Schedule (subject to change)
7:00a - 7:30a- Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - Chronic Pain Assessment
UAN 0530-0000-18-035-L01-P
AANP Rx Hours 0.0
Course Description
Effective clinical interviewing and pain assessment are critical to the appropriate diagnosis and management of pain. In this presentation, the clinician learns how to apply principles of effective communication and also ascertain how to evaluate available assessment tools.
Michael R. Clark,
MD, MPH, MB
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by Arbor Pharmaceuticals, Gerald Aronoff, MD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - 3's Company: COX-2 Inhibitors, Medicinal Marijuana, and Opioid Prescribing
UAN 0530-0000-18-031-L01-P
AANP Rx Hours 0.0
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
10:40a - 11:40a - Topical Opioids: The Perfect Solution for Reducing Systemic Opioid Exposure
UAN 0530-0000-18-167-L01-P
AANP Rx Hours 0.5
Course Description
Topically applied opioids provide effective analgesia in adult patients with painful inflammatory conditions, due to opioid receptors found on peripheral nerves and inflamed tissue. Topicals may offer rapid reduction in pain scores in patients, without reported adverse effects or tolerance. Because topical opioid gels are not available commercially and need to be prepared by pharmacy, this course will identify medical staff and implementation strategies, along with patient and family education needs. The insight that opioids exert a local analgesic effect is based on the observation that morphine and its metabolites are largely undetectable systemically when applied topically to skin ulcers (suggesting the analgesic effect is local), and because peripheral opioid injections for local analgesia, such as intra-articular morphine after knee surgery, have been found to be effective in several trials. Several small case series have shown rapid relief using topical opioids in patients with pain due to skin infiltration of tumors, skin ulcers of malignant and nonmalignant origin, oral mucositis, and knee arthritis. Monitoring and drug interactions of topical opioids is the same as for systemic opioids--excess sedation, respiratory depression, pruritus. This course will summarize current literature supporting topical opioid administration for pain and explore logistics of adding topical morphine to a health system formulary, establishing medication prescribing guidelines, developing an order set in an electronic health record, and identifying a list of approved prescribers.
Annas Aljassem, MD
Levi M. Hall, PharmD, BCPS
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 - How Does Acute Pain Become Chronic?
UAN 0530-0000-18-059-L01-P
AANP Rx Hours 0.0
Course Description
Many factors have been proposed to increase the likelihood of acute pain becoming chronic including, but not limited to undertreatment. The number of contributing factors along with the lack of consistent algorithms can often make the prediction and prevention of this transition to chronic pain challenging. This session will describe this phenomenon and some theories behind its development, along with case based situations that outline strategies that can help to decrease the likelihood that patients with acute pain will develop chronic pain and experience its associated consequences.
Michael R. Clark, MD, MPH, MBA
2:00p - 2:10p - Break & Exhibits
2:10p - 3:00p - Product, Disease Awareness, Medical Information Program*
Refreshments will be served.
Sponsored by ADAPT® Pharma, Bill McCarberg, MD
3:00p - 3:50p - 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
3:50p - 4:40p - IV Methadone: When All Else Fails
UAN 0530-0000-18-166-L01-P
AANP Rx Hours 0.0
Course Description
Due to incomplete cross-tolerance with other opiates, reduction in doses is required when rotating from another opiate. Several published conversions exist for opioid rotation to methadone, making the calculation more challenging. Numerous studies suggest that the equianalgesic depends on the previous opioid treatment, but there are few data on the use of intravenous (IV) methadone for the management of severe or refractory cancer pain. This requires introduction of more clinical experience and judgement. The pharmacokinetic profile, including variations between oral and parenteral formulations, presents significant challenges to prescribers in providing this effective therapy. This session addresses the complex nature of the pharmacokinetic profile of methadone. It recommends that only those clinicians who are well versed in the interpatient variabilities of methadone, and who maintain awareness of the limitations of the data we have available, should prescribe this medication.
