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, Rasheed Singleton, MD
9:30a - 9:40a - Break & Exhibits
9:40a - 10:40a - 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.
Courtney M. Kominek, PharmD
10:40a - 11:40a - The Other Opioid Crisis: Fentanyl and Heroin
UAN 0530-0000-18-055-L01-P
AANP Rx Hours 0.0
Course Description
There is a significant amount of media, political, and public attention paid to the opioid crisis/opioid epidemic in the United States today. With the seemingly ever-increasing number of opioid-related overdoses and fatalities, there has been a feverish push by stakeholders to diminish the amount of opioids prescribed in order to help stem these worrisome trends. Unfortunately, there may be a lack of focus regarding the true definition and characterization of the opioid epidemic. There may also be a rush to judgment about the role of appropriately prescribed opioid analgesics in the addiction crisis we face today as well. This presentation will discuss the roles and statistics of both prescription and illicit opioids (namely heroin and fentanyl) in today's "opioid overdose epidemic" with the intention of clarifying important differences and similarities between these competing epidemics including concerns and clinical considerations specific to each of them. Additionally, this program will examine and identify how these medications and drugs share potentially tragic adverse effect profiles in many cases. However, it is important for clinicians to make sure that appropriate chronic pain patients that may be candidates for opioid analgesic therapy aren't penalized, and still get the treatment that they deserve.
Kevin L. Zacharoff, MD, FACIP, FACPE, FAAP
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
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 PERNIX Therapeutics, Gerald Sacks, MD
3:00p - 3:50p - 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.
Courtney M. Kominek, PharmD
3:50p - 4:40p - The Regulatory Agency Will See You Now
UAN 0530-0000-18-056-L01-P
AANP Rx Hours 0.4
Course Description
Despite high prevalence and seemingly continuous attention, the clinical challenges associated with assessing, treating, and managing patients with chronic pain continue to persist. Many different forces are at play and responsible for this frequently frustrating situation and, as is often the case, the person with the most at risk is the patient with chronic pain. There is no deficit of opinions for possible solutions to this problem. In fact, the number of potential solutions seems to increase each year, all with the intent of helping pain care be more safe and effective, and most trying to stem the negative consequences of abuse, misuse, and diversion of prescription pain medications. Clinicians have had to juggle these good intentions along with the fear of regulatory scrutiny. This course will present and detail the variety of current regulatory forces that need to be considered in clinical practice; how they can potentially impact clinical decisions regarding chronic pain; and how they can be negotiated. A number of regulatory agencies are now "sitting at the pain management table" for the foreseeable future and it is critical to navigate the waters without sacrificing that most important stakeholder: the patient.
Kevin L. Zacharoff, MD, FACIP, FACPE, FAAP
*Not certified for credit.
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.
John F. Peppin, DO, FACP
8:30a - 9:30a - Product, Disease Awareness, Medical Information Program*
Breakfast will be served.
Sponsored by AstraZeneca, Michael Brennan, 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 Gregory, PharmD, CPE
10:40a - 11:40a - 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
11:40a - 12:00p - Faculty Q&A
12:00p - 12:10p - Break & Exhibits
12:10p - 1:00p - When Acute Pain Becomes Chronic
UAN 0530-0000-18-059-L01-P
AANP Rx Hours 0.0
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.
John F. Peppin, DO, FACP
1:00p - 1:10p - Break & Exhibits
1:10p - 2:00p - Rational Polypharmacy
UAN 0530-0000-18-048-L01-P
AANP Rx Hours 0.0
Course Description
Many painful conditions are not able to be treated by one therapy alone. The use of multiple modalities is generally more effective and the same is true with medications. Rational polypharmacy will provide the learner with details regarding the safe and effective use of different medications in different classes to manage certain painful conditions. Through rational polypharmacy the learner will be more prepared to use medications in combinations that can increase effectiveness and decrease potential side effects of each medication on its own.
Thomas Gregory, PharmD, CPE
2:00p - 2:50p - 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
*Not certified for credit.
