PAINWeek 2011 Schedule

Stephen J. Ziegler, PhD, JD
John F. Peppin, DO, FACP
Bruce M. Stark, MD
David T. Thornton
Joseph P. Furman, JD

One of the most often cited barriers to the treatment of pain stems from a prescriber’s fear of investigation and increased regulatory scrutiny whenever opioids are involved. A panel of notable presenters from the pain and regulatory communities offers a unique program for attendees to hear real-world experiences and opinions. The panel represents a wide variety of experts including an investigated physician, defense and prosecution experts, and a former executive director of a state medical board. Practice tips on preventing and/or surviving an investigation are also addressed.

David M. Glick, DC, DAAPM, CPE

In order to successfully clinically manage pain, it is essential to begin with an understanding of the underlying mechanisms responsible for its generation. A skillful approach based on solid knowledge of the anatomical structures, pathways, and events that result in pain is more likely than a single standard approach to lead to effective clinical management of pain. The presentation includes an overview of medication classes typically considered for pain and the pathways they affect.

*Recommended for PAINWeek "first time" attendees.

Kevin L. Zacharoff, MD, FACPE, FACIP, FAAP
Emil Chiauzzi, PhD

Drs. Chiauzzi and Zacharoff discuss specific challenges that exist in the course of managing chronic pain—challenges for the frontline practitioner as well as other important stakeholders. Periodic visits and re-assessments are important components of chronic pain management, as are approaches that help people deal with their pain between office visits. Specific techniques, such as reinforcement of shared decision-making, the importance of self-management, and the “Medical Home” model of care, are discussed. Data supporting the role of interventions that help improve self-management and the role of behavioral interventions in the treatment of the chronic pain patient are presented as well.

Rebecca Curtis, ACC

Gain insight into a patient's perspective on chronic pain and the process necessary to move from victim to self-manager. As a person with chronic pain, Rebecca Curtis has learned from first-hand experience what it takes to truly move a patient forward from dependence and passivity to taking an active role in their own program of pain management.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

Mind/body techniques offer physicians excellent resources for helping their patients increase coping and pain-relief skills and abilities. Additionally, evidence-based mind/body techniques are effective in stress reduction, improving immune function, mood, motivation and compliance, and promoting healing.

Charles E. Argoff, MD, CPE

Among the many manifestations of chronic pain experienced by patients, neuropathic pain syndromes are among the most challenging to diagnose and treat. This presentation focuses on the diagnosis and management of common neuropathic pain conditions, with special emphasis on when it is appropriate to refer the patient to a pain specialist.

Presented by Neurology Reviews.

Michael J. Brennan, MD

This symposium reviews the necessity for the FDA-mandated Risk Evaluation and Mitigation Strategies (REMS) and its components. Faculty will also review a model of a Transmucosal Immediate Release Fentanyl (TIRF) REMS system using an approved REMS and will provide practical guidance and resources for implementing REMS into your practice. Time will be allotted for Q&A at the end of the symposium.

Sponsored by Cephalon Ready For REMS. This activity is not certified for credit. Breakfast will be served.

The Ready For REMS (Risk Evaluation and Mitigation Strategy) Resource Lounge features live “Meet the Expert” sessions, where attendees will hear firsthand about topics relating to REMS implementation. A schedule for “Meet the Expert” sessions will be posted throughout the hotel. General REMS and opioid safety information for HCPs and patients will also be available, as well as specific information on Transmucosal Immediate Release Fentanyl (TIRF) REMS to prepare you to implement REMS in your practice.

Stop by the Resource Lounge for a light snack and to pick up REMS materials to support you in the REMS era. The Lounge will be open throughout the day.

Sponsored by Cephalon Ready For REMS. This activity is not certified for credit. Refreshments will be served.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

According to a 2010 survey released by the AARP/NCCAM (National Center for Complementary and Alternative Medicine), 73% of respondents who utilized complementary alternative medicine (CAM) did so to help reduce pain or to treat a painful condition. “Integrative” pain management physicians can offer their patients the best pharmaceutical and nonpharmaceutical treatments available. The future is now!

Jennifer Bolen, JD

Fraud, waste, and abuse are prevalent in today's healthcare community, and investigations designed to recover health plan assets can be very costly to the practitioner. These investigations often focus on lack of medical necessity and documentation for a specific procedure, laboratory test(s) ordered/performed, and medication prescribed. Pain management practitioners should take steps to minimize the potential for adverse outcomes in the event of an investigative inquiry. From case examples, attendees learn about key areas of fraud and abuse in pain management and how to identify fact patterns that give rise to investigative concerns. Case examples also provide insight into the value of practice self-evaluation and the use of compliance plans and practice protocols. The workshop focuses on providing practitioners with basic "how to" steps to initiate a practice evaluation and create a plan for responding to investigative inquiries—from notice of overpayment through search warrant.

Philip Getson, DO

Complex regional pain syndrome (CRPS) is an old problem with a new name. In the past, type 1 was termed reflex sympathetic dystrophy (RSD) and type 2 was called causalgia. This lecture discusses the fundamentals of CRPS, its clinical manifestations, and basic treatment. Following this informative presentation is a full hour of case studies and in-depth discussion of treatment options.

Michael R. Clark, MD, MPH, MBA

Effective clinical interviewing and pain assessment are critical to the appropriate diagnosis and management of pain. In this presentation, the clinician learns how to apply principles of effective communication and also ascertain how to evaluate available assessment tools.

*Recommended for PAINWeek "first time" attendees.

Roger B. Fillingim, PhD
Joseph L. Riley, III, PhD

Sex differences in pain have received increasing attention in recent years, and there has emerged a proliferation of both preclinical and clinical research on the topic. The goal of this session is to highlight important issues and to place sex differences in pain into the broader context of individual differences in pain. Quantitative sex differences refer to male-female differences in the numbers of persons visiting their providers about a condition (such as women more often reporting pain than men). In contrast, qualitative differences refer to sex differences in the mechanisms contributing to an outcome (for example, if a genetic marker were associated with pain responses in women but not in men). The relative importance of quantitative vs qualitative differences will be discussed. Additional conceptual issues discussed include between-group vs within-group differences and the potential practical significance of sex differences.

Peter Foreman, DDS, DAAPM

Orofacial and other head and neck pain is usually treated by medical, dental, or other health practitioners. However, inaccurate diagnosis can lead to inappropriate or invasive procedures, creating further problems. Treatment approaches may differ—some are controversial, and some may even be harmful. Not all treatments are evidence-based. Advances in the understanding of pain mechanisms have shown that convergent afferent nociceptive transmissions from nontrigeminal, extra-oral cervical sources can enter the trigeminal system. Pain may thus present as dental, sinus, temporomandibular, or another specific type of pain. However, the pain site may not always be the pain source. Part 1 of this master class addresses some of these issues and looks at some of the solutions. Part 2 provides an opportunity for practical work in pairs, which helps consolidate the material presented in Part 1.

Charles E. Argoff, MD, CPE

This interactive session explores how our actions as practitioners may play an important role in reducing undesirable events as a consequence of untreated or poorly treated pain. Several patient scenarios are presented demonstrating that how we act determines whether we may be able to reduce or, conversely, actually facilitate unwanted results in the management of pain. These scenarios include, for example, an approach to acute pain that may limit the development of chronic pain (a desirable effect), or a migraine headache treatment that may inadvertently lead to a more difficult headache problem (an untoward event). The management of chronic pain with opioids is an area in which it has been increasingly clear how vital the practitioner’s role is in helping to reduce (or not) the risk associated with this treatment approach.

David M. Glick, DC, DAAPM, CPE

Diagnostic testing is an integral component of differential diagnosis. In routine clinical practice, examinations have tended to become more cursory, largely because of increased demands on practitioners’ time, compounded by patient expectations of technological advances. The end result may lead to an over-reliance on technology for basic clinical diagnosis. The purpose of this session is two-fold: (1) to provide a review (for some, an introduction) to basic structural and functional studies used for the diagnosis of pain-related problems, and (2) to call attention to the limitations of such studies and the importance of establishing clinical relevance to their findings. Factors that adversely affect clinical management, potentially resulting in failed treatment, will be discussed, along with best practices for utilizing studies to help enhance clinical outcomes for treatment.

*Recommended for PAINWeek "first time" attendees.

Roger B. Fillingim, PhD
Joseph L. Riley, III, PhD

Abundant evidence suggests potentially important sex differences in the experience of pain. A large number of epidemiologic studies demonstrate increased prevalence of many forms of pain among women compared to men. The existing epidemiologic, clinical, and experimental literature addressing sex differences in pain are reviewed in this presentation. Additionally, the presenters examine patterns of sex differences across different types of pain (eg, back pain vs fibromyalgia, acute pain vs chronic pain).

Michael R. Clark, MD, MPH, MBA

Many factors have been identified as predictive of acute pain becoming chronic. Unfortunately, the number of factors and the lack of consistent algorithms make the prediction and prevention of chronic pain difficult. A patient centered approach to developing a risk profile for a patient in acute pain can decrease the likelihood of this patient developing chronic pain and experiencing its associated consequences. Specific examples are reviewed from each relevant domain or perspective of this approach.

Paul Glare, MD
Jeffrey A. Gudin, MD
Barbara A. Murphy, MD
Neal E. Slatkin, MD, DABPM
Sharon M. Weinstein, MD, FAAHPM

This activity will provide clinicians with an interactive forum to review evidence-based and best practice guidelines on the recognition, assessment, diagnosis, and management of persistent and breakthrough cancer pain. Led by an expert faculty panel, the program will include practical insights into the available evidence and allow participants to share their clinical decision-making using interactive video case studies and iPod touch technology.

This activity is supported by an independent educational grant from Cephalon, Inc. This activity is certified for credit. Lunch will be served.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

Although hypnosis is one of the oldest healing modalities known in medicine, it is just beginning to take its place in modern medical practice. This presentation focuses on the modern theory and implementation of hypnosis in pain management settings.

Gary W. Jay, MD, DAAPM, FAAPM

This course describes various types of primary headache disorders and differentiates between migraine headache and other kinds of headache disorders. The presentation details diagnosis, acute treatment, and prophylactic measures that can reduce pain in patients who experience migraine headaches.

Christopher M. Herndon, PharmD, BCPS, CPE

The treatment of pain, while multifaceted, often centers on the rational use of multiple pharmacotherapeutic options. Opioids, co-analgesics, and adjuvant analgesics are efficacious treatment options; however, a sound understanding of the patient specific use of these medications is paramount. In this session, clinical pearls—focusing on selection of pharmacotherapy for pain using case-based learning—are shared.

