Schedule (subject to change)
8:00a - 8:30a - Registration and Exhibits
Coffee will be served.
8:30a - 9:30a - Pain Pathophysiology Unraveled
UAN 0530-0000-18-047-L01-P
AANP Rx Hours 0.0
Course Description
In order to successfully clinically manage pain, it is essential to begin with an understanding of the underlying mechanisms responsible for its generation. A skillful approach based upon better knowledge concerning the anatomical structures, pathways, and events that result in pain is more likely to lead to effective clinical management of pain. The discussion will include an overview of medication classes typically considered for pain and the pathways they affect.
David M. Glick, DC, DAAPM, CPE, FASPE
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - Innovative Interventional Approaches to Pain Management in the Elderly
UAN 0530-0000-18-169-L01-P
AANP Rx Hours 0.0
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 specialty 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.
Michael M. Bottros, MD
10:40a - 11:40a - 3's Company: COX-2 Inhibitors, Medicinal Marijuana, and Opioid Prescribing
UAN 0530-0000-18-031-L01-P
AANP Rx Hours 0.5
Course Description
There is much controversy around many aspects of pain treatment, and compelling arguments have focused on both sides of the fence regarding appropriate opioid use and prescribing, legalization of marijuana, and the safety of cox-2 inhibitors. In all 3 cases, there are issues associated with strong positions, although the evidence, when put into practice, is less black and white. For each topic, we will evaluate current literature and debate the clinical, legal, and ethical controversies surrounding recent developments in pain management. Attendees will get a better understanding as presenters debate evidence based application of the cdc guidelines in various clinical settings, evaluate clinical and ethical concerns regarding marijuana for medicinal or recreational use, and take a critical look at the literature and its application when using cox-2 inhibitors for treating pain.
Alexandra McPherson, PharmD
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, Joseph Pergolizzi, Jr, MD
1:10p - 2:00p - Pain Diagnostics: Clinical Pearls to Improve Common Tests for Pain
UAN 0530-0000-18-046-L01-P
AANP Rx Hours 0.0
Course Description
Diagnostic testing is an integral component for the differential diagnosis. In routine clinical practice there has been a tendency for clinical examinations to become more cursory, largely influenced by increasing demands of time and patient expectations of technological advances. The end result may arguably lead to an overreliance on technology for basic clinical diagnosis. The purpose of this session is 2-fold. It is meant to provide a review and, for some, an introduction to basic structural and functional studies used for the diagnosis of pain related problems. Attention will also be given to the limitations of such studies and the importance of establishing clinical relevance to their findings. Factors that adversely affect clinical management potentially resulting in failed treatment will be discussed as well as best practices when utilizing such studies to help enhance clinical outcomes for treatment.
David M. Glick, DC, DAAPM, CPE, FASPE
2:00p - 2:10p - Break & Exhibits
2:10p - 3:00p - The 411 on Nonprescription Analgesics: When to Hold 'Em, When to Fold 'Em
UAN 0530-0000-18-052-L01-P
AANP Rx Hours 0.7
Course Description
Pain is the number one reason why patients seek advice from their pharmacist or primary care provider. Patients very often seek to use a nonprescription analgesic to self-treat a painful complaint, yet often do not understand the exclusions to selftreatment or how to select the best analgesic. Participants in this presentation will learn what nonprescription analgesics are available, indications for use, appropriate dosing and duration of therapy, appropriateness of candidates, and how to monitor and educate patients about their nonprescription analgesic. At this presentation, participants will learn the mechanism of action, indications, adverse effects, and precautions of oral and topical nonprescription analgesics, along with patient counseling points when recommending a nonprescription analgesic.
Alexandra McPherson, PharmD
3:00p - 3:50p - A Gathering Storm: Are Perioperative Opioids Problematic?
UAN 0530-0000-18-168-L01-P
AANP Rx Hours 0.0
Course Description
The United States is in the midst of a prescription drug crisis. Each year, over 100 million surgical procedures are performed in the US and routinely opioid use is prescribed for postoperative pain. While the recent CDC guidelines are geared towards outpatient chronic pain management, few concerns have been directed toward the postoperative setting as a potential source of this problem. In this lecture, we will examine the current opioid problem and the evidence suggesting that we should rethink how to care for these patients postoperatively.
Michael M. Bottros, MD
*Not certified for credit.
Schedule (subject to change)
8:00a - 8:30a - Registration and Exhibits
Coffee will be served.
8:30a - 9:30a - Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization
UAN 0530-0000-18-039-L01-P
AANP Rx Hours 0.0
Course Description
The government has ramped up its efforts in 2018 to connect claims of inappropriate opioid prescribing to financial gain, including gain from urine drug testing. While most physicians do not have a financial interest in a clinical laboratory, the government's decision to highlight an opioid prescriber's failure to timely utilize drug test results is significant, and suggests the government is looking at other factors tied to medical decision making. Thus, prescribers should pay attention to licensing board, payor, and professional society guidance on ordering drug tests and how to use drug test results when treatment involves opioid prescribing.
