In this online CME self-learning program:

Chronic pain is a serious medical condition found in a diverse range of patient populations.  Because of the etiologically heterogeneous nature of this condition, many treatment modalities exist, some of which apply to a broader range of patient populations than do others.  For several reasons that are both patient- and provider-specific and include concern over medication dependence, stigma to narcotic use, and the inherent difficulty in measuring the subjective phenomenon of pain itself, chronic pain is frequently undertreated.

Opioids are the mainstay of pharmacologic care for most forms of chronic pain; however, other classes of drugs are also used in specific types of pain, such as neuralgia, referred pain secondary to psychiatric disease, and others.  These alternative treatments not only have lower risk for dependence, but also may be better options to control these types of pain, and therefore provide better outcomes. 

Opioids are available in many dosage forms with novel routes of administration, adding a layer of complexity to their prescription.  There are also many products combining opioids with other medications providing an additional set of therapeutic options.  These dual products may either contain synergistic combinations of medications for added efficacy or agonist-antagonist combinations meant to reduce abuse potential or side effects.  Yet another, emerging trend in chronic pain management is opioid rotation.  Also, new treatments like pain rehabilitation and strategies to improve compliance and understanding of medical therapy may permit treatment with lower doses of opioids. 

Healthcare professionals must navigate an array of regulations specifically aimed at the prescription of controlled substances when managing chronic pain, and the uninformed may skirt or traverse the law, whether intentionally or not, when they prescribe analgesics.  Only about 0.1% of practices of physicians practicing patient care are ever charged with offenses stemming from the prescription of opioids.  However, a plurality – just over 39% – are general practitioners, suggesting that education about analgesia prescribing is warranted in this population.  Dentistry is also increasingly becoming a targeted health discipline for those with substance abuse disorders.  Because extended-release medications are the most likely to be abused due to increased potency, additional education should be provided and caution used when prescribing them.  The FDA is seeking ways to make these medications safer but, in the mean time, stronger caution may be needed on the part of prescribers.  These long-acting opiates, particularly methadone, are responsible for at least 37% of poisoning deaths in the US between 1999 and 2006.  Moreover, in over a quarter of U.S. states, more people die from opioid overdoses than car crashes.  These statistics illustrate just some of the dangers associated with these medications’ use and emphasize the need for more education about prescribing them.  Another drug of concern is acetaminophen which, because it is sometimes present in multiple medications a patient is taking, prescription and non-, has become the leading cause of acute liver failure in the U.S.  Taken in aggregate, these factors suggest that a gap exists between best practices and actual medical practice.  This should be addressed through education of medical professionals who can then adjust their practices to better serve their patients. 

This program has been designed to bring healthcare professionals’ knowledge of the strategies for management of chronic pain up to date.

By the end of the session the participant will be able to:

• Describe challenges to the successful management of chronic pain.
• Apply existing diagnostic recommendations and criteria to practice in the management of chronic pain.
• Develop strategies to minimize adverse effects associated with chronic pain treatment in different patient populations.
• Develop a monitoring plan aimed at streamlining therapeutic titration of chronic pain treatment in different patient populations.

• Read the learning objectives above
• Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
• View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
• Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
• Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

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