*Recommended for PAINWeek "first time" attendees.

Roger B. Fillingim, PhD
Joseph L. Riley, III, PhD

While the presence of sex differences in pain is well documented, the mechanisms underlying these differences remain poorly understood. Existing evidence clearly indicates that a variety of biological and psychosocial factors contribute to sex differences in the experience of pain. For example, multiple lines of evidence suggest that gonadal hormones can substantially influence pain responses. Additionally, sex differences in the activation of pain inhibitory processes, such as the endogenous opioid system, have been reported. In addition, psychosocial factors such as gender roles, pain coping, and anxiety have been associated with sex differences in pain. This presentation discusses the mechanisms underlying sex differences in pain, using the biopsychosocial model of pain as the guiding framework for understanding this phenomenon. The potential interactions among biological and psychosocial factors are also points of discussion.

Peter Foreman, DDS, DAAPM

Practical management approaches to common orofacial pain problems are discussed, including vapocoolant spray and stretch, and trigger point injections. Prevention and management of oral neuropathies are briefly reviewed. Patient self-management programs are covered, followed by demonstrations of palpation and spray and stretch. Volunteers from the audience are solicited—there are usually several present with head and neck pain in these workshops. Trigger point injection techniques are demonstrated using very fine-gauge tuberculin syringes and acupuncture needles. Note: no local anesthetic will be injected. Practical work in pairs follows, with a final wrap-up and question and answer session.

Rebecca Curtis, ACC

Every clinician knows that certain modalities offer huge benefits to enhance a patient's ability to manage chronic pain, yet few patients follow through on “doctor's orders.” This leaves both patient and provider frustrated and discouraged. In this session, Rebecca Curtis shares several case studies from her own pain-management coaching experience to demonstrate the effectiveness that coaching has in breaking this cycle.

*Recommended for PAINWeek "first time" attendees.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

This presentation explores healthcare provider communication skills that help patients feel better and take an active role in self-care. Tips, techniques, and strategies for assisting patients and promoting compliance are covered.

Mary Lynn McPherson, PharmD BCPS, CPE

Acetaminophen is one of the most widely used analgesic/antipyretic medications in the United States, with over 25 million doses sold each year. While acetaminophen is safe and effective when used according to directions on nonprescription and prescription labeling, patients and their healthcare professionals are often unaware of the sources of acetaminophen in combination drug products, or the total daily dose of acetaminophen patients are taking. This is particularly important for patients taking multiple medications including acetaminophen/opioid combinations chronically. Join us at this educational program where Mary Lynn McPherson, PharmD, BCPS, CPE, will review the prevalence of acetaminophen use in the US, efficacy data as an analgesic when used as monotherapy and in combination with other analgesics, clinical scenarios where acetaminophen does not contribute additional pain relief, and common toxicities associated with acetaminophen.

Sponsored by Zogenix, Inc.
This activity is not certified for credit. Breakfast will be served.

Morning and afternoon breaks are built into the conference schedule, and these are good times to visit the exhibit hall. The PAINWeek Cyber Café is also located in the exhibit hall.

Thomas B. Gregory, PharmD, BCPS, CGP, CPE

Chronic pain affects millions of patients around the world. Unlike acute injury or insult that subsides with time and treatment, chronic pain lingers long after the initial injury. Those lingering effects impact not only the patient’s physiological but also their psychological well-being. This course presents evidence related to chronic pain syndromes, along with a case-based approach, to incorporate that information into daily practice.

*Recommended for PAINWeek "first time" attendees.

Roger B. Fillingim, PhD
Joseph L. Riley, III, PhD

In addition to recognizing sex differences in clinical and experimental pain, a substantial body of literature has addressed whether women and men respond differently to pain treatments. This session will address sex differences in responses to opioid analgesics, differences in responses to nonpharmacologic pain treatment, and whether predictors of response to pain treatment differ for women vs men. This session also devotes considerable discussion time to considering the clinical relevance of sex differences in pain and whether the existing literature justifies sex-specific tailoring of pain treatments.

Barbara L. Kornblau, JD, OTR/L, CPE

By 2014, almost all of the provisions of the health reform law called the Affordable Care Act (ACA) will take effect. What does this mean for pain clinicians, their patients, and the nation’s pain policy? And what happens in the meantime? This session reviews key provisions of the ACA and their potential impact on pain practice and pain patients. The presentation discusses how ACA strengthens the nation’s pain policy and, in juxtaposition, the current threats and challenges to ACA's existence.

Jennifer Bolen, JD
Eric Vinsant, JD

The pain community is in the midst of unprecedented legislative action and guideline overhaul as a result of the ever-growing problem of prescription drug abuse and diversion. Many states have passed laws governing the licensing and operation of pain clinics as a means of stopping the explosive growth of illegal “pill mills.” These new laws attempt to distinguish between proper and improper pain management, yet may have unintended consequences and impact on legitimate pain management operations. It is imperative that pain professionals take steps to understand legislative efforts in their own states and demonstrate compliance with new laws and guidelines. The workshop will focus on current events and provide specific updates on the impact of new laws and guidelines on dispensing and prescribing controlled medications. The workshop also reviews questions that the pain community has not yet addressed, and how these unanswered questions may impact developing clinical and regulatory guidelines.

*Recommended for PAINWeek "first time" attendees.

Barbara L. Kornblau, JD, OTR/L, CPE

Medication, surgery, heat, cold, and injections are not enough. People who live with pain must learn to redesign their lives to manage their pain and learn how to do things in a different way. This session explains how occupational therapists work with people—within their own environments, doing their own tasks—to effect lifestyle alteration in order to maximize participation and improve quality of life. Learn what occupational therapists do. Through case studies, determine when to refer to occupational therapy, and what patients and their providers can expect from it.

Michael R. Clark, MD, MPH, MBA
Myra Christopher
Kevin Pho, MD

Marcia J. Jackson, PhD, FACME

Health literacy describes a patient’s ability to read, understand, and act on health information, and by doing so, learn to function successfully. Health literacy is especially important to a pain educator, since the patients you think you are educating may be struggling to understand your instructions, unable to fill out your forms, or incapable of reading prescription labels or self-care instructions. Poor compliance is not only dangerous to the patient but also presents legal ramifications for the pain educator. Patient education materials should be prepared in such a way that they enhance the likelihood of patient understanding, yet many examples of current materials fall short. This session presents strategies for providers to support patients with low health literacy. Providers can do this by learning how to prepare materials at an appropriate reading level, by using effective communication methods, and by recognizing cultural differences that may contribute to low health literacy. The session also gives participants the opportunity to practice several of these strategies.

Clinical Implications of the Opioid REMS

Kevin L. Zacharoff, MD, FACPE, FACIP, FAAP

This presentation details the background and chronology of the events leading up to the requirement by the FDA for a Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioids. The discussion examines potential clinical implications of the opioid REMS for the frontline practitioner, and also offers suggestions for healthcare practitioners to prepare for the future of chronic pain management with opioid therapy.

*Recommended for PAINWeek "first time" attendees.

Anthony A. Whitney, MS, LHMC, BCB

This course introduces the utilization of general biofeedback and relaxation techniques that can be easily modified by the practitioner to meet clients' individual needs, using functionally appropriate formats. Heart rate variability biofeedback (HRV) has multiple clinical applications including pain management. Clinical observation supports the role of HRV in stabilizing states of emotional dysregulation and improves auto-regulation when utilized both during and between sessions. HRV can be used to build competence in emotional regulation, increase internal focus of control, and improve body awareness. HRV also promotes somatic awareness and differentiation via rapid access to different physiological states. Specific applications to improve client/patient outcomes are discussed.

Lisa McElhaney

Law enforcement has a long history of fighting diversion and prescription drug abuse. The present drug regulations and federal laws focus on physician prescribing while at the same time failing to investigate the many methods of pharmaceutical drug diversion. This presentation provides an analysis of the influencing factors that have enabled the explosion of pharmaceutical diversion, and a summary of the “red flags” that alert law enforcement to the activities of diversion and drug trafficking.

Ted W. Jones, PhD
Darren McCoy, FNP-BC

Frontline practitioners, due to various circumstances, find themselves taking on the treatment of medium-risk to high-risk chronic pain patients. This workshop offers practical suggestions for practitioners who want increased skills to help these patients. Various treatment protocols that have been successfully used in our practice are presented, along with monitoring techniques, medication options, and case examples.

Rebecca Curtis, ACC

Michael J. Brennan, MD

Join your colleagues to hear Dr. Michael Brennan discuss considerations for appropriate use and prescribing of selected transdermal and oral extended-release opioid analgesics in the management of moderate-to-severe chronic pain in patients requiring a continuous, around-the-clock opioid for an extended period of time.

Sponsored by Purdue Pharma L.P. This activity is not certified for credit. Breakfast will be served.

Joanne Loewy, DA, LCAT, MT-BC

Music affects and alters both the body and mind experiencing painful stimuli. Music has been used to treat pain in a multitude of ways arguably since the beginning of time—one example occurs as far back as the Old Testament story of Saul soothing David by playing the harp. Chronic pain can be of neuropathic origin and the cycle of one's pain experience can have severe ramifications on one's experience and quality of life. Music therapy and the alteration of pain are exemplified through live and case-study examples.

Morning and afternoon breaks are built into the conference schedule, and these are good times to visit the exhibit hall. The PAINWeek Cyber Café is also located in the exhibit hall.

Ted W. Jones, PhD
Darren McCoy, FNP-BC

Self-hypnosis, exercise, cognitive behavioral therapy—so many nonmedicinal techniques could be helpful to patients with chronic pain that a practitioner might wonder, “Where do I start?” This workshop outlines a practical treatment approach to teaching basic pain coping skills. Five core patient skills are outlined, and easy and practical ways for any practitioner to teach them to patients are presented in this interactive workshop. Outcome data are presented on a brief treatment program that shows promise for use in primary care and in busy practices.

Anthony A. Whitney, MS, LHMC, BCB

This course defines what biofeedback and relaxation techniques are and how such treatment modalities can be incorporated into the care of patients with chronic illness. We first identify and challenge common myths about biofeedback and relaxation techniques, and then learn how to determine when it is appropriate to explore the option of referring patients for biofeedback and relaxation services. We discuss various strategies to address the negative stigma and the potential of patient resistance often associated with the recommendation of biofeedback. Participants become more familiar with the benefits of biofeedback and more knowledgeable about the unusual challenges that patients may face while participating in biofeedback treatment.

