Best Practices in the Assessment and Management of Chronic Pain (NURSING)
Perry G. Fine, MD;
Patricia Bruckenthal, PhD, APRN-BC, ANP;
Susan Cochella, MD, MPH;
April Hazard Vallerand, PhD, RN, FAAN;
David M. Kaufman, MD;
Linda Dallam, MS, NP-BC, CWCN-AP;
Mary McLoughlin, RN-BC, MSN, CEN
Jointly sponsored by Albert Einstein College of Medicine of Yeshiva University and Montefiore Medical Center, and Asante Communications, LLC.
This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com
Activity Goal
The goal of this educational activity is to enhance the diagnostic and clinical skills of healthcare professionals who treat patients with chronic pain.
Intended Audiences
The educational activity is intended for physicians, physician assistants, nurse practitioners, and other healthcare professionals interested in chronic pain management.
PLEASE NOTE: If you are a physician looking to receive CME credit for this activity, please direct your browser here.
Statement of Need and Learner’s Gap
At least 116 million adult Americans suffer from chronic pain, which remains the leading reason for patient visits to primary care.1 The socioeconomic burden is significant. Medical expenses and lost productivity associated with chronic pain conditions reach an estimated $635 billion in the United States each year.1 Effectively treating this patient population is particularly challenging because pain can be caused and maintained by numerous biologic factors—including genetic predisposition, tissue injury, aging, joint and disc degeneration, previous medical interventions, and such chronic diseases as osteoarthritis, diabetes, and cancer, to name a few.2,3 Further, the patient-specific pain experience is not solely dependent on painful sensory inputs; emotional status, psychological responses, and social circumstances markedly contribute to pain levels and impairments in physical, affective, cognitive, and occupational functioning.2,3 The heterogeneity of chronic pain—in etiologies, clinical presentations, and outcomes—confounds diagnosis and treatment. Mechanism-based pain classification, comprehensive patient histories, and targeted approaches to physical exams can help clinicians better identify the causes of chronic pain and select appropriate treatments.4 For example, whenever possible, clinicians should match the analgesic mechanisms of action of prescribed medications with the likely underlying pain etiology. Further, combinations of pharmacologic, nonpharmacologic, and interventional treatment approaches may be required for some individuals.5,6 Primary care clinicians are on the frontline of chronic pain management. Long-term relationships with patients facilitate comprehensive and longitudinal assessment of evolving symptoms, allowing for tailored therapeutic regimens that help patients reach functional goals.
References
1. United States Institute of Medicine (IOM) of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington DC: IOM; 2011.
2. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
3. McCarberg BH, Nicholson BD, Todd KH, Palmer T, Penles L. The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey. Am J Ther. 2008;15(4):312-320.
4. Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med. 2004;140(6):441-451.
5. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.
6. American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management. Anesthesiology. 2010;112(4):810-833.
Learning Objectives
At the completion of this initiative, participants should be better prepared to:
- Discuss the neurobiology of pain processing and how dysfunction in nociceptive pathways contributes to various chronic pain disorders
- Comprehensively assess patients with chronic pain based on biopsychosocial factors that shape the severity, chronicity, and adverse functional consequences of the painful conditions
- Evaluate the clinical profiles of available pharmacologic agents based in part on mechanisms of action, analgesic effectiveness, and treatment-related risks and side effects
- Employ mechanism-based pharmacotherapy for patients with common chronic pain syndromes, such as low back pain, osteoarthritis, fibromyalgia, and painful neuropathic disorders
- Combine pharmacologic and nonpharmacologic therapies for patients with chronic pain with the objectives of reducing pain, meeting predefined functional goals, and minimizing potential treatment-related harm
Accreditation Statement
Contact hours are provided by Montefiore Learning Network, an approved provider of continuing nursing education by the New Jersey State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Credit Designation
This program provides 2.0 contact hours by Montefiore Learning Network.
Method of Participation
There are no fees for participating in and receiving credit for this activity. To receive CME/CE credit, participants should read the information carefully, study the activity and answer the questions at the end. Participants will have two attempts to obtain a passing grade of 70% on the posttest and be eligible to obtain CME/CE credit.
Conflict of Interest Statement
The Conflict of Interest Disclosure Policies of Albert Einstein College of Medicine and Montefiore Learning Network require that faculty participating in any CME/CE activity disclose to the audience any relationship(s) with a pharmaceutical product or device company. Faculty whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to participate.
Albert Einstein College of Medicine and Montefiore Learning Network also require that faculty participating in any CME/CE activity or anyone in a position to influence content disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.
Faculty/Planning Committee Disclosures
Faculty/Planning Committee members of this program have indicated the following disclosure information:
Patricia Bruckenthal, PhD, APRN-BC, ANP
Endo Pharmaceuticals (Consultant); Pfizer Inc. (Consultant); Purdue Pharma L.P. (Consultant)
Susan Cochella, MD, MPH
Has no relevant financial relationships to disclose.
Perry G. Fine, MD
Ameritox (Consultant); Archimedes Pharma LTD. (Consultant); Cephalon, Inc. (Consultant); Johnson & Johnson (Consultant); Mylan Inc. (Consultant); Nektar (Consultant); Nuvo Research Inc. (Consultant); Purdue Pharma L.P. (Consultant)
April Hazard Vallerand, PhD, RN, FAAN
Janssen Pharmaceuticals, Inc. (Consultant); Johnson & Johnson (Consultant); Teva Pharmaceuticals USA (Speakers Bureau)
CME/CE Reviewers
David M. Kaufman, MD
Has no relevant financial relationships to disclose.
Linda Dallam, MS, NP-BC, CWCN-AP
Has no relevant financial relationships to disclose.
Mary McLoughlin, RN-BC, MSN, CEN
Has no relevant financial relationships to disclose.
Planning Committee Members
The staff of Albert Einstein College of Medicine and Montefiore Medical Center and the staff of Asante Communications, LLC, have no conflicts of interest with commercial interests related directly or indirectly to this educational activity.
The Center for Continuing Medical Education (CCME) staff at Albert Einstein College of Medicine has no disclosures to report other than the following:
Steven Jay Feld of Albert Einstein College of Medicine, or a member of his household, owns securities in Bioheart, Inc.; Chelsea Therapeutics, Inc.; and Pharmacopeia, Inc.
Jim Kappler, PhD, of Asante Communications, LLC, helped draft the chapters and has no relevant financial relationships to disclose.
Disclaimer
The opinions, ideas, recommendations, and perspectives expressed in this program and accompanying materials are those of the faculty only and do not necessarily reflect the opinions, ideas, recommendations, or perspectives of their affiliated institutions, Albert Einstein College of Medicine and Montefiore Medical Center, Asante Communications, LLC, or the activity’s commercial supporter.
Copyright Information
© 2012 Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications, LLC. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.
