Disclosures: This article is based in part on a continuing medical education (CME)-certified symposium held at the American Pain Society's 2010 annual meeting which was supported by an educational grant from King Pharmaceuticals.
Multimodal Approaches to Optimize Outcomes of Chronic Opioid Therapy in the Management of Chronic Pain
Article first published online: 12 JAN 2011
Wiley Periodicals, Inc.
Special Issue: Application of Multimodal Therapy to Improve Patient Outcomes
Volume 12, Issue Supplement s1, pages S1–S11, January 2011
How to Cite
Kirsh, K. L. and Fishman, S. M. (2011), Multimodal Approaches to Optimize Outcomes of Chronic Opioid Therapy in the Management of Chronic Pain. Pain Medicine, 12: S1–S11. doi: 10.1111/j.1526-4637.2010.00992.x
Program Overview This program is designed to review clinical strategies for opioid management and monitoring for patients with moderate-to-severe pain with varying levels of risk for drug-related aberrant behavior, including high-risk patients. Such strategies may include use of multimodal therapy, continual reassessment, compliance monitoring, patient education, and cognitive–behavioral therapy. Guideline recommendations will be reviewed regarding management and monitoring of chronic opioid therapy for patients with chronic noncancer pain. A review of pharmacologic strategies designed to resist or deter drug-related aberrant behavior will be provided.
Target Audience: This activity has been designed to meet the educational needs of physicians and health care providers involved in the care of patients with pain.
Learning Objectives: Upon completion of this activity, participants should be better able to 1) employ an evidence-based approach to the risk assessment and multimodal management of patients with chronic noncancer pain; 2) utilize guideline-based recommendations for monitoring patients receiving chronic opioid therapy; and 3) describe pharmacologic strategies intended to deter aberrant drug-related behaviors.
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 Postgraduate Institute for Medicine (PIM) and Integrity Continuing Education, Inc. PIM is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation PIM designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Disclosure of Conflicts of Interest PIM requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by PIM for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: Scott M. Fishman, MD, states that he or his spouse/life partner do not have any financial relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. Kenneth L. Kirsh, PhD Speakers Bureau: King Pharmaceuticals. The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: Sean M. Gregory, PhD, hereby states that he or his spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. The following PIM planners and managers, Jan Hixon, RN, BSN, MA, Trace Hutchison, PharmD, Julia Kimball, RN, BSN, Samantha Mattiucci, PharmD, Jan Schultz, RN, MSN, CCMEP, and Patricia Staples, MSN, NP-C, CCRN hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
Method of Participation There are no fees for participating and receiving CME credit for this activity. During the period January 1, 2011, through January 1, 2012, participants must read the learning objectives and faculty disclosures and study the educational activity. PIM supports Green CME by offering your Request for Credit online. If you wish to receive acknowledgement for completing this activity, please complete the posttest and evaluation on http://www.cmeuniversity.com. On the navigation menu, click on “Find Post-test/Evaluation by Course” and search by course ID 7111. Upon registering and successfully completing the posttest with a score of 70% or better and the activity evaluation, your certificate will be made available immediately. Processing credit requests online will reduce the amount of paper used by nearly 100,000 sheets per year.
Media Print supplement.
Disclosure of Unlabeled Use This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. PIM, Integrity Continuing Education, Inc., and King Pharmaceuticals, Inc., do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, Integrity Continuing Education, Inc., or King Pharmaceuticals, Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. For questions about the accreditation of this program, please contact PIM: email@example.com or visit http://www.pimed.com Jointly sponsored by Postgraduate Institute of Medicine Integrity Continuing Education, Inc. This activity is supported by an educational grant from King Pharmaceuticals.
- Issue published online: 12 JAN 2011
- Article first published online: 12 JAN 2011
- Chronic Pain;
- Multimodal Therapy;
- Universal Precautions;
- Abuse-Deterrent Formulations
Objective. To review clinical strategies for long-term opioid management as well as strategies to assess and monitor patients with moderate to severe chronic pain who may be at risk for aberrant drug-related behaviors.
Design. A symposium was held to disseminate a review of opioid use strategies, including use of the Universal Precautions in Pain Medicine as well as the Federation of State Medical Boards Model Policy for Prescribing Controlled Substances (FSMB model policy). These include continual reassessment of pain and risk, treatment agreements, compliance monitoring, urine drug screening, documentation, compliance with the law, and patient education. Additionally, the use of multimodal strategies to treat patients, with techniques such as cognitive-behavioral therapy, is discussed as an essential part of a comprehensive pain management plan.
Setting. The review summarizes a continuing medical education (CME)-accredited symposium conducted at the American Pain Society Annual Meeting in Baltimore, Maryland, in May 2010.
Results. Recommendations for the management and monitoring of long-term opioid therapy for patients with chronic noncancer pain are rooted in evidence-based clinical guidelines, which also provide guidance for the identification of aberrant behaviors or overt addiction.
Conclusions. Vigilance and frequent interactions may sometimes be inadequate to prevent problematic behaviors; therefore, pharmacologic strategies designed to deter abusive behaviors are also discussed.