Bob Visit 2: A 61-Year-Old Man With Chronic Back Pain

Title:

Bob Visit 2: A 61-Year-Old Man With Chronic Back Pain
Topic: Pain Management
Relevant Terms: Abuse, Addiction, Analgesia, Chemical Coping, Chronic Low Back Pain, Controlled Substances, Degenerative Disc Disease, Degenerative Facet Disease, Diversion, Misuse, Neuropathy, Opioids, Pain Intensity Scales, Screening Tools, Urine Toxicology
Primary Audience: physicians and other healthcare professionals who treat patients with chronic pain
Launch Date: 17-Jun-10
Credits: 0.75 AMA PRA Category 1 Credit™
Expiration Date: 16-Jun-11

Learning Objectives

Upon completion of the activity, participants should be able to:

  1. Summarize the risk for opioid diversion and abuse among patients with chronic pain
  2. Explain the public health consequences of prescription opioid diversion and abuse and their impact on the use of these agents for the treatment of patients with chronic pain
  3. Identify patient- and medication-related factors that increase the potential for opioid diversion and abuse
  4. Implement interventions aimed at improving adherence to, and decreasing risk for abuse of, opioid analgesics
  5. Assess emerging opioid formulations and combinations with the potential to decrease the risks for diversion and abuse

    Faculty

    Bruce D. Nicholson, MD
    Clinical Associate Professor
    Department of Anesthesia
    Penn State School of Medicine
    Hershey, Pennsylvania
    Director, Division of Pain Medicine
    Department of Anesthesiology
    Lehigh Valley Hospital and Health Network
    Allentown, Pennsylvania
     Bill H. McCarberg, MD
    Adjunct Assistant Clinical Professor
    Department of Medicine
    University of California
    Staff Physician
    Department of Family Medicine
    Kaiser Permanente
    San Diego, California     Seddon R. Savage, MD, MS
    Director
    Dartmouth Center on Addiction Recovery and Education (DCARE)
    Associate Professor, Adjunct Faculty
    Department of Anesthesiology, Dartmouth Medical School
    Hanover, New Hampshire
    Pain Consultant
    Manchester VA Medical Center
    Manchester, New Hampshire
    DIME Editor
    Nancy Moran
    Associate Scientific Director
    DIME
    Chicago, Illinois

    Course Topic    : Chronic low back pain and opioid abuse
     
    Target Audience: Physicians and other healthcare professionals who treat patients with chronic pain
     
    Activity Purpose 
    The purpose of this activity is to outline strategies for evaluating a patient with chronic low back pain who is at risk of opioid abuse, using an interactive case study that encompasses the perspectives of multiple specialties. 

    Statement of Need
    Chronic pain may be the most costly health problem in the United States. Estimated annual costs approach $50 billion for the approximately 50 million people in the US with chronic pain. Despite extensive clinical trial support for the safety and efficacy of opioid analgesics for the management of patients with chronic pain, well-founded concerns about the abuse and diversion of these drugs may override the benefits. Knowledge of government regulations, coupled with abuse-deterrent opioid analgesics, are only part of a comprehensive and multifaceted approach that must include screening, assessment of the risks and benefits, and patient monitoring. Physicians and other healthcare professionals who manage patients with chronic pain must balance the needs of patients vs the alarming trend in prescription opioid abuse and diversion. To meet this goal, clinicians require the latest information about approaches that provide optimal pain relief for their patients yet limit the risks for drug abuse and diversion.

    DISCLOSURE ATTESTATION
    DIME requires that all persons who were in a position to control or influence the content of this CME activity disclose all relevant financial relationships with any commercial interest. This information is used to: (1) determine whether a conflict exists, (2) resolve the conflict by initiating a content validation process, and (3) advise learners of this information.
     
    Faculty Disclosures
    Dr. Nicholson has received funding from Ortho-McNeil-Janssen Pharmaceuticals, Inc.
    Dr. Nicholson has consulted for King Pharmaceuticals, Inc.; PriCara®, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.
    Dr. Nicholson has been a speaker and/or received an honorarium from PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.
    Dr. Nicholson has no discussion of off-label, investigational, or experimental drug use to disclose.
     
    Dr. McCarberg has been a speaker and/or received an honorarium from Cephalon, Inc.; Endo Pharmaceuticals; Forest Pharmaceuticals, Inc.; Eli Lilly and Company; Merck & Co., Inc.; Ortho-McNeil-Janssen Pharmaceuticals, Inc.; Pfizer Inc; PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.
    Dr. McCarberg has no discussion of off-label, investigational, or experimental drug use to disclose.
     
    Dr. Savage has consulted for Ameritox; Meda Pharmaceuticals, Inc.; Registrat Inc.
    Dr. Savage has no discussion of off-label, investigational, or experimental drug use to disclose.
     

    DIME Editor
    Nancy Moran has nothing to disclose.
     
     
    DISCLOSURE POLICY STATEMENT
    This CME activity might describe the off-label, investigational, or experimental use of medications that may exceed their FDA-approved labeling. Physicians should consult the current manufacturers' prescribing information for these products. DIME requires the speaker to disclose that a product is not labeled for the use under discussion. The provider's documentation of common practices that make the disclosure requirement known to faculty demonstrates compliance with ACCME guidelines.
    DISCLAIMER
    In accordance with DIME policies regarding financial and off-label disclosure, the learner is advised that this CME activity may contain references to off-label or unapproved uses of drugs or devices. The use of these agents outside currently approved labeling is considered experimental, and participants are advised to consult prescribing information for these products. This CME activity was planned and produced in accordance with ACCME Essential Areas and Policies.
     
    This activity is funded through an educational grant from King Pharmaceuticals, Inc. The activity content was developed independently by the contributing faculty or editors. The materials included in this activity have undergone peer review by the chairperson(s) or editor(s). All materials are included with the permission of the authors. The opinions expressed are those of the faculty and are not to be construed as those of the publisher or grantor.
     
    ACCREDITATION STATEMENT
    DIME is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
     
    CREDIT DESIGNATION
    DIME designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
     
    HOW TO RECEIVE CREDIT
    By reviewing the course content and successfully completing the posttest and evaluation, physicians are entitled to receive credit. Your statement of credit will be available to print from your user history page.
     
     
    • Read the learning objectives and faculty disclosures
    • Participate in the activity
    • Complete the post-test and activity evaluation
    • Physicians who successfully complete the post-test and evaluation will receive CME credit
    • All other participants who successfully complete the post-test and evaluation will receive a certificate of participation

    To earn additional CME credit, check out the monograph, Combining Nonpharmacologic & Pharmacologic Strategies: Optimizing Safe & Effective Opioid Therapy in Patients with Chronic Pain, which is accessible at the following link: http://www.dimeded.org/downloads/20005_monograph.pdf
    COURSE VIEWING REQUIREMENTS
     
    PC
    Internet Explorer (v6 or greater), or Firefox
    MAC
    Safari

    This continuing medical education activity is sponsored by DIME.
    www.DIMedEd.org
     
    COMMERCIAL SUPPORT
    This activity is supported by an educational grant from King Pharmaceuticals, Inc.
     
     
     

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