John J. Burke

This presentation explores prescription drug abuse, and is designed to assist prescribers and their employees in recognizing and dealing with the prescription drug seeker. Following an overview of this issue in America today, common-sense solutions are offered for prescribers to effectively deal with drug seekers and, in doing so, protect their practices. The program is designed to make the vast majority of prescribers more comfortable in prescribing for legitimate patients, with the ultimate goal of increasing quality care to those truly in pain. Several examples of egregious prescriber behavior are reviewed, offering insightful examples of how prescribers can be significantly out of the scope of any professional’s idea of legitimate medical practice.

Michael E. Schatman, PhD, CPE

This presentation focuses on three models for improving chronic pain management in primary care: (1) a collaborative model, (2) a utilization of nurse practitioners and physician assistants model, and (3) a solo practitioner person centered pain treatment model. Strengths and weaknesses of each model are discussed, along with appropriate situations in which to consider them. Considerable emphasis is placed on strategies for primary care providers (PCPs) practicing in underserved areas including rural settings. The challenges of individual PCPs providing biopsychosocial treatment are outlined, with discussion of the use of Brief Motivational Interviewing within primary care as a compliance enhancing tool for pain patients.

*Recommended for PAINWeek "first time" attendees.

Stephen J. Ziegler, PhD, JD
Scott M. Fishman, MD
James C. Moeller, BS

In an effort to reduce the risk of overdose deaths and diversion associated with opioids, the state of Washington recently passed legislation that will require a pain consultation once a chronic, noncancer pain patient has reached 120 mg minimum effective dose per day (MED/day). Panelists discuss the extent of the national problem, how public policy is created, Washington state’s unique approach, and the need for increased collaboration between policymakers and prescribers.

Allen J. Togut, MD

Patients with neurogenic thoracic outlet syndrome usually present with pain, paresthesias, and dysfunction of the upper extremity. Unfortunately, the diagnosis is either discounted or not considered seriously, because there often is no muscle loss or atrophy and neurological examination of the upper extremity is limited. The traditional electromyographic/nerve conduction study (EMG/NCS), although done, is typically negative and therefore does not implicate the brachial plexus. This master class helps participants better understand this often-missed diagnosis—from comprehending it, to making the diagnosis, to providing appropriate treatment options.

Gary W. Jay, MD,DAAPM, FAAPM

Long-term 10-year survival rates that approach 59% in adults and 75% in children are increasing the percentage of patients with cancer who outlive their disease. Cancer survivors have poorer health outcomes across multiple measures after the diagnosis of cancer than do noncancer pain patients, and psychosocial difficulties in cancer survivors can significantly affect their pain. This master class addresses the numerous issues (psychiatric and social needs) and treatment options for cancer survivors who experience chronic pain.

Marcia J. Jackson, PhD, FACME

Knowing something and applying it in practice are two different outcome responses to an educational activity. The foundation for planning and assessing the outcomes of educational activities is an accurate description of the learning gap. This leads directly to the statement(s) of intended, measurable outcomes—which in turn leads to succinct learning objectives and appropriate activity plans. In this session, participants learn how to: identify levels of educational outcomes; differentiate knowledge-outcomes statements from application-outcomes statements; describe the instructional design links between outcomes, objectives, and activity design; and practice writing in both knowledge-outcomes and application-outcomes statements.

Kevin L. Zacharoff, MD, FACPE, FACIP, FAAP
Salma Lemtouni, MD

Drs. Lemtouni and Zacharoff discuss the challenges of the medical treatment of chronic pain in the geriatric patient population. In addition to correlating the increasing incidence of geriatric pain with the “aging of America,” comparisons of risks and benefits of specific medical treatment approaches are made. Also addressed are the context of existing clinical guidelines and practice recommendations, as well as other factors that should be considered for safe use of medical therapy in this patient population.

*Recommended for PAINWeek "first time" attendees.

Forest Tennant, MD, DrPH

This presentation discusses how peripheral pain, whether caused by injury or disease, may imprint itself permanently in the central nervous system (CNS). This profound discovery compels clinical practitioners to diagnose the presence of central pain and determine if the patient has central pain, peripheral pain, or a combination of the two. The hallmark of central pain is a history of constant pain and poor or nonresponse to peripheral pain treatments. Central pain occurs because of glial activation, after which follow neuroinflammation, tissue destruction, and cellular reformation. These CNS changes are associated with many clinical findings including hormone abnormalities, excess sympathetic discharge, and a variety of mental changes. Treatment of central pain optimally requires tissue regeneration.

Charles Argoff, MD
Michael Brennan, MD
Paul Doghramji, MD, FAAFP
Douglas Schottenstein, MD

This activity is supported by educational grants from Janssen Pharmaceuticals, Inc., administered by Janssen Scientific Affairs, LLC. and Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com. This activity is certified for credit. Lunch will be served.

Lisa McElhaney

Organized prescription drug fraud rings are becoming commonplace in our society. This block of instruction provides an overview of the structure of an organized fraud ring and the steps that law enforcement followed to dismantle the operation.

Barbara L. Kornblau, JD, OTR/L, CPE

The motivational interview is an approach developed by psychologists Miller and Rollnick to treat alcoholism and substance abuse. This session explores how to assess and enhance a patient’s willingness, ability, and readiness to embrace behavior change. Specifically, participants learn about Motivational Interviewing, which has been shown to have better outcomes than traditional care, including the ineffective “should”–ing of a patient.

Michael E. Schatman, PhD, CPE

Chronic pain patients represent an extremely vulnerable population, particularly because of deficiencies in the quality of treatment they often receive, as well as medicolegal and reimbursement pitfalls. Theories regarding advocacy by clinicians have been posited, although there exists considerable disagreement regarding the extent to which advocacy is appropriate or even beneficial to patients. Ethical and practical implications of advocating for chronic pain patients are addressed from different perspectives.

Presented by Clinician Reviews.

*Recommended for PAINWeek "first time" attendees.

Eric J. Larson, MD

“Ouch, that hurts! I need to be seen!” Acute pain is the number one reason for a visit to the Emergency Department, whether it is abdominal pain, chest pain, or pain from a broken bone. While treatment of the underlying condition is often the most effective means to alleviate the patient’s pain, there are also numerous general principles for clinicians to employ while tending to their patients in the emergency room.

*Recommended for PAINWeek "first time" attendees.

Rebecca Curtis, ACC

Bruce Nicholson, MD

Geared to the frontline clinician, this course discusses establishing a diagnosis and matching appropriate procedure to diagnosis. Curative vs palliative and acute vs chronic back pain are described and delineated. Additionally, the material covers components of the clinical assessment (medical history, physical and neurologic examination, and neuroanatomic imaging) for patients with low back pain (LBP).

Forest Tennant, MD, DrPH

This presentation discusses pain and opioids and their different effects on the endocrine system. Pain is the ultimate stressor. When pain is uncontrolled, the pituitary-adrenal axis secretes excessive amounts of cortisone and other hormones in an effort to heal the offending cause of pain. Over time, the pituitary, adrenals, and gonads may exhaust, causing a multitude of complications. Opioids commonly suppress the component of the pituitary that produces testosterone, so clinicians who prescribe opioids must be prepared to replace this important hormone. Opioids seldom suppress other hormones to the point that replacement is necessary. Certain hormones, particularly medroxyprogesterone and human chorionic gonadotropin, appear to have central nervous system regenerative capabilities and show early promise in treating intractable ceainntral

Morning and afternoon breaks are built into the conference schedule, and these are good times to visit the exhibit hall. The PAINWeek Cyber Café is also located in the exhibit hall.

Bruce Nicholson, MD

This presentation continues the discussion of low back pain (LBP) with a specific focus on evaluation and treatment of facet joint arthropathy. Degenerative disc and facet disease are discussed, along with intra-articular facet blocks. Indications, benefits, and complications of facet rhizotomy are also discussed.

Mary Lynn McPherson, PharmD, BCPS, CPE
Thomas B. Gregory, PharmD, BCPS, CGP, CPE
Michelle A. Lamantia, MD, CPE
Christopher M. Herndon, PharmD, BCPS, CPE

The Certified Pain Educator (CPE) credential is being increasingly sought by practitioners who want to demonstrate achievement of a measurable level of competency in this important field. Participants in this session will learn about the process of fulfilling requirements that will qualify them to sit for the CPE examination. This panel of experts will also describe how the CPE credential allows and encourages practitioners to expand their practice opportunities in a variety of settings including inpatient, outpatient, and academia.

*Recommended for PAINWeek "first time" attendees.

Steven D. Passik, PhD

This presentation addresses the clinical phenomenon of chemical coping and focuses on a framework for working with patients who use this method to try to control their pain. The measurement of chemical coping will be highlighted as will motivational strategies. Specifically, this course covers diagnosis, offers structured treatment paradigms for the care of the chemical coper, and provides motivational strategies for working with this group of pain patients.

Lisa McElhaney

Pharmaceutical diversion is a widespread epidemic across the nation. In any effort to combat the numerous facets of this problem, one must be able to clearly understand the basic elements of diversion and the cycle of fraudulent activities. This presentation identifies the elements of a basic prescription drug fraud case, from describing the workings of a detailed “pill mill” operation to explaining the variety of codependent relationships that exist in each area. This provides for legitimate medical practitioners the ability to recognize the many tricks and trends of diverters, in order to prevent criminal activity from entering their own medical offices.

Eric J. Larson, MD

"Ouch, I still hurt! I have been hurting for a long time, and the only thing that works is Dilaudid!" Chronic pain is a daily complaint in the Emergency Department and it is difficult to differentiate the acute worsening of a chronic condition vs a patient seeking drugs for pleasure. In this session, these patients (“drug seekers”) and their management is the topic of discussion. Concrete suggestions are offered for dealing with the addicted patient seeking pain medication for nonmedical conditions.

*Recommended for PAINWeek "first time" attendees.

Mary Lynn McPherson, PharmD, BCPS, CPE

Pain educators are frequently asked to develop educational materials for patients and peers. This session covers how to conduct an audience needs assessment, craft learning objectives, develop educational materials, and devise assessment activities. Principles of adult learning and active learning strategies will be stressed.

