Schedule (subject to change)
7:00a - 7:30a - Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - The Psychology Toolbox: Evidence Based Treatments for Pain Management
UAN 0530-0000-18-332-L01-P
AANP Rx Hours 0.0
Course Description
The opioid epidemic has caused many patients, clinicians, and payers to seek nonpharmacologic options to assist with managing pain. Psychology has a well-established role in the treatment of pain conditions but familiarity with the range of pain related interventions varies widely among clinicians. The Psychology Toolbox seeks to fill the knowledge gap by briefly explaining the role of psychology in pain treatment and reviewing a range of evidence based interventions to assist this burgeoning clinical population. Although cognitive behavioral therapy based interventions are the most frequently studied and applied paradigms, a number of other treatments also have demonstrated efficacy in pain care, but are lesser known. Thus, cognitive behavioral therapy for pain will be discussed, followed by an overview of several other pain treatment modalities: biofeedback training, mindfulness based stress reduction, and acceptance and commitment therapy. At the conclusion of the session, participants should possess a greater awareness of the vast array of evidence based treatments that can be used to help this group of individuals.
Ravi Prasad, PhD
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by Teva, Jack D. Schim, MD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - Update: How the CDC Guidelines Are Impacting Patient Care
UAN 0530-0000-18-071-L01-P
AANP Rx Hours 0.0
Course Description
On September 16, 2015, the Centers for Disease Control and Prevention (CDC), hosted a semi-public webinar where they revealed a draft of their twelve (12) prescribing guidelines for chronic pain. After concerns over the limited amount of participation was raised by the pain community, and following a congressional inquiry, the CDC offered an extended open comment period. In March 2016 the CDC's final guidelines were released and although voluntary, many states and regulatory authorities have adopted them with little recognition of the limitations stated in the guideline itself. This presentation will examine the impact of the guidelines on patient care, health care providers, and unintentional overdose.
Stephen J. Ziegler, PhD, JD
10:40a - 11:40aInterdisciplinary Management of Pelvic Pain: Bridging the Gap Between Primary Care and Specialty Referral
UAN 0530-0000-18-333-L01-P
AANP Rx Hours 0.1
Course Description
The prevalence of chronic pelvic pain in women aged 18 to 50 is around 15%. However, only one-third of these women seek medical care. Also, the average time from presentation to a primary care provider and appropriate spe-cialty referral and diagnosis ranges from 3 to 7 years. Not only is it essential for primary care providers to recognize the broad differential diagnoses contributing to pelvic pain, but also to understand appropriate and prompt specialist referral. Furthermore, many of these conditions require ongoing interdisciplinary management for optimal outcomes. In order to enhance care, it is essential for the primary care provider to appreciate the epidemiology, risks factors, and etiology of a spectrum of pelvic pain conditions in addition to relevant treatment options. In order to narrow the gap between current and optimal practice, a case based learning discussion will engage the audience to illustrate aspects of interdisciplinary management relevant to the treatment of pelvic pain.
Jennifer M. Hah, MD, MS
11:40a - 12:00p - Faculty Q&A
12:00p - 12:10p - Break & Exhibits
12:10p - 1:10p - Product, Disease Awareness, Medical Information Program*
Lunch will be served.
Sponsored by Salix Pharmaceuticals, Gerald Sacks, MD
1:10p - 2:00p - Crisis=Opportunity: Reducing Medication Burden While Managing Chronic Pain
UAN 0530-0000-18-060-L01-P
AANP Rx Hours 0.6
Course Description
Although long regarded as an appropriate standard of care for treating acute and cancer pain, the use of prescription opioids to treat chronic benign pain conditions has been highly controversial. The lack of empirical support in conjunction with the increased prevalence of prescription opioid abuse has subsequently led professional and regulatory boards, as well as the general public, to become more critical of physician prescribing practices. As a result, patients who were once prescribed high doses of opioid medication are now being told that they need to reduce or eliminate their reliance on this form of treatment. How can individuals successfully eliminate use of a substance that they have relied on for an extended period of time? A pain physician will review current literature related to the use of opioids and will discuss the medical challenges associated with weaning individuals off of this class of drug. A psychologist will then speak about the role of interdisciplinary treatment programs in facilitating opioid cessation while concurrently improving patients' functional outcomes. Emphasis will be placed on the critical role that psychological and behavioral interventions play in this process, and the evidence which supports their inclusion.
