JOURNAL SUPPLEMENT A CME/CE Supplement to PWJ—PAINWeek Journal Exploring Relief and of Effects Side Managing RELEASE DATE: December 1, 2014 EXPIRATION DATE: December 31, 2015 Sponsored by Global Education Group. Med Learning Group is the education partner. This activity is supported by an educational grant from AstraZeneca. Faculty Program Overview Sanford M. Silverman, MD This case-based enduring activity will cover the personalized care of patients with Medical Director chronic pain. Comprehensive Pain Medicine Target Audience Pompano Beach, Florida This activity is designed to meet the educational needs of frontline clinicians who care for patients with chronic pain such as physicians, nurse practitioners, physician assistants, and pharmacists. Learning Objectives Upon completion of the program, attendees should be able to: - Discuss the different classes of analgesics used in the treatment of chronic pain, and their safety, efficacy and indications - Recognize the most common opioid-induced side effects, OIC, and the impact of treatments on analgesia - Identify attitudes, barriers and facilitators to communicating with patients about their bowel habits - Identify treatments used for the management of OIC Physician Accreditation Statement- Global Education Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Physician Credit Designation- Global Education Group designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nursing Continuing Education- Global Education Group is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA. This educational activity for 1.0 contact hours is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity. Pharmacist Accreditation Statement- Global Education Group (Global) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Credit Designation- Global Education Group designates this continuing education activity for 1.0 contact hour(s) (0.1 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number - 0530-9999-14-170-H01-P). This is a knowledge based activity. Nurse Practitioner Continuing Education- Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 11021. This program has been approved for 0.25 contact hours of continuing education (1.0 Pharmacology hours). Physician Assistants - AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hours of Category 1 credit for completing this program. 1 Exploring Relief and Managing Side Effects of Instructions to Receive Credit- There are no fees for participating and receiving CME credit for this enduring activity. To receive CME/CE credit participants must: - Read the learning objectives and faculty disclosures. - Complete the pre-test through this link: https://www.research.net/s/PainSupppre - Participate in the activity. - Complete the post-test and activity evaluation through this link: https://www.research.net/s/Painsupppost - Physicians who successfully complete the post-test and evaluation will receive CME credit. - All non-physician participants who successfully complete the post-test and evaluation will receive a certificate of participation. All certificates will be emailed within 30 days. Fee & Refund/Cancellation Policy- There is no fee for this educational activity. Disclosure of Conflicts of Interest- Global Education Group (Global) requires instructors, planners, managers and other individuals and their spouse/life partner 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 Global 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: Name of Faculty or Presenter Reported Financial Relationship Sanford M. Silverman, MD Nothing to disclose 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: Name of Planner or Manager Reported Financial Relationship Ashley Marostica, RN, MSN Nothing to disclose Amanda Glazar, PhD Nothing to disclose Matthew Frese Nothing to disclose Andrea Funk Nothing to disclose Christina Gallo Nothing to disclose Melissa Johnson Nothing to disclose Cheryl Zigrand Nothing to disclose Disclosure of Unlabeled Use- This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) does 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 any organization associated with this activity. 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 in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. 2 The PAINWeekEnd™ Educational Summit Series brings live education Hypogonadism and likely hypogonadotropic hypogonadism have about pain management to healthcare professionals through regional correlated with side effects in men such as sexual dysfunction, professional conferences. Each conference also includes an accredited depression, and decreased energy levels. Chronic opioid continuing medical education activity hosted by a faculty chairperson. administration can lead to decreases in testosterone in a dose- This supplement is designed to capture and expand upon some of the dependent manner. Women can also have hormonal side effects of content of the PAINWeekEnd™ live program in print form. The opioids, such as depression, dysmenorrhea, sexual dysfunction, and management of chronic pain with opioids and the ensuing side reduced bone mineral density.4 effects will be discussed, with a particular focus on opioid-induced Hyperalgesia or hyperalgia is an increased sensitivity to pain that constipation (OIC), and how to communicate with patients about presents as increased pain despite increasing doses of opioids. constipation. Long-term opioid use or use of high doses may be associated with the development of hyperalgesia, which may be related to opioid CHRONIC PAIN OVERVIEW metabolites and opioid-induced cell apoptosis.4 The Institute of Medicine has estimated that more than 100 million Americans are living with pain that lasts from weeks to years, and that OPIOID-INDUCED CONSTIPATION 1 the financial costs of chronic pain total up to $635 billion annually. Constipation is an extremely common side effect of opioid treatment, The high prevalence of chronic pain goes hand in hand with high rates occurring in 40% to 95% of patients, with the possibility of occurring of opioid therapy. Sales of opioid analgesics quadrupled between 1999 after just a single dose.5 And, with the increase in the use of opioids, and 2010, with more than 256 million opioid prescriptions filled in 2009 the absolute numbers of patients affected by OIC is also growing.8 2 alone. Opioid therapy is not without its side effects, though, and In patients who require chronic analgesia, constipation can be a clinicians must be aware of the common side effects and ready to debilitating side effect that negatively impacts quality of life.4,9 With up address them in a timely manner to prevent its toxicity from to 56% of patients discontinuing their opioid treatment due to lack of outweighing its effectiveness in treating pain. Of the side effects efficacy or side effects, addressing constipation is critical.3,10 commonly associated with opioid use, constipation is the most prevalent.3 Opioid-induced constipation (OIC) is an expected part of While OIC can occur in any patient treated with opioids, there are opioid treatment that is unlikely to improve over time, and so it should certain risk factors that can increase a patient’s likelihood of be closely monitored and treated prophylactically, with a bowel regimen developing