Joseph V. Pergolizzi, MD

Michael E. Schatman, PhD, CPE
John F. Peppin, DO, FACP
Ana Smith Iltis, PhD

This panel presents the conflict that exists in the treatment of chronic pain patients. Patients in pain clinics are frequently required to submit to a range of procedures such as pill counts, urine screens, and similar demoralizing testing, in a very paternalistic setting. Many times patients are discharged if they do not comply with requirements such as these. Conversely, autonomy is described as the foundation of the patient–physician encounter. How are these two apparent conflicting settings reconciled? This panel discusses this conflict and recommends potential resolutions.

Jennifer Bolen, JD
Eric Vinsant, JD

Licensing boards and investigative authorities often view drug testing as a standard of care when medical treatment involves the long-term use of controlled medications. Conversely, payers may take a more restrictive view of drug testing in pain management and challenge the nature and frequency of drug testing through denial of claims as well as a myriad of financial recovery tools. While there may not be universal agreement on the nature and frequency of drug testing, clinical and regulatory guidelines may aide the practitioner in establishing or re-evaluating a drug testing platform in the private practice. Whatever a practice’s current testing platform, it is critical that providers have and can produce compliance documentation tying their plan for drug testing to clinical and regulatory guidelines to improve chances of surviving a fraud, waste, and abuse investigation and a legal challenge to prescribing of controlled medications. This workshop will focus on the "how to" development and evaluation of a drug testing platform and a compliance plan to facilitate proper testing and documentation.

Mary Lynn McPherson, PharmD, BCPS, CPE

Assessing a pain complaint is a critically important step in pain management, and is a major consideration in drug therapy selection. Participants in this session learn about the pathogenesis and clinical presentation of pain in a variety of advanced illnesses including cancer, cardiovascular disease, neuromuscular disorders, respiratory disease, and other common causes of advanced illness.

Kathryn L. Hahn, PharmD, DAAPM, CPE

Opioids are a mainstay of therapy for moderate-to-severe pain. Practitioners are fortunate to have the choice of numerous opioids and a wide variety of dosage formulations to best tailor treatment plans to individual patients. Participants in this program learn how to select from the opioids, based on drug-related and patient-related variables, including choosing between (or converting between) short-acting and long-acting opioids, and how to appropriately dose opioids for breakthrough pain.

*Recommended for PAINWeek "first time" attendees.

Joseph V. Pergolizzi, MD

Srinivas Nalamachu, MD
James Rho, MD

This program introduces a unique transmucosal fentanyl that has been shown to be effective for treating breakthrough cancer pain in opioid-tolerant patients. Patient cases will be presented both to highlight the safety and tolerability of sublingual fentanyl as well as to give healthcare providers insight into how this medication can be used effectively and appropriately in their own practice to manage breakthrough pain in patients with cancer. Sponsored by ProStrakan, Inc. This activity is not certified for credit. Breakfast will be served.

Mary Lynn McPherson, PharmD BCPS, CPE

Acetaminophen is one of the most widely used analgesic/antipyretic medications in the United States, with over 25 million doses sold each year. While acetaminophen is safe and effective when used according to directions on nonprescription and prescription labeling, patients and their healthcare professionals are often unaware of the sources of acetaminophen in combination drug products, or the total daily dose of acetaminophen patients are taking. This is particularly important for patients taking multiple medications including acetaminophen/opioid combinations chronically. Join us at this educational program where Mary Lynn McPherson, PharmD, BCPS, CPE, will review the prevalence of acetaminophen use in the US, efficacy data as an analgesic when used as monotherapy and in combination with other analgesics, clinical scenarios where acetaminophen does not contribute additional pain relief, and common toxicities associated with acetaminophen.

Sponsored by Zogenix, Inc.
This activity is not certified for credit. Breakfast will be served.

Rebecca Curtis, ACC

Hal Blatman, MD, DAAPM, ABIHM

Carpal tunnel syndrome (CTS) has been largely defined and treated as an inflammatory condition caused by repetitive strain injury. Surgical treatment was first recorded in the 1920s and continues to be an option. Other treatments include various chiropractic, physical therapy, and modality techniques and/or nutritional or vitamin therapies. Diagnostic studies include measurement of carpal canal size, electrodiagnostics, thermal imaging, and physical examination tests. In the past several years, musculoskeletal ultrasound has been researched as a diagnostic tool with application to CTS. In addition, medical understanding of the anatomy of fascia has evolved. These advances have given rise to new ideas of pathophysiology and treatment for CTS. This course will identify theories and causes of, and compare treatment options for, CTS.

Mary Lynn McPherson, PharmD, BCPS, CPE

Many patients receiving opioids will need to switch from one opioid to another during therapy, or at least from one dosage formulation or route of administration to another. During this session, practitioners learn to recognize clinical situations in which opioid switching would be appropriate. Attendees will also work on a problem set designed to sharpen skills in opioid conversion calculation.

R. Norman Harden, MD

Postamputation pain is ubiquitous in amputees, but very poorly understood by those who treat these patients. This presentation discusses possible pathophysiology with an eye to therapeutic targets.

Presented by The Federal Practitioner.

*Recommended for PAINWeek "first time" attendees.

Daniel B. Carr, MD, FABPM
Melanie Thernstrom

The patient and clinician do not merely bring different perspectives to bear on a clinical encounter, they occupy different universes. They are—literally and figuratively—living the problem in different ways. The patient suffers not only from pain intensity, but from stress, loss of function, diminished quality of life, and a host of important emotions and considerations that remain unseen from the clinician’s view. While the patient is preoccupied with the complexity and inability to describe the experience, the clinician is focused on trying to reduce that complexity in order to assemble signs and symptoms into a biomedical model that will allow him or her to come to a conclusion about treatment. This master class is a dialogue between a journalist and a pain specialist and researcher. Dr. Carr will teach the basic biomedical framework by which clinicians assess and treat pain—how to locate the pain generator and choose a treatment option. Ms. Thernstrom will address the interpersonal dynamics of the clinical encounter, as informed both by her work as a journalist and as one of the authors of the Institute of Medicine (IOM) report Relieving Pain in America: A Blueprint for Action. While serving on the committee, Ms. Thernstrom reviewed 2000 responses from pain patients and clinicians who completed a public survey. From this volume of testimony, she has distilled the principle concerns and frustrations of clinicians and pain sufferers and what they are seeking from clinical encounters. The dialogue then examines current scientific research that validates some of these experiential aspects of pain and sheds light on their biological substrates. Examples include hormonal and brain imaging studies of pain-related phenomena, such as the feeling of isolation and the engagement/empathy for another’s pain. Participants learn how to leverage these ideas to create a more successful and mutually satisfying clinical encounter.

Peter Foreman, DDS, DAAPM

Howard A. Heit, MD, MSc, FACP, FASAM
Douglas L. Gourlay, MD, FRCPC, FASAM

Urine Drug Testing (UDT) is playing an increasing role in the management of risk in clinical care. Unfortunately, drug testing in general suffers from several shortcomings, especially when relied on to identify problematic use of controlled substances, including drug diversion. UDT is the preferred tool in patient centered care. It can offer clinicians valuable insight into the identification, treatment, and monitoring of their patients while providing objective data in risk evaluation and minimization strategies necessary for responsible clinical care. Drs. Heit and Gourlay present a two-hour session that gives attendees the unique experience of examining several interactive UDT cases. Through a combination of didactic and case-based learning, this session helps participants explore UDT in a defensible, rational, and compassionate fashion.

Robert A. Bonakdar, MD, FAAFP

Historically, acupuncture and auricular therapy have been utilized in the treatment of pain and related disorders. More recently, scientific evaluation has provided mechanistic understanding of these techniques, including tissue and neurobiological modulation. Additionally, recent clinical trials have demonstrated the efficacy of acupuncture in the setting of acute pain and migraine prevention. The 2009 Cochrane review stated, “Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and [has] fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.” The presentation discusses the background and various techniques involved in acupuncture and auricular therapy and reviews the evidence regarding these methods and how they can be clinically incorporated in the treatment of acute and chronic headache and neck pain.

Christopher M. Herndon, PharmD, BCPS, CPE

Alternative administration techniques for the delivery of analgesics and anesthetics are commonplace in the management of pain. Several new topical and transdermal analgesics have been recently approved or are in late-stage development. This session will review the physiology of the epidermis as it relates to drug delivery and the pharmacologic properties of analgesics or anesthetics commonly administered topically or transdermally.

*Recommended for PAINWeek "first time" attendees.

Sean Mackey, MD, PhD, CPE

Chronic pain affects millions of patients worldwide, costing billions of dollars in medical expenses. Only recently has the CNS been shown to play a pivotal role in the generation and maintenance of chronic pain. Investigators have used functional magnetic resonance imaging (fMRI) and other neuroimaging tools to open windows into the brain in order to better characterize the neural correlates of pain. They have discovered that certain brain regions involved with pain include the somatosensory cortex, prefrontal cortex, anterior cingulate cortex, and insular cortex. Other imaging technologies, such as structural imaging, magnetic resonance spectroscopy, and diffusion tensor imaging have provided insights into the anatomic, chemical, and connectivity changes, respectively, induced by pain. This session reviews the current neuroimaging data for pain and describes the abnormalities shown in the frontal and limbic brain systems. Also explained are the brain changes involved with both evoked stimuli in pain as well as changes seen in the resting brain. At the end of this lecture, participants will have a better appreciation of the neural plasticity involved with pain and its therapeutic implications.

Michael R. Clark, MD, MPH, MBA

Pain transmission and processing occurs in the peripheral and central nervous system. Acute pain serves as a warning to prevent damage. Chronic pain is defined as pain that persists beyond acute pain or beyond the expected time of normal healing. This presentation will review pain pathways in the peripheral and central nervous system and the mechanisms leading to the development of chronic pain.

Sponsored by Lilly USA, LLC. This activity is not certified for credit. Lunch will be served.

Robert A. Bonakdar, MD, FAAFP

Stress is a common presenting complaint in patients in the clinical setting. Patients with chronic pain as well as those with specific pain disorders (headache, irritable bowel syndrome, etc) have a higher burden of stress-related disorders, which can significantly impact onset and/or progression, as well as cause a decline in their general health. The behavioral, cardiometabolic, and cognitive impact that stress can have may combine detrimentally in areas already affected in chronic pain patients, such as brain atrophy. Evidence shows that stress management techniques (mindfulness, meditation, biofeedback) may improve parameters of pain as well as patients' self-management and coping strategies. This presentation covers how these techniques can be incorporated as components of clinic- and home-based therapies to address stress and improve pain management.