Ravi Prasad, PhD
2:00p - 2:10p - Break & Exhibits
2:10p - 3:00p - Product, Disease Awareness, Medical Information Program*
Refreshments will be served.
Sponsored by PERNIX Therapeutics, Gerald Sacks, MD
3:00p - 3:50p - Measure for Measure: Prescribing Guidelines, Rules, and Regulations
UAN 0530-0000-18-041-L01-P
AANP Rx Hours 0.0
Course Description
Washington was one of the first states to legislate prescribing rules for the treatment of chronic pain, a unique model which relied on the use of a dosage trigger and the necessity to calculate morphine equivalency. Following Washington's lead, other states and the Centers for Disease Control and Prevention (cdc) have created their own guidelines and rules that not only vary widely but are often in conflict with each other. This presentation will discuss the recent history of prescribing guidelines, their diffusion across the United States, and their potential impact on medical practice and the treatment of pain.
Stephen J. Ziegler, PhD, JD
3:50p - 4:40p - Policies and Practicalities: Focusing on the Patient, Not the Opioid
UAN 0530-0000-18-330-L05-P
AANP Rx Hours0.5
Course Description
The current opioid epidemic has resulted in numerous professional and society guidelines focused on safe opioid prescribing. In addition, policymakers have focused on state legislation to limit the duration of opioid prescribing for acute pain. As a result of the increased scrutiny, prescribers have shifted their focus to limiting opioid prescribing for patients with chronic noncancer pain. Now, more than ever, evidence based behavioral treatment modalities are essential for fostering pain coping skills and providing support as part of optimal interdisciplinary pain management. This course will begin with a brief review of the opioid epidemic. Current opioid prescribing guidelines will be discussed with a particular emphasis on indications for opioid tapering. Strategies for the medical management of opioid tapering will be presented, along with a detailed discussion of evidence based psychotherapeutic interventions known to result in improvements in physical and emotional functioning while promoting opioid tapering.
Jennifer M. Hah, MD, MS
*Not certified for credit.
Schedule (subject to change)
7:00a - 7:30a - Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - Role of All Practice Providers Involved in Pain Management in the Acute-Care Setting
UAN 0530-0000-18-331-L01-P
AANP Rx Hours 0.1
Course Description
Millions of patients each year suffer from acute pain as a result of trauma, illness, or surgery. Pain is the most common reason for admission to the emergency department (ED), comprising more than 40% of the over 100 million ED visits annually. The prevalence of intense acute pain is similarly high among patients undergoing surgery: in the United States, over 73 million surgical procedures are performed annually, and most patients report experiencing a high degree of pain postoperatively. Studies indicate that treatment of acute pain remains suboptimal due to attitudes and educational barriers on the part of clinicians and patients, as well as the intrinsic limitations of available therapies. Inadequate management of acute pain negatively impacts numerous aspects of patient health and may increase the risk of developing chronic pain. This presentation will review the differences between acute and chronic or persistent pain, while providing attendees with a multimodal treatment approach for the acute care setting. Emphasis will be placed on the role of the advanced practice provider.
Theresa Mallick-Searle, MS, NP-BC, ANP-BC
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by SCILEX, Bill McCarberg, MD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - Falling Down the Rabbit Hole: A Primer for Chronic Pain Management and Substance Abuse Disorders
UAN 0530-0000-18-038-L01-P
AANP Rx Hours 0.0
Course Description
The field of pain management has undergone a circuitous adventure, much like a rabbit hole. As the economic, mental health, and medical consequences of prescribing opioid medications have mounted, the prevailing logic regarding the usefulness of prescribing opioids for chronic pain has shifted. The widespread dissemination of opiates and the lax safety measures placed on their storage has also led to an increase in nonmedical use. Given the high level of comorbidity between opioid use disorders and chronic pain, providers' decisions about how to address treatment with patients who may have or who have been diagnosed with substance use disorders are often complex. The new CDC guidelines will require providers to assess for risk of overdose or development of a substance use disorder, and to be keenly aware of their patients' pain levels and pain management strategies when working as part of a system where opioid medications may be prescribed. Participants will learn how patient and provider education programs and communication interventions may improve outcomes in pain management. Participants will also learn how to select candidates for opioid trials, assess for risk, and initiate opioid therapy, but only after exploring nonopioid and nonpharmacological strategies.
