in the care of patients with chronic pain.

Statement of Need
Chronic pain affects more than 75 million Americans and is the most common reason for seeking health care. One-third of all Americans will experience chronic pain that is attributed to postoperative pain, cancer pain, or non-cancer pain at some point in their lives. This is a condition that consists of two distinct components: persistent pain that is continuous throughout the day, and breakthrough pain which is a transitory flare of moderate to severe pain in patients with otherwise stable persistent pain.

The role of opioid therapy is expanding for different types of chronic pain. The use of opioids to manage chronic pain associated with cancer is well accepted. However, the use of opioids to treat patients with chronic non-cancer pain is controversial because of concerns about efficacy and safety and the possibility of addiction or abuse. Several clinical guidelines for non-cancer pain have been published or are in process for the management of chronic non-cancer pain. These will help to define the role for opioid therapy in chronic non-cancer pain and establish criteria for patient selection and specific treatment algorithms.

The decisions about whether to initiate opioid therapy or continue it over time should be guided by a comprehensive patient assessment. There has been a need for an assessment tool for providers who treat chronic pain patients to determine the potential risk of abuse when prescribing opioids for pain. With the proper tools, the treating physician can build confidence in assessing the patient and develop a comfort level managing risk associated with opioid therapy.

LEARNING OBJECTIVES:
After completing this activity the participant should be able to:

• Define the principles of patient assessment and selection for opioid therapy.
• Discuss the principles of risk stratification, monitoring, and management of patients treated with opioid therapy, as well as the relevant regulations for prescribing controlled substances.
• Increase personal confidence in utilizing opioid therapy for patients when appropriate.

Physician Continuing Medical Education
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 the Dannemiller Memorial Educational Foundation and Vital Issues in Medicine (VIM®). The Dannemiller Memorial Educational Foundation is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
The Dannemiller Memorial Educational Foundation designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Pharmacist Continuing Education

Credit Designation
Purdue University School of Pharmacy and Pharmaceutical Sciences is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is a continuing education activity of Purdue University, an equal access/equal opportunity institution. Universal Program Number (UPN): 018-999-08-111-H01-P; 1.00 contact hours (0.100 CEU). Release Date: October 2008. Expiration Date: October 31, 2009.

Nurse Practitioner Continuing Education
Credit Designation
This program has been approved for 1.0 contact hours of continuing education by the American Academy of Nurse Practitioners. Program ID 0807333.

Registered Nurses
The Dannemiller Memorial Educational Foundation is a provider approved by the California Board of Registered Nursing, Provider Number 4229 for 1.2 contact hours.

RNs outside California must verify with their licensing agency for approval of this course.

Method of Participation:
This activity should take approximately 1 hour to complete. The participant should, in order, read the objectives and other introductory CME information, review the slides and listen to the accompanying audio, and complete the registration form, post-test, and evaluation form. The evaluation form provides each participant the opportunity to comment on the extent to which educational objectives were met, the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his or her views on future educational needs. To access the registration form and post-test, click on the “CME Post-Test” button on the final slide in the presentation. To receive credit for this activity, follow the instructions provided on the post-test. This activity expires on October 31, 2009. No credit will be given after this date. There is no fee associated with this CME activity.

In the event you are unable to print the certificate, please submit the post-test and then e-mail editor@dannemiller.com; a certificate will be mailed within 2 weeks.

Disclosure of Conflicts of Interest
In accordance with the Accreditation Council for Continuing Medical Education (ACCME), the Dannemiller Memorial Educational Foundation requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest. Individual faculty disclosures of conflicts of interest listed below. The Dannemiller staff and Vital Issues in Medicine staff that were involved in the development of this activity have no financial relationships with any commercial interests that are relevant to this activity. Sy Schlager, MD, PhD, medical writer for VIM, has nothing to disclose.

To resolve identified conflicts of interest, the educational content was fully peer-reviewed by a physician member of the Dannemiller Clinical Content Review Committee who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced.

Perry G. Fine, MD, reported the following financial interests/relationships or affiliations with commercial interests related to the content of this CME activity:

Consulting Fees (e.g. advisory boards): Abbott Laboratories; Alpharma Inc.; Cephalon, Inc.; Endo Pharmaceuticals; Eli Lilly and Company; Ortho-McNeil, Inc.; and Wyeth.
Speaker Bureaus: Abbott Laboratories; Alpharma Inc.; Cephalon, Inc.; Endo Pharmaceuticals; Eli Lilly and Company; Ortho-McNeil, Inc.; and Wyeth.

Howard A. Heit, MD, FACP, FASAM, reported the following financial interests/relationships or affiliations with commercial interests related to the content of this CME activity:

Consulting Fees (e.g. advisory boards): Abbott Laboratories; Alpharma Inc.; Cephalon, Inc.; Endo Pharmaceuticals; King Pharmaceuticals, Inc.; Meda Pharmaceuticals Inc.; Purdue Pharma L.P.; and Titan Pharmaceuticals, Inc.
Speaker Bureaus: Abbott Laboratories; Cephalon, Inc.; King Pharmaceuticals, Inc.; Purdue Pharma L.P.; and Titan Pharmaceuticals, Inc.

Bill H. McCarberg, MD, reported the following financial interests/relationships or affiliations with commercial interests related to the content of this CME activity:

Speaker Bureaus: Alpharma Inc.; Cephalon, Inc.; Endo Pharmaceuticals; King Pharmaceuticals, Inc.; Eli Lilly and Company; Merck & Co., Inc.; Pfizer Inc.; and PriCara™, Unit of Ortho-McNeil, Inc.

Steven D. Passik, PhD, reported the following financial interests/relationships or affiliations with commercial interests related to the content of this CME activity:

Consulting Fees (e.g. advisory boards): Cephalon, Inc.; King Pharmaceuticals, Inc.; Ligand Pharmaceuticals Inc.; Eli Lilly and Company; and PriCara™, Unit of Ortho-McNeil, Inc.
Speaker Bureaus: Cephalon, Inc.; King Pharmaceuticals, Inc.; Ligand Pharmaceuticals Inc.; Eli Lilly and Company; and PriCara™, Unit of Ortho-McNeil, Inc.
Contracted Research: Cephalon, Inc., and Ligand Pharmaceuticals Inc.

Howard S. Smith, MD, FACP, has no real or apparent conflicts of interest to report.

Disclosure of Unlabeled or Investigational Drugs
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, participants should critically appraise the information presented and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Disclaimer
The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of The Dannemiller Memorial Educational Foundation, Vital Issues in Medicine, or Cephalon, Inc. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.