Thomas B. Gregory, PharmD, BCPS, CGP, CPE

Every pharmacologic agent used by modern medicine carries the risk of side effects, and opioids are no exception to this rule. One of the most widely known side effects is constipation; however, there are a multitude of other side effects ranging from those that are simply benign or annoying to those that are potentially severe or even life threatening. This course affords the participant a broader appreciation of the common and not-so-common side effects of opioids.

Sean Mackey, MD, PhD, CPE

With the dramatic increase in the amount of prescription opioids used for the treatment of pain, opioids have become the most commonly prescribed medication class in the United States. Vicoden® is the most prescribed medication, at 128 million prescriptions per year. Opioids remain the gold standard of treatment for moderate-to-severe acute and chronic pain. Despite this high usage, increasing evidence shows that chronic use of opioids has deleterious effects on the patient. In this session, we review the positive aspects of opioid use for chronic pain as well as the negative consequences. We specifically examine the current literature on opioid-induced hyperalgesia, opioid-induced androgen deficiency, and the effects of opioids on the immune system. Additionally, we present recent evidence from our lab demonstrating the effects of prescription opioids on the human brain.

*Recommended for PAINWeek "first time" attendees.

Peter Foreman, DDS, DAAPM

Howard A. Heit, MD, MSc, FACP, FASAM
Douglas L. Gourlay, MD, FRCPC, FASAM

The concept of “therapeutic trial of therapy” has been an important part of clinical medicine, never more so than with the recent increased use of agonist classes of drugs such as opioids and benzodiazepines. The notion that “those who don’t need these agents come off them easily” has failed miserably as a clinically useful concept. Those who struggle are often mislabeled as “addicted,” while those who don’t struggle are sometimes presumed to be diverting the prescribed agent. In fact, physical dependency, withdrawal, and tolerance are all subject to intrapersonal and interpersonal variability. Drs. Heit and Gourlay present a two-hour session that gives attendees a rational look at tapering, substitution, and ultimate discontinuation of several common, dependency-producing agents. This session emphasizes the concept of abandoning the molecule, not the patient, in a manner that is defensible, rational, and compassionate.

Joseph V. Pergolizzi, MD

PAINWeek’s Scientific Poster and Abstracts Committee Chairman Joseph V. Pergolizzi, MD, will be joined by Joseph W. Stauffer, DO; Robert Raffa, PhD; Rami Ben-Joseph, PhD; Edmundo Muniz, MD, PhD; Sri Nalamachu, MD; and Errol Gould, PhD; for a two-hour plenary session on pain clinical trials. The expert panel will speak to FDA regulations and testing for pain products, analgesic preclinical testing, designing components of analgesic clinical trials, HOPE (hospital visit is an opportunity for prevention) studies in analgesic drug development, and investigator initiated trials. The panel then offers a concluding discussion.

Please note that this session is not certified for credit.

Rebecca Curtis, ACC

R. Norman Harden, MD

Headache research is problematic due to the absence of animal models and sketchy diagnostic criteria. This session will delineate the “broad stroke” categories of head pain, with emphasis on neck pathology.

Ronald J. Rapoport, MD, FACR

The differential diagnosis of a patient entering a healthcare provider’s office with monoarticular, oligoarticular, or polyarticular presentation can provide a daunting challenge. This session reviews a logical approach based on Dr. Rapoport’s clinical experience. Also included are a review of the literature and selected clinical studies.

*Recommended for PAINWeek "first time" attendees.

Morning and afternoon breaks are built into the conference schedule, and these are good times to visit the exhibit hall. The PAINWeek Cyber Café is also located in the exhibit hall.

Hal Blatman, MD, DAAPM, ABIHM

Myofascial medicine has been a developing field in pain management since the 1940s. Many believe that the myofascia is part of most pain symptoms in the body. New understanding of both the anatomy of fascia as well as autonomic nervous system integration provides insight that leads to a more comprehensive treatment plan for pain patients. This treatment plan integrates trigger point injections, prolotherapy, platelet-rich plasma (PRP) and regenerative therapy injections, myofascial release, and other body work disciplines. This session identifies the connection between stress and pain and the impact on fascia anatomy. Herbal therapies and compounding pharmacy solutions are addressed as well.

Jennifer Bolen, JD
Eric Vinsant, JD

Practitioners’ claims are often denied as a consequence of failure to document medical necessity for drug testing. Payers either have adopted or are in the process of adopting coverage determinations and/or policies governing the medical necessity for qualitative drug screening. Failure to document medical necessity may also detract from the prescriber’s rationale for the ongoing use of controlled medications, potentially increasing liability for inappropriate prescribing. Proper documentation is critical to demonstrating good faith compliance with clinical guidelines and licensing board/DEA guidelines/rules tied to the use of controlled medication. This workshop offers case examples of both sufficient and insufficient documentation of medical necessity for drug testing, and also provides a survey of current coverage determinations and medical policies of the major carriers.

Mary Lynn McPherson, PharmD, BCPS, CPE

Pain is a common symptom associated with advanced illness, and is frequently complex in presentation and management. This session reviews the management of pain associated with both cancer and noncancer advanced illness, with emphasis on how to craft rational polypharmacy regimens, and how to adjust therapy based on patient response.

*Recommended for PAINWeek "first time" attendees.

Ronald J. Rapoport, MD, FACR

The diagnosis of an older patient with musculoskeletal pain can be a true challenge for all of us. Take into consideration associated illnesses that pose an even greater threat, and all of our clinical skills are needed to point the care of the patient in the right direction. The presentation and clinical approach to polymyalgia rheumatica (PMR) and giant-cell arteritis (GCA) provide just such a challenge. Diagnosis, treatment, and further concerns are reviewed in this course.

Yvonne D'Arcy, MS, CRNP

This presentation discusses all aspects of acute pain management using an evidence-based format. Many practices continue in acute pain management although there may not be adequate research support. This presentation looks at acute pain management treatments and includes a discussion of the evidence that supports their use. Discussed will be pain management techniques such as preemptive analgesia, safe patient controlled analgesia (PCA), and regional analgesic blocks.

Presented by the Journal of Family Practice.

Geralyn Datz, PhD

“Just get me out of this pain! I need medicine!” When patients present to pain professionals, they are often desperate, but also uninformed. Opioids can increase functionality and provide reduction in chronic noncancer pain to some patients. However, opioids are also dangerous, misused, can activate addiction potential, and are associated with rising overdose deaths. This perplexing current situation can lead to poor treatment outcome, misunderstanding, nonadherence, and confusion for patients as well as frustration for providers. Patient centered health care suggests using “shared decision-making” between prescribers and their patients. This presentation reviews practical strategies for using effective spoken and written communication to help your patients prepare for chronic opioid therapy.

*Recommended for PAINWeek "first time" attendees.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

Mary Lynn McPherson, PharmD, BCPS, CPE

Magic, mystical, mysterious methadone is an excellent opioid that requires special handling. Participants in this program will learn about the unique pharmacokinetic and pharmacodynamic properties of methadone, how to initiate methadone therapy in an opioid-naïve patient, and how to switch patients from other opioids to methadone. Participants also learn appropriate titration strategies as well as how to monitor a patient converted from another drug to methadone.

Mark A. Young, MD, MBA, FACP

Knee and ankle pain are common regional causes of pain that pose diagnostic and treatment challenges to the clinician. Accurate evaluation of the multiple causes of these musculoskeletal conditions is based on a comprehensive knowledge of associated biomechanical and anatomical features. This lecture provides an overview of common pain conditions associated with the knee and ankle. An analysis of underlying kinesiologic and structural characteristics is highlighted.

Lynn R. Webster, MD, FACPM, FASAM

This interactive program is framed around the principles of the NIPC® Critical Thinking Model for Chronic Opioid Therapy. Integrating these principles into your practice can aid in responsibly and appropriately prescribing opioids, fostering compliance with state and federal regulations, and optimizing analgesia for your patients. This symposium will utilize audience response technology (ARS) to encourage ongoing interaction between you, the expert faculty, and your colleagues.

This independent medical education activity is sponsored by the American Pain Foundation (APF) and supported through an educational grant from Endo Pharmaceuticals. This activity is not certified for credit. Breakfast will be served.

Geralyn Datz, PhD

This presentation teaches providers how to identify the sources of problematic behavior in their patients and offers strategies for reducing the impact of this difficult behavior on their pain management goals. Participants learn how to identify unusual prescribing patterns of their patients as well as their verbal and interactional behaviors that are especially counterproductive. Provided communication techniques will promote mutual understanding, diffuse tension, de-escalate negative interactions, promote limit-setting, and minimize obstructions in care.

Kathryn L. Hahn, PharmD, DAAPM, CPE

Extensive evidence demonstrates the analgesic efficacy of adjuvants, anti-inflammatories, and simple analgesics. The use of these classes of medications for chronic pain using rational polypharmacy may allow sparing of the use of opioids, but new studies question the safety of certain nonopioids. Therefore, knowledge of the pharmacology of nonopioids is important to ensure that analgesic treatment decisions are based on the best available information.

Colleen M. Fitzgerald, MD

This session focuses on the epidemiology and impact of female chronic pelvic pain (CPP) including its known pathophysiology, differential diagnosis, and the clinical diagnosis and treatment of CPP along with specific rehabilitation approaches. This includes an interdisciplinary approach to CPP and current modalities utilized such as manual therapy; motor control training; joint/trigger point, sympathetic, botulinum-toxin injections; psychological interventions to reduce anxiety and catastrophizing; and the rational application of neuromodulatory pain medications including the controversial role of opioids. New research in the field will be highlighted. The presentation helps learners enhance their care of female CPP patients.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

*Recommended for PAINWeek "first time" attendees.

Daniel B. Carr, MD, FABPM
Melanie Thernstrom

The increasingly sophisticated nature of pain research has allowed examination and analysis of complex, subtle processes inaccessible to earlier investigators. Such processes include reconstruction of others’ subjective experience through premotor “mirror” neurons, activation of limbic circuitry during empathy, neuroendocrine effects upon cognition, provision of and patient satisfaction with pain care as a social process, and the impact of social isolation or nurturing on the affective correlates of nociception. The widening of scope parallels broader developments in postmodern science and mathematics, deepens our understanding of the intersubjective and biopsychosocial qualities of pain, and emphasizes the importance of qualitative and narrative approaches to studying and educating others about the topic of pain. These recent developments in pain research make it clear that pain education requires more than simply a description of the machinery of nociception. Pain educators have begun to design curricula that supplement neuroanatomy and pharmacology with (in Murinson’s words) “socio-emotional experiences.” This presentation surveys these challenges and the efforts of Tufts’ decade-old program in pain research, education, and policy to inform its approach to interdisciplinary pain education through the incorporation of these recent insights.