Annas Aljassem, MD
Levi M. Hall, PharmD, BCPS
*Not certified for credit.
Schedule (subject to change)
7:00a - 7:30a - Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - Urine Drug Testing in Pain Management: A Patient Centered Approach
UAN 0530-0000-18-171-L01-P
AANP Rx Hours 0.0
Course Description
Urine drug testing (UDT) is playing an increasing role in the management of risk in clinical care. Unfortunately, drug testing in general suffers from several shortcomings, especially when called upon to identify problematic use of controlled substances, including drug diversion. UDT is the preferred tool in patient-centered care. It can offer clinicians valuable insight into the identification, treatment, and monitoring of their patients while providing objective data in risk evaluation and minimization strategies necessary for responsible clinical care.
Douglas L. Gourlay, MD, MSc, FRCPC, FASAM
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by Collegium Pharmaceuticals, Robert Klickovich, MD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - Nonopioid Analgesics: Antidepressants, Adjuvant Therapies, and Muscle Relaxants
UAN 0530-0000-18-042-L01-P
AANP Rx Hours 1.0
Course Description
Nonopioid analgesics are oftentimes considered first-line therapy for most chronic pain syndromes. A strong understanding of these agents' mechanism of action, pharmacokinetics, and toxicity profiles is paramount for today's pain practitioner. This course will provide an in-depth look at each of the agents within these drug classes, their potential role in pain management, and available data supporting their use. Additionally, clinically relevant monitoring pearls will be discussed.
Thomas B. Gregory, PharmD, BCPS, CPE, FASPE
10:40a - 11:40a - 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
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 PERNIX Therapeutics, Christopher Gharibo, MD
1:10p - 4:20p - Extended-Release and Long-Acting Opioid Analgesics: Risk Evaluation and Mitigation Strategy (REMS)
3.0 AMA PRA Category 1TM Credits [Compliant with the FDA ER/LA Opioid REMS education requirements]
UAN 0530-9999-18-064-L01-P
AANP Rx Hours 0.5
Program Overview: Pain is a significant public health problem, affecting more than 100 million adults in the US and causing significant reductions in patients' quality of life. The use of narcotic medications for pain management has increased dramatically in the US over the past two decades. However, pain patients are often undertreated due to a variety of physician- and patient-related concerns and barriers.
In addition, despite the pain-relieving properties of opioid medications, the potential for abuse remains a concern. In response to this apprehension about opioid misuse, overdose, abuse, and addiction, the Food and Drug Administration (FDA) developed the Risk Evaluation and Mitigation Strategy (REMS) to ensure that the benefits outweigh the risks for long-acting and extended-release opioid analgesics.
The activity, Extended-Release and Long-Acting Opioid Analgesics: Risk Evaluation and Mitigation Strategy (REMS), incorporates the REMS blueprint into education that is designed to induce changes in physician knowledge, competence, and performance that will translate into improved quality of patient care and reduced pain for patients.
Target Audience: This education is intended for primary care providers and other clinicians involved in pain management, and is designed to help them recognize and balance optimal pain reduction to improve function and productivity with minimization of adverse events (e.g. abuse, addiction, and risk of workplace accidents). Additional challenges to optimal pain management include keeping up to date with the increasing volume of information on pain management, implementing changes recommended by evolving guidelines, and recognizing changes to practice needed to combat the growing rate of opioid abuse.
Jointly provided by Global Education Group and Rockpointe
This educational activity is supported by an independent educational grant from the Extended-Release/Long-Acting Opioid Analgesic REMS Program Companies. Please see http://ce.er-laopioidrems.com/IwgCEUI/rems/pdf/List_of_RPC_Companies.pdf for a listing of REMS Program Companies. This activity is intended to be fully compliant with the Extended-Release/Long-Acting Opioid Analgesics REMS education requirements issued by the US Food & Drug Administration.
*Not certified for credit.