Attendees will learn how to identify the core elements of medical necessity and document an individualized testing plan for each patient. This course will cover critical areas of medical record documentation, including: (a) the decision to drug test, when and how often; (b) determining which drugs to test and why; and (c) how to coordinate timely review and use of drug test results in connection with the patient's plan of care. Attendees will gain additional insight into these issues through position papers published in late 2017 and early 2018, by the American Academy of Pain Medicine and the American Association for Clinical Chemistry. The overall goal of the course is to assist prescribers in their quest to provide quality pain care to their patients and to document their rationale for drug testing and their treatment decisions.
Jennifer Bolen, JD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - A Comedy of Errors: Methadone and Buprenorphine
UAN 0530-0000-18-032-L01-P
AANP Rx Hours 1.0
Course Description
The 3 most contentious, poorly understood analgesics today are methadone, cannabis, and buprenorphine. This fast paced workshop will equip practitioners with immediately implementable practical tips regarding when and how to use these analgesics, including dosage formulations, routes of delivery, appropriate use in therapy, drug interactions, dosage titration (both up and down), opioid conversion calculations, and more. All discussions will be aimed at enhancing clinical, economic, and humanistic outcomes on the individual patient and health system level.
Douglas L. Gourlay, MD, MSc, FRCPC, FASAM
10:40a - 11:40a - Reefer Madness: Taking the Insanity Out of Medical Cannabinoids
UAN 0530-0000-18-049-L01-P
AANP Rx Hours 0.0
Course Description
Medical, and recreational, marijuana serve as sources of great confusion to patients and clinicians alike. A culture of "neuromysticism" around medical marijuana has arisen, leaving patients and clinicians alike confused regarding what constitutes "medical" marijuana. A part of this confusion is related to the poor quality of the available research on safety and efficacy, which are due, in part, to the restrictive scheduling of the drug. This lecture will focus on what we know, and what we don't know, about the efficacy and safety of medical cannabinoids. Specific recommendations regarding the safest and most effective use of medical marijuana as part of a pain management armamentarium will be provided.
Michael E. Schatman, PhD, CPE, DASPE
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 Collegium Pharmaceuticals, Abraham A. Cherrick, MD
1:10p - 2:00p - Evidence-Based Approaches to Chronic Pain Management: Time to Reconsider the Benefit of Technophilism?
UAN 0530-0000-18-037-L01-P
AANP Rx Hours 0.0
Americans are obsessed with all that is technical, yet technologically-focused approaches to chronic pain management are not necessarily the most effective approaches. Despite their perceived promise, unimodal approaches such as medications, surgery, spinal cord stimulation, intrathecal opioid pumps, and various other interventional approaches are not necessarily the most effective ways to treat chronic pain. Primary care physicians, when overwhelmed by these patients, are apt to refer them either to interventionalists or surgeons prematurely, resulting in myriad unnecessary injections and surgeries--with iatrogenic complications associated with both. This presentation will emphasize the potential benefits of considering referral of patients with chronic pain to physiatrists--who are the pain specialists with the broadest armamentaria for treating the biopsychosocial complexities of these conditions.
Michael E. Schatman, PhD, CPE, DASPE
2:00p - 2:10p - Break & Exhibits
2:10p - 3:00p - Trainwreck: Addressing Complex Pharmacotherapy With the Inherited Pain Patient
UAN 0530-0000-18-057-L01-P
AANP Rx Hours 0.5
Course Description
The prescription drug problem in America has led to many guidelines and, in some cases, regulations aimed at stemming the tide of prescription drug abuse. Some are evidence based, but most are driven by fear and an overwhelming need to do "something." Unfortunately, while these guidelines have offered suggestions of how to apply this information in a clinical context going forward, they provide little information as to the management of those patients who already exceed these current guidelines. This is where the concept of the "inherited patient" comes into play. Some of these patients are doing well while some are doing quite poorly. The undeniable fact is that as these guidelines are being exceeded, risk of a bad outcome increases while likelihood of achieving therapeutic goals decreases. This workshop will, through the use of representative cases, help participants to recognize irrational pharmacotherapy and, when necessary, address it through a combination of pharmacological as well as biopsychosocial frameworks.
Douglas L. Gourlay, MD, MSc, FRCPC, FASAM
3:00p - 3:50p - Embrace Changes and Prevent Overdose: A Basic Blueprint for Legal Risk Mitigation and Response
UAN 0530-0000-18-045-L01-P
AANP Rx Hours 0.0
Course Description
Overdose--a small word that packs a major punch, and a big reason for many recent legal regulatory changes in controlled substance prescribing and pain management. Too many physicians and allied healthcare practitioners are caught unawares by the legal issues surrounding overdose events, fatal and nonfatal. Often, prescribers are the last to learn about an overdose event and, worse yet, fail to take action once notified. Through a series of case examples, attendees will learn how to develop and implement overdose event policies and protocols. Attendees will receive copies of sample policies and protocols and learn how to tailor them to their respective practices and state licensing board framework. Professional licensing board and criminal cases involving overdose events do not usually end well for the prescriber, but there is much the prescriber can do proactively to signal his/her intent to get things right. While prescribers cannot control what their patients do once they leave the medical office, they are responsible for establishing a safe framework for opioid prescribing, including a proper response when something goes wrong.
Jennifer Bolen, JD
*Not certified for credit.
