Persistent And Breakthrough Pain: Multidimensional Assessment and Opioid-Based Multimodal Treatment
- CreditType
- CME
- Credit Amount
- 1.5
- Release Date
- 12/21/2009
- Expiration Date
- 12/20/2010
- Activity Type
- Monograph
Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications
This activity is supported by an educational grant from Cephalon, Inc.
Activity Goal
The goal of this activity is to disseminate best practices in the assessment, diagnosis, and formulation and ongoing refinement of opioid-based therapeutic plans for persistent and breakthrough pain.
Intended Audience
This activity is intended for pain specialists, neurologists, rheumatologists, physical medicine and rehabilitation specialists, family practitioners, oncologists, internal medicine physicians, and general practitioners.
There are no prerequisites for this educational activity.
Statement of Need
Numerous epidemiologic studies have estimated chronic pain syndromes to be responsible for an annual cost of 80 billion dollars in the United States alone, reflecting the more than 50 million people who have chronic pain syndromes.1 Previously regarded as a symptom of underlying disorders, chronic pain is now considered a disease state unto itself. Comprehensive, continual assessment and treatment are needed to address its deleterious effects on multiple functional dimensions, including affective, cognitive, physical, and work-related.2 Further, because daily fluctuations in pain levels are common, health care practitioners need to optimize therapy for persistent baseline pain while independently assessing and treating breakthrough pain. For each patient, clinicians should consider the potential benefits and risks of all available treatment modalities, from behavioral and pharmacologic to interventional approaches.3-6 Clinical experience and a growing evidence base suggest that opioids are an important analgesic option in appropriately selected patients with functionally impairing persistent and breakthrough pain. Selection of patients for opioid-based multimodal analgesic strategies necessitates careful consideration of pathophysiology, patient-specific treatment goals, risks related to opioid pharmacology, and the ability of the prescriber to structure therapy accordingly and monitor adherence to the pain management plan.7
Learner’s Gap
Chronic pain is prevalent, underdiagnosed, often misdiagnosed, and undertreated.8,9 Evidence-based discussions of chronic pain supported by expert clinical experience enable clinicians to better manage pain and improve outcomes in patients with chronic pain.
Learning Objectives
At the completion of this initiative, participants should be better prepared to:
- Implement a continuous, multidimensional, and vigilant assessment of persistent and breakthrough pain based, in part, on the phenomenology and inferred pathophysiology of the pain syndrome, patient function, goals, and level of risk
- Select appropriate patients for opioid-based management of persistent and breakthrough pain
- Employ multimodal treatment strategies tailored to the multidimensional pain assessment of patients with persistent and breakthrough pain
- Explain the respective roles of long-acting, short-acting, and rapid-onset opioids in the management of persistent and breakthrough pain
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
Albert Einstein College of Medicine designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Conflict of Interest Statement
The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Presenters whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present. Albert Einstein College of Medicine also requires that faculty participating in any CME activity 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 of this program have indicated the following disclosure information:
Michael J. Brennan, MD
Cephalon, Inc.; Eli Lilly and Company (speaker bureau); Endo Pharmaceuticals; King Pharmaceuticals, Inc; Pfizer Inc; Purdue Pharma L.P. (consultant, speaker bureau)
Perry G. Fine, MD
Alkermes, Inc.; Ameritox, Ltd.; Cephalon, Inc.; Forest Laboratories, Inc.; King Pharmaceuticals, Inc.; NeuroAdjuvants, Inc.; PriCara [Ortho-McNeil-Janssen Pharmaceuticals]; Purdue Pharma L.P. (consultant); Wyeth (speaker bureau)
David M. Simpson, MD
Cephalon, Inc.; Eli Lilly and Company (speaker bureau); Meda Pharmaceuticals Inc.; NeurogesX; Pfizer Inc (consultant, grant/research support)
David M. Kaufman, MD CCME Reviewer
Dr Kaufman has no conflict of interest to report.
Albert Einstein College of Medicine, CCME staff, and the staff of Asante Communications have no conflicts of interest with commercial interests related directly or indirectly to this educational activity.
James Kappler, PhD, of Asante Communications, has no conflicts of interest with commercial interests related directly or indirectly to this educational activity. Steven Jay Feld, of Albert Einstein College of Medicine, or a member of his household own securities in Bioheart, Inc., Chelsea Therapeutics, Inc., and Pharmacopeia, Inc.
Copyright Information
Copyright © 2009 Albert Einstein College of Medicine and Montefiore Medical Center, and Asante Communications. 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.
References
- American Pain Society. Pain: Current Understanding of Assessment, Management and Treatments Section I: Background and Significance. Available at: http://www.ampainsoc.org/ce/enduring.htm. Accessed March 2009.
- Gatchel RJ, et al. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psych Bull. 2007;133(4):581-624.
- Pergolizzi J, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008;8(4):287-313.
- De Leon-Casasola OA. Current developments in opioid therapy for management of cancer pain. Clin J Pain. 2008;24 Suppl 10:S3-S7.
- Soares LG, Chan VW. The rationale for a multimodal approach in the management of breakthrough cancer pain: a review. Am J Hosp Palliat Care. 2007;24(5):430-439.
- Jensen TS, et al. New perspectives on the management of diabetic peripheral neuropathic pain. Diab Vasc Dis Res. 2006;3(2):108-119.
- Portenoy RK. Appropriate use of opioids for persistent non-cancer pain. Lancet. 2004;364(9436):739-740.
- Walid MS, et al. The Fifth Vital Sign—What Does It Mean? Pain Pract. 2008;8(6):417-422.
- Gore M, et al. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J Pain. 2006;7(12):892-900.
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