Schedule (subject to change)
7:00a - 7:30a - Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - 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
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by Arbor Pharmaceuticals, Ashish Udeshi, MD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - 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
Course Description
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
10:40a - 11:40a - What's All the "GABA" About? Pregabalin and Gabapentin Abuse
UAN 0530-0000-18-058-L01-P
AANP Rx Hours 0.0
Course Description
The gabapentinoids are a popular class of medications among prescribers for use in chronic pain and various other neurological conditions. In fact, prescription rates for both gabapentin and pregabalin have increased in the United States and other countries in recent years. However, these medications have a street value to a newer niche of users, including patients taking them at megadoses to enhance the effects of other psychotropic drugs, and other patients taking them to manage or mitigate opioid withdrawal symptoms and possibly even opioid cravings. While pregabalin is already classified as a controlled substance, gabapentin does not yet carry this classification. In response to rising abuse, various states and regulatory bodies are considering changes to enhance patient safety and protect the provider's license. Learn what changes you should make to your practice, if any, in light of the growing abuse of gabapentinoids and how to identify patients potentially abusing them.
Abigail T. Brooks, 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 Collegium Pharmaceuticals, Melanie Rosenblatt, 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 - Product, Disease Awareness, Medical Information Program*
Refreshments will be served.
Sponsored by ADAPT® Pharma, George Avetian, DO
3:00p - 3:50p - 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
3:50p - 4:40p - Not for Human Consumption: New Drugs of Abuse and Their Detection
UAN 0530-0000-18-043-L01-P
AANP Rx Hours 1.0
Course Description
Designer drugs are structurally related to illegal psychoactive drugs and include cathinones (bath salts and flakka), synthetic cannabinoids (K2), piperazines (Molly), salvia, kratom, and desomorphine (krokodil). Often designer drugs are readily available on the Internet or in head shops and skirt regulation through the development of novel analogs and labeling the products "not for human consumption." These novel psychoactive substances are consumed typically by younger males via various routes and modes for their desirable effects; however, undesirable and even life-threatening reactions or death may occur. Additionally, designer drugs are often coingested with other psychoactive substances and may be metabolized through cytochrome P450 pathways leading to drug-drug interactions furthering the potential for harm. Management is normally with supportive measures and symptomatic care. Unfortunately, most of these agents are challenging to detect as they are not readily identified by immunoassay urine drug testing, though some may lead to false positives. More advanced testing with liquid or gas chromatography/mass spectroscopy is able to detect designer drugs but is limited due to its availability, cost, delay in results, and the ever-changing designer drug structures.
Abigail T. Brooks, PharmD
*Not certified for credit.
Schedule (subject to change)
7:00a - 7:30a - Registration and Exhibits
Coffee will be served.
7:30a - 8:30a - Regional Pain Syndromes: Neck and Back
UAN 0530-0000-18-051-L01-P
AANP Rx Hours 0.0
Course Description
Every year, thousands of patients go see their primary care practitioner for the treatment of regional pain syndromes. This lecture focuses on regional pain syndromes including acute low back pain, chronic low back pain, cervicobrachial syndrome, cervical dystonia, lumbosacral/ cervical radiculopathy, spinal stenosis, and disk herniation. We will discuss symptoms, the physical exam, diagnostic testing, and pharmacologic/nonpharmacologic treatment options.
Srinivas Nalamachu, MD
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by AstraZeneca and Daiichi Sankyo, Inc., Brooks D. Cash, 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 - Osteoarthritis Pain: Past, Present, and Future
UAN 0530-0000-18-044-L01-P
AANP Rx Hours 0.3
Course Description
Pain related to osteoarthritis is extremely common, affecting a very large segment of the adult population. For years, many therapeutic approaches have been used with variable degrees of success. Over time, however, we have learned that some commonly used therapies may be ineffective or, worse yet, can lead to significant harm. In this course, available management methods, including oral agents, topical and physical agents, orthotics, and various injectable agents will be discussed, emphasizing existing and emerging medical evidence with proliferant/reparative agents and support of their use. Basic concepts regarding surgical options and their evidence will also be discussed in order for primary and specialty care providers in the audience to better use these treatment options, and know when to refer and how to educate their patients more effectively.
Ramon L. Cuevas-Trisan, MD
11:40a - 12:00p - Faculty Q&A
12:00p - 12:10p - Break, Exhibits & Lunch
Light lunch will be served
12:10p - 3:20p - Extended-Release and Long-Acting Opioid Analgesics: Risk Evaluation and Mitigation Strategy (REMS)
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.