David Cosio, PhD
10:40a - 11:40a - Mirror, Mirror on the Wall: Graded Motor Imagery to Treat Complex Regional Pain Syndrome
UAN 0530-0000-18-326-L01-P
AANP Rx Hours 0.1
Course Description
Complex regional pain syndrome (CRPS) is a painful condition localized to a limb or body region, typically in response to trauma or surgery. Although several contributing mechanisms of CRPS have been described, the exact pathophysiology of the condition is not completely known. Graded motor imagery (GMI) is a comprehensive program aimed at sequentially activating motor cortical networks of the disordered limb to improve neural reorganization. GMI includes phases of progressive sensory-motor restructuring beginning with laterality training, guided imagery, and ultimately leading to mirror therapy. In this lecture, leading mechanisms for the development of CRPS will be discussed, along with the role of reorganization of the somatosensory cortex. In addition, treatment algorithms will be included along with medications, injections, and a thorough review of GMI and its outcomes.
Michael M. Bottros, MD
11:40a - 12:00p - Faculty Q&A
12:00p - 12:10p - Break & Exhibits
12:10p - 1:10p - Product, Disease Awareness, Medical Information Program*
Lunch will be served.
Sponsored by ADAPT® Pharma, Bill McCarberg, MD
1:10p - 2:00p - Medical Efficacy of Cannabis Therapeutics: Focus on Pain Management
UAN 0530-0000-18-061-L01-P
AANP Rx Hours 0.0
The endocannabinoid system (ecs) is now recognized as an important modulator of many physiological processes. Even more recently, an increasing body of evidence has been accumulated to suggest the antioxidant, anti-inflammatory, neuroprotective, and antinociceptive roles of the ecs. In 1997, the Office of National Drug Control Policy commissioned the Institute of Medicine (iom) to conduct a comprehensive study of the medical efficacy of cannabis therapeutics. The iom concluded that cannabis is a safe and effective medicine, patients should have access, and the government should expand avenues for research and drug development. This course will discuss cannabis as it relates to effective pain management.
Theresa Mallick-Searle, MS, NP-BC, ANP-BC
2:00p - 2:10p - Break & Exhibits
2:10p - 3:00p - The Gentle Art of Saying No: How to Establish Appropriate Boundaries With Chronic Pain Patients
UAN 0530-0000-18-054-L01-P
AANP Rx Hours 0.0
Course Description
Effective pain management has been deemed a human right, but some chronic pain patients perceive that to mean they are entitled to opioid analgesics for prolonged pain control. In response to these expectations, providers may feel pressured to say "Yes" and continue prescribing opioids, thereby reinforcing the patient's beliefs and reliance on medication. This has contributed to a dramatic rise in opioid analgesic misuse and deaths from prescription drug overdose. In fact, the CDC has identified opioid misuse as a "public health epidemic" and released new guidelines in March 2016. While a collaborative relationship is optimal for pain management, there may be times when a practitioner saying "No" is the best treatment. Many providers feel uncomfortable setting boundaries; however, boundary setting is important work because rights as a provider are also important. When reasonable limits are placed on a patient and the patient continues to step beyond those limits, it is imperative that providers maintain boundaries and be consistent in their message. Participants will learn about the gentle art of saying "No" and how to use a decision tree when making pain management decisions. Sample cases will be presented along with recommended treatment strategies.
David Cosio, PhD
3:00p - 3:50p - How Central is Central Poststroke Pain?
UAN 0530-0000-18-325-L01-P
AANP Rx Hours 0.2
Course Description
Central poststroke pain (CPSP) is a neuropathic pain disorder frequently described as burning pain associated with allodynia and hyperalgesia over affected regions of the body. The underlying mechanisms are not well understood. It has been suggested that stroke associated loss of inhibitory neurons in the spinothalamic tract causes disinhibition of thalamic neurons, which generate ectopic nociceptive action potentials responsible for the pain experience. However, recent data suggests that pain is dependent on the peripheral afferent input and may be mediated by misinterpretation of sensory input. In this course, we review the pathophysiology, clinical presentation, and symptoms of CPSP. Recent findings may also shed light about future targets for treatment.
Michael M. Bottros, MD
*Not certified for credit.