David M. Glick, DC, DAAPM, CPE

The prevalence of back pain continues in spite of the many treatments available, without any single treatment emerging as a panacea. In routine clinical practice, clinical examinations have tended to become more cursory, the result of increasing demands on clinicians’ time and possible over-reliance on technology. It has been suggested that the failure to adequately differentially diagnose the cause of back pain can account for clinical failures in treatment. The purpose of this discussion is to assist the clinician in the development of a more specific problem-focused examination that can enhance the differential diagnosis of specific pain generators and lead to more patient specific treatment. Attention is given to considering all aspects of the examination, including physical assessment as well as imaging studies, plus the clinician’s ability to recognize pathologies seen on imaging studies as clinically significant or not. The importance of considering how failed treatments influence the differential diagnosis is also discussed.

Allen J. Togut, MD

Mary Lynn McPherson, PharmD, BCPS, CPE

Patients with advanced illnesses may experience a wide range of symptoms in addition to pain. Participants in this session will learn about the management of cardiorespiratory symptoms (dypsnea, secretions, cough), genitourinary symptoms (urinary incontinence and retention, bladder spasms), and gastrointestinal symptoms (nausea/vomiting, constipation, diarrhea, anorexia/cachexia).

Mark A. Young, MD, MBA, FACP

Patient pain arising regionally in the hip and lower extremity often poses a diagnostic and therapeutic challenge to the treating clinician. Differentiation of the various etiologies associated with these conditions requires a thorough anatomical and biomechanical understanding of potential causes and exacerbating factors. This presentation offers a comprehensive overview of the gamut of musculoskeletal pain states and diagnoses responsible for regional lower extremity pain.

Yvonne D'Arcy, MS, CRNP

Using a case-based approach, several patient profiles are presented for discussion. In each case the patient presents with a complaint of pain and the presentation focuses on diagnosis and treatment options. The audience is invited to participate and discuss treatment choices and alternate options for pain management. This approach is particularly helpful for practitioners who see large numbers of patients in a general practice.

*Recommended for PAINWeek "first time" attendees.

Richard Glickman-Simon, MD

The successful management of a complex problem like chronic pain almost always depends on a multidisciplinary strategy equal to the task. As evidence continues to mount in support of this observation, pain educators are beginning to recognize the value of creating interprofessional partnerships across educational programs and institutions that have overlapping missions. Dr. Glickman-Simon reviews the potential benefits and risks associated with these collaborative initiatives and discusses in some detail one such innovative alliance between Tufts University School of Medicine and the New England School of Acupuncture. The session concludes with a consideration of how emerging educational methodologies and innovations can broaden alliances across disciplines and geographical locations.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

*Recommended for PAINWeek "first time" attendees.

Robert D. Sproul, PharmD

Both within and outside the palliative care setting, novel approaches are being considered or implemented to manage severe neuropathic pain. Two such treatment modalities of interest are the off-label use of ketamine and lidocaine for analgesia rather than as an anesthetic or for rhythm control. The evidence base for use of these agents to treat severe pain is limited to small studies, weak evidence, anecdotal stories, and case reports. Additional research is necessary to corroborate the safety and efficacy of these medications for off-label uses. Granted, the utilization of ketamine or lidocaine as an analgesic for a select population of patients under a given set of conditions may be appropriate. However, practitioners must have the necessary education about the limitations and benefits of these medications to make informed decisions about whether and when to use them.

John F. Peppin, DO, FACP
John J. Coleman, MA, MS, PhD

This session discusses the history and development of REMS up to the recent failed submission by the FDA of a class-wide REMS. It reviews the weaknesses of REMS and discusses why we currently do not have a class-wide REMS for long-acting opioids. It also reviews current REMS for ultra-short–acting opioids. This panel will review published recommendations for a REMS that would address the FDA’s own goal terms, which included reduction of “abuse, misuse, addiction, and overdose deaths.”

Ylisabyth Bradshaw, DO, MS

The human social instincts of empathy and compassion underlie the entire healing enterprise. This session explores how to construct pain-related curricula that both convey objective knowledge and also create communities of engaged learners who support each other through a shared sense of collegiality rather than professional rivalry. These professionals’ compassion for patients is deliberately sustained and fostered by the curriculum and the context within which it is provided as well as the role models who epitomize this paradigm.

Mark A. Young, MD, MBA, FACP

Although pain is well recognized to affect both men and women, accumulating scientific evidence suggests that each sex experiences pain in very different ways. A recent symposium on gender and pain sponsored by the National Institutes of Health (NIH) provided a comprehensive scientific synopsis of research developments in this area. This master class highlights the key musculoskeletal conditions frequently treated by physiatrists that are likely to be influenced by gender-specific pain, including osteoarthritis, rheumatoid arthritis, migraine headache, tension headache, knee injury, fibromyalgia, carpal tunnel syndrome, facial pain, and osteoporosis. The session systematically reviews sex-related differences that distinguish men and women. This is followed by a consideration of specific putative mechanisms proposed by scientific investigators to explain why pain experienced by men and women is so radically different. Knee degenerative joint disease with its differential gender-specific manifestations is given special focus. An expanded discussion of scientifically supported complementary and integrative medical strategies (eg, acupuncture, music therapy, hypnosis) in the rational management of women's pain is also covered. The presentation concludes with a brief summary to guide frontline pain clinicians in their recognition and practice of gender-based pain evaluation and management.

Carol P. Curtiss, MSN, RN-BC

Socio-cultural, ethical, and organizational values and beliefs produce different expectations about pain and pain relief among individuals and organizations. Education alone in this area rarely produces practice changes. This session discusses challenges and opportunities inherent when integrating biopsychosocial, cultural, and ethical aspects of pain and pain management into education and everyday practice. Strategies to promote organizational change to improve pain care are also discussed.

Michael B. Ellner, CHt, MSH
Daniel F. Cleary

Robert D. Sproul, PharmD

A basic principle of palliative care is to embrace the concept (goal) of optimal patient comfort by addressing a patient’s emotional, physical, social, and spiritual needs through appropriate global assessment and symptoms management. Neuropsychiatric symptoms at end of life—such as anxiety, depression, and delirium—may significantly impact or undermine a clinician's efforts to achieve the goals of comfort and quality of life in the patient's final days. Pharmacologic management is an important component of treating neuropsychiatric symptoms at the end of life and is the emphasis of this training. However, it is essential to use a holistic approach with the necessary psychosocial and spiritual support systems in place to best serve the needs of our end-of-life patients.

Mary Lynn McPherson, PharmD, BCPS, CPE

Medications are used extensively to manage pain and nonpain symptoms associated with advanced illness. It is imperative that practitioners be knowledgeable about new drugs and dosage formulations introduced to the market. Participants learn about the indications, dosing, adverse effects, drug interactions, and appropriate use of new analgesics and other medications used for palliative care in this fast paced discussion.

*Recommended for PAINWeek "first time" attendees.

Joanne Loewy, DA, LCAT, MT-BC

Thursday/9.8
8:35 AM - 9:30 AM

Ted W. Jones, PhD; Darren McCoy, FNP-BC

Frontline practitioners, due to various circumstances, find themselves taking on the treatment of medium-risk to high-risk chronic pain patients. This workshop offers practical suggestions for practitioners who want increased skills to help these patients. Various treatment protocols that have been successfully used in our practice are presented, along with monitoring techniques, medication options, and case examples.

Thursday/9.8
10:00 AM - 10:55 AM

Ted W. Jones, PhD; Darren McCoy, FNP-BC

Self-hypnosis, exercise, cognitive behavioral therapy—so many nonmedicinal techniques could be helpful to patients with chronic pain that a practitioner might wonder, “Where do I start?” This workshop outlines a practical treatment approach to teaching basic pain coping skills. Five core patient skills are outlined, and easy and practical ways for any practitioner to teach them to patients are presented in this interactive workshop. Outcome data are presented on a brief treatment program that shows promise for use in primary care and in busy practices.

Saturday/9.10
7:30 AM - 8:25 AM

Geralyn Datz, PhD

“Just get me out of this pain! I need medicine!” When patients present to pain professionals, they are often desperate, but also uninformed. Opioids can increase functionality and provide reduction in chronic noncancer pain to some patients. However, opioids are also dangerous, misused, can activate addiction potential, and are associated with rising overdose deaths. This perplexing current situation can lead to poor treatment outcome, misunderstanding, nonadherence, and confusion for patients as well as frustration for providers. Patient centered health care suggests using “shared decision-making” between prescribers and their patients. This presentation reviews practical strategies for using effective spoken and written communication to help your patients prepare for chronic opioid therapy.

Saturday/9.10
8:35 AM - 9:30 AM

Geralyn Datz, PhD

This presentation teaches providers how to identify the sources of problematic behavior in their patients and offers strategies for reducing the impact of this difficult behavior on their pain management goals. Participants learn how to identify unusual prescribing patterns of their patients as well as their verbal and interactional behaviors that are especially counterproductive. Provided communication techniques will promote mutual understanding, diffuse tension, de-escalate negative interactions, promote limit-setting, and minimize obstructions in care.

Thursday/9.8
7:30 AM - 8:25 AM

Anthony A. Whitney, MS, LHMC, BCB

This course introduces the utilization of general biofeedback and relaxation techniques that can be easily modified by the practitioner to meet clients' individual needs, using functionally appropriate formats. Heart rate variability biofeedback (HRV) has multiple clinical applications including pain management. Clinical observation supports the role of HRV in stabilizing states of emotional dysregulation and improves auto-regulation when utilized both during and between sessions. HRV can be used to build competence in emotional regulation, increase internal focus of control, and improve body awareness. HRV also promotes somatic awareness and differentiation via rapid access to different physiological states. Specific applications to improve client/patient outcomes are discussed.

Thursday/9.8
10:00 AM - 10:55 AM

Anthony A. Whitney, MS, LHMC, BCB

This course defines what biofeedback and relaxation techniques are and how such treatment modalities can be incorporated into the care of patients with chronic illness. We first identify and challenge common myths about biofeedback and relaxation techniques, and then learn how to determine when it is appropriate to explore the option of referring patients for biofeedback and relaxation services. We discuss various strategies to address the negative stigma and the potential of patient resistance often associated with the recommendation of biofeedback. Participants become more familiar with the benefits of biofeedback and more knowledgeable about the unusual challenges that patients may face while participating in biofeedback treatment.

Friday/9.9
10:00 AM - 10:55 AM

Hal Blatman, MD, DAAPM, ABIHM

Carpal tunnel syndrome (CTS) has been largely defined and treated as an inflammatory condition caused by repetitive strain injury. Surgical treatment was first recorded in the 1920s and continues to be an option. Other treatments include various chiropractic, physical therapy, and modality techniques and/or nutritional or vitamin therapies. Diagnostic studies include measurement of carpal canal size, electrodiagnostics, thermal imaging, and physical examination tests. In the past several years, musculoskeletal ultrasound has been researched as a diagnostic tool with application to CTS. In addition, medical understanding of the anatomy of fascia has evolved. These advances have given rise to new ideas of pathophysiology and treatment for CTS. This course will identify theories and causes of, and compare treatment options for, CTS.

Friday/9.9
11:05 AM - 12:00 PM

Robert A. Bonakdar, MD, FAAFP

Historically, acupuncture and auricular therapy have been utilized in the treatment of pain and related disorders. More recently, scientific evaluation has provided mechanistic understanding of these techniques, including tissue and neurobiological modulation. Additionally, recent clinical trials have demonstrated the efficacy of acupuncture in the setting of acute pain and migraine prevention. The 2009 Cochrane review stated, “Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and [has] fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.” The presentation discusses the background and various techniques involved in acupuncture and auricular therapy and reviews the evidence regarding these methods and how they can be clinically incorporated in the treatment of acute and chronic headache and neck pain.

Friday/9.9
2:00 PM - 2:55 PM

Robert A. Bonakdar, MD, FAAFP

Stress is a common presenting complaint in patients in the clinical setting. Patients with chronic pain as well as those with specific pain disorders (headache, irritable bowel syndrome, etc) have a higher burden of stress-related disorders, which can significantly impact onset and/or progression, as well as cause a decline in their general health. The behavioral, cardiometabolic, and cognitive impact that stress can have may combine detrimentally in areas already affected in chronic pain patients, such as brain atrophy. Evidence shows that stress management techniques (mindfulness, meditation, biofeedback) may improve parameters of pain as well as patients' self-management and coping strategies. This presentation covers how these techniques can be incorporated as components of clinic- and home-based therapies to address stress and improve pain management.

Friday/9.9
4:30 PM - 5:25 PM

Hal Blatman, MD, DAAPM, ABIHM

Myofascial medicine has been a developing field in pain management since the 1940s. Many believe that the myofascia is part of most pain symptoms in the body. New understanding of both the anatomy of fascia as well as autonomic nervous system integration provides insight that leads to a more comprehensive treatment plan for pain patients. This treatment plan integrates trigger point injections, prolotherapy, platelet-rich plasma (PRP) and regenerative therapy injections, myofascial release, and other body work disciplines. This session identifies the connection between stress and pain and the impact on fascia anatomy. Herbal therapies and compounding pharmacy solutions are addressed as well.

Thursday/9.8
3:05 PM - 4:00 PM

Eric J. Larson, MD

“Ouch, that hurts! I need to be seen!” Acute pain is the number one reason for a visit to the Emergency Department, whether it is abdominal pain, chest pain, or pain from a broken bone. While treatment of the underlying condition is often the most effective means to alleviate the patient’s pain, there are also numerous general principles for clinicians to employ while tending to their patients in the emergency room.

Thursday/9.8
5:35 PM - 6:30 PM

Eric J. Larson, MD

"Ouch, I still hurt! I have been hurting for a long time, and the only thing that works is Dilaudid!" Chronic pain is a daily complaint in the Emergency Department and it is difficult to differentiate the acute worsening of a chronic condition vs a patient seeking drugs for pleasure. In this session, these patients (“drug seekers”) and their management is the topic of discussion. Concrete suggestions are offered for dealing with the addicted patient seeking pain medication for nonmedical conditions.

Wednesday.9.7
8:35 AM - 9:30 AM

Rebecca Curtis, ACC

Gain insight into a patient's perspective on chronic pain and the process necessary to move from victim to self-manager. As a person with chronic pain, Rebecca Curtis has learned from first-hand experience what it takes to truly move a patient forward from dependence and passivity to taking an active role in their own program of pain management.

Wednesday/9.7
3:05 PM - 4:00 PM

Rebecca Curtis, ACC

Every clinician knows that certain modalities offer huge benefits to enhance a patient's ability to manage chronic pain, yet few patients follow through on “doctor's orders.” This leaves both patient and provider frustrated and discouraged. In this session, Rebecca Curtis shares several case studies from her own pain-management coaching experience to demonstrate the effectiveness that coaching has in breaking this cycle.

Thursday/9.8
8:35 AM - 9:30 AM

Rebecca Curtis, ACC

Thursday/9.8
3:05 PM - 4:00 PM

Rebecca Curtis, ACC

Friday/9.9
8:35 AM - 9:30 AM

Rebecca Curtis, ACC

Friday/9.9
3:05 PM - 4:00 PM

Rebecca Curtis, ACC

Wednesday/9.7
8:35 AM - 9:30 AM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

Mind/body techniques offer physicians excellent resources for helping their patients increase coping and pain-relief skills and abilities. Additionally, evidence-based mind/body techniques are effective in stress reduction, improving immune function, mood, motivation and compliance, and promoting healing.

Wednesday/9.7
10:00 AM - 10:55 AM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

According to a 2010 survey released by the AARP/NCCAM (National Center for Complementary and Alternative Medicine), 73% of respondents who utilized complementary alternative medicine (CAM) did so to help reduce pain or to treat a painful condition. “Integrative” pain management physicians can offer their patients the best pharmaceutical and nonpharmaceutical treatments available. The future is now!

Wednesday/9.7
2:00 PM - 2:55 PM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

Although hypnosis is one of the oldest healing modalities known in medicine, it is just beginning to take its place in modern medical practice. This presentation focuses on the modern theory and implementation of hypnosis in pain management settings.

Wednesday/9.7
3:05 PM - 4:00 PM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

This presentation explores healthcare provider communication skills that help patients feel better and take an active role in self-care. Tips, techniques, and strategies for assisting patients and promoting compliance are covered.

Saturday/9.10
7:30 AM - 8:25 AM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

Saturday/9.10
10:00 AM - 10:55 AM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

Saturday/9.10
2:00 PM - 2:55 PM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

Saturday/9.10
3:05 PM - 4:00 PM

Michael B. Ellner, CHt, MSH; Daniel F. Cleary

Thursday/9.8
3:05 PM - 4:00 PM

Bruce Nicholson, MD

Geared to the frontline clinician, this course discusses establishing a diagnosis and matching appropriate procedure to diagnosis. Curative vs palliative and acute vs chronic back pain are described and delineated. Additionally, the material covers components of the clinical assessment (medical history, physical and neurologic examination, and neuroanatomic imaging) for patients with low back pain (LBP).

Thursday/9.8
4:30 PM - 5:25 PM

Bruce Nicholson, MD

This presentation continues the discussion of low back pain (LBP) with a specific focus on evaluation and treatment of facet joint arthropathy. Degenerative disc and facet disease are discussed, along with intra-articular facet blocks. Indications, benefits, and complications of facet rhizotomy are also discussed.

Wednesday/9.7
6:30 PM - 7:30 PM

Michael R. Clark, MD, MPH, MBA; Myra Christopher; Kevin Pho, MD

Wednesday/9.7
10:00 AM - 12:00 PM

Peter Foreman, DDS, DAAPM

Orofacial and other head and neck pain is usually treated by medical, dental, or other health practitioners. However, inaccurate diagnosis can lead to inappropriate or invasive procedures, creating further problems. Treatment approaches may differ—some are controversial, and some may even be harmful. Not all treatments are evidence-based. Advances in the understanding of pain mechanisms have shown that convergent afferent nociceptive transmissions from nontrigeminal, extra-oral cervical sources can enter the trigeminal system. Pain may thus present as dental, sinus, temporomandibular, or another specific type of pain. However, the pain site may not always be the pain source. Part 1 of this master class addresses some of these issues and looks at some of the solutions. Part 2 provides an opportunity for practical work in pairs, which helps consolidate the material presented in Part 1.

Wednesday/9.7
2:00 PM - 4:00 PM

Peter Foreman, DDS, DAAPM

Practical management approaches to common orofacial pain problems are discussed, including vapocoolant spray and stretch, and trigger point injections. Prevention and management of oral neuropathies are briefly reviewed. Patient self-management programs are covered, followed by demonstrations of palpation and spray and stretch. Volunteers from the audience are solicited—there are usually several present with head and neck pain in these workshops. Trigger point injection techniques are demonstrated using very fine-gauge tuberculin syringes and acupuncture needles. Note: no local anesthetic will be injected. Practical work in pairs follows, with a final wrap-up and question and answer session.

Thursday/9.8
10:00 AM - 12:00 PM

Allen J. Togut, MD

Patients with neurogenic thoracic outlet syndrome usually present with pain, paresthesias, and dysfunction of the upper extremity. Unfortunately, the diagnosis is either discounted or not considered seriously, because there often is no muscle loss or atrophy and neurological examination of the upper extremity is limited. The traditional electromyographic/nerve conduction study (EMG/NCS), although done, is typically negative and therefore does not implicate the brachial plexus. This master class helps participants better understand this often-missed diagnosis—from comprehending it, to making the diagnosis, to providing appropriate treatment options

Friday/9.9
10:00 AM - 12:00 PM

Daniel B. Carr, MD, FABPM; Melanie Thernstrom

The patient and clinician do not merely bring different perspectives to bear on a clinical encounter, they occupy different universes. They are—literally and figuratively—living the problem in different ways. The patient suffers not only from pain intensity, but from stress, loss of function, diminished quality of life, and a host of important emotions and considerations that remain unseen from the clinician’s view. While the patient is preoccupied with the complexity and inability to describe the experience, the clinician is focused on trying to reduce that complexity in order to assemble signs and symptoms into a biomedical model that will allow him or her to come to a conclusion about treatment. This master class is a dialogue between a journalist and a pain specialist and researcher. Dr. Carr will teach the basic biomedical framework by which clinicians assess and treat pain—how to locate the pain generator and choose a treatment option. Ms. Thernstrom will address the interpersonal dynamics of the clinical encounter, as informed both by her work as a journalist and as one of the authors of the Institute of Medicine (IOM) report Relieving Pain in America: A Blueprint for Action. While serving on the committee, Ms. Thernstrom reviewed 2000 responses from pain patients and clinicians who completed a public survey. From this volume of testimony, she has distilled the principle concerns and frustrations of clinicians and pain sufferers and what they are seeking from clinical encounters. The dialogue then examines current scientific research that validates some of these experiential aspects of pain and sheds light on their biological substrates. Examples include hormonal and brain imaging studies of pain-related phenomena, such as the feeling of isolation and the engagement/empathy for another’s pain. Participants learn how to leverage these ideas to create a more successful and mutually satisfying clinical encounter.

Friday/9.9
10:00 AM - 12:00 PM

Peter Foreman, DDS, DAAPM

Friday/9.9
2:00 PM - 4:00 PM

Peter Foreman, DDS, DAAPM

Thursday/9.8
10:00 AM - 12:00 PM

Gary W. Jay, MD, DAAPM, FAAPM

Long-term 10-year survival rates that approach 59% in adults and 75% in children are increasing the percentage of patients with cancer who outlive their disease. Cancer survivors have poorer health outcomes across multiple measures after the diagnosis of cancer than do noncancer pain patients, and psychosocial difficulties in cancer survivors can significantly affect their pain. This master class addresses the numerous issues (psychiatric and social needs) and treatment options for cancer survivors who experience chronic pain.

Saturday/9.10
10:00 AM - 12:00 PM

David M. Glick, DC, DAAPM, CPE

The prevalence of back pain continues in spite of the many treatments available, without any single treatment emerging as a panacea. In routine clinical practice, clinical examinations have tended to become more cursory, the result of increasing demands on clinicians’ time and possible over-reliance on technology. It has been suggested that the failure to adequately differentially diagnose the cause of back pain can account for clinical failures in treatment. The purpose of this discussion is to assist the clinician in the development of a more specific problem-focused examination that can enhance the differential diagnosis of specific pain generators and lead to more patient specific treatment. Attention is given to considering all aspects of the examination, including physical assessment as well as imaging studies, plus the clinician’s ability to recognize pathologies seen on imaging studies as clinically significant or not. The importance of considering how failed treatments influence the differential diagnosis is also discussed.

Saturday/9.10
10:00 AM - 12:00 PM

Allen J. Togut, MD

Saturday/9.10
2:00 PM - 4:00 PM

Mark A. Young, MD, MBA, FACP

Although pain is well recognized to affect both men and women, accumulating scientific evidence suggests that each sex experiences pain in very different ways. A recent symposium on gender and pain sponsored by the National Institutes of Health (NIH) provided a comprehensive scientific synopsis of research developments in this area. This master class highlights the key musculoskeletal conditions frequently treated by physiatrists that are likely to be influenced by gender-specific pain, including osteoarthritis, rheumatoid arthritis, migraine headache, tension headache, knee injury, fibromyalgia, carpal tunnel syndrome, facial pain, and osteoporosis. The session systematically reviews sex-related differences that distinguish men and women. This is followed by a consideration of specific putative mechanisms proposed by scientific investigators to explain why pain experienced by men and women is so radically different. Knee degenerative joint disease with its differential gender-specific manifestations is given special focus. An expanded discussion of scientifically supported complementary and integrative medical strategies (eg, acupuncture, music therapy, hypnosis) in the rational management of women's pain is also covered. The presentation concludes with a brief summary to guide frontline pain clinicians in their recognition and practice of gender-based pain evaluation and management.

Stephen J. Ziegler, PhD, JD; John F. Peppin, DO, FACP; Bruce M. Stark, MD; David T. Thornton; Joseph P. Furman, JD

Wednesday/9.7

7:30 AM - 8:25 AM

Level 3/Gracia 4

One of the most often cited barriers to the treatment of pain stems from a prescriber’s fear of investigation and increased regulatory scrutiny whenever opioids are involved. A panel of notable presenters from the pain and regulatory communities offers a unique program for attendees to hear real-world experiences and opinions. The panel represents a wide variety of experts including an investigated physician, defense and prosecution experts, and a former executive director of a state medical board. Practice tips on preventing and/or surviving an investigation are also addressed.

Wednesday/9.7
10:00 AM - 10:55 AM

Jennifer Bolen, JD

Fraud, waste, and abuse are prevalent in today's healthcare community, and investigations designed to recover health plan assets can be very costly to the practitioner. These investigations often focus on lack of medical necessity and documentation for a specific procedure, laboratory test(s) ordered/performed, and medication prescribed. Pain management practitioners should take steps to minimize the potential for adverse outcomes in the event of an investigative inquiry. From case examples, attendees learn about key areas of fraud and abuse in pain management and how to identify fact patterns that give rise to investigative concerns. Case examples also provide insight into the value of practice self-evaluation and the use of compliance plans and practice protocols. The workshop focuses on providing practitioners with basic "how to" steps to initiate a practice evaluation and create a plan for responding to investigative inquiries—from notice of overpayment through search warrant.

Wednesday/9.7
5:35 PM - 6:30 PM

Jennifer Bolen, JD; Eric Vinsant, JD

The pain community is in the midst of unprecedented legislative action and guideline overhaul as a result of the ever-growing problem of prescription drug abuse and diversion. Many states have passed laws governing the licensing and operation of pain clinics as a means of stopping the explosive growth of illegal “pill mills.” These new laws attempt to distinguish between proper and improper pain management, yet may have unintended consequences and impact on legitimate pain management operations. It is imperative that pain professionals take steps to understand legislative efforts in their own states and demonstrate compliance with new laws and guidelines. The workshop will focus on current events and provide specific updates on the impact of new laws and guidelines on dispensing and prescribing controlled medications. The workshop also reviews questions that the pain community has not yet addressed, and how these unanswered questions may impact developing clinical and regulatory guidelines.

 

Friday/9.9
7:30 AM - 8:25 AM

Jennifer Bolen, JD; Eric Vinsant, JD

Licensing boards and investigative authorities often view drug testing as a standard of care when medical treatment involves the long-term use of controlled medications. Conversely, payers may take a more restrictive view of drug testing in pain management and challenge the nature and frequency of drug testing through denial of claims as well as a myriad of financial recovery tools. While there may not be universal agreement on the nature and frequency of drug testing, clinical and regulatory guidelines may aide the practitioner in establishing or re-evaluating a drug testing platform in the private practice. Whatever a practice’s current testing platform, it is critical that providers have and can produce compliance documentation tying their plan for drug testing to clinical and regulatory guidelines to improve chances of surviving a fraud, waste, and abuse investigation and a legal challenge to prescribing of controlled medications. This workshop will focus on the "how to" development and evaluation of a drug testing platform and a compliance plan to facilitate proper testing and documentation.

Friday/9.9
4:30 PM - 5:25 PM

Jennifer Bolen, JD; Eric Vinsant, JD

Practitioners’ claims are often denied as a consequence of failure to document medical necessity for drug testing. Payers either have adopted or are in the process of adopting coverage determinations and/or policies governing the medical necessity for qualitative drug screening. Failure to document medical necessity may also detract from the prescriber’s rationale for the ongoing use of controlled medications, potentially increasing liability for inappropriate prescribing. Proper documentation is critical to demonstrating good faith compliance with clinical guidelines and licensing board/DEA guidelines/rules tied to the use of controlled medication. This workshop offers case examples of both sufficient and insufficient documentation of medical necessity for drug testing, and also provides a survey of current coverage determinations and medical policies of the major carriers.

Thursday/9.8
7:30 AM - 8:25 AM

Lisa McElhaney

Law enforcement has a long history of fighting diversion and prescription drug abuse. The present drug regulations and federal laws focus on physician prescribing while at the same time failing to investigate the many methods of pharmaceutical drug diversion. This presentation provides an analysis of the influencing factors that have enabled the explosion of pharmaceutical diversion, and a summary of the “red flags” that alert law enforcement to the activities of diversion and drug trafficking.

Thursday/9.8
10:00 AM - 10:55 AM

John J. Burke

This presentation explores prescription drug abuse, and is designed to assist prescribers and their employees in recognizing and dealing with the prescription drug seeker. Following an overview of this issue in America today, common-sense solutions are offered for prescribers to effectively deal with drug seekers and, in doing so, protect their practices. The program is designed to make the vast majority of prescribers more comfortable in prescribing for legitimate patients, with the ultimate goal of increasing quality care to those truly in pain. Several examples of egregious prescriber behavior are reviewed, offering insightful examples of how prescribers can be significantly out of the scope of any professional’s idea of legitimate medical practice.

Thursday/9.8
2:00 PM - 2:55 PM

Lisa McElhaney

Organized prescription drug fraud rings are becoming commonplace in our society. This block of instruction provides an overview of the structure of an organized fraud ring and the steps that law enforcement followed to dismantle the operation.

Thursday/9.8
4:30 PM - 6:30 PM

Lisa McElhaney

Pharmaceutical diversion is a widespread epidemic across the nation. In any effort to combat the numerous facets of this problem, one must be able to clearly understand the basic elements of diversion and the cycle of fraudulent activities. This presentation identifies the elements of a basic prescription drug fraud case, from describing the workings of a detailed “pill mill” operation to explaining the variety of codependent relationships that exist in each area. This provides for legitimate medical practitioners the ability to recognize the many tricks and trends of diverters, in order to prevent criminal activity from entering their own medical offices.

Wednesday/9.7
8:35 AM - 9:30 AM

Charles E. Argoff, MD, CPE

Among the many manifestations of chronic pain experienced by patients, neuropathic pain syndromes are among the most challenging to diagnose and treat. This presentation focuses on the diagnosis and management of common neuropathic pain conditions, with special emphasis on when it is appropriate to refer the patient to a pain specialist.

Presented by Necrology Reviews.

Wednesday/9.7
10:00 AM - 10:55 AM

Philip Getson, DO

Complex regional pain syndrome (CRPS) is an old problem with a new name. In the past, type 1 was termed reflex sympathetic dystrophy (RSD) and type 2 was called causalgia. This lecture discusses the fundamentals of CRPS, its clinical manifestations, and basic treatment. Following this informative presentation is a full hour of case studies and in-depth discussion of treatment options.

Wednesday/9.7
11:05 AM - 12:00 PM

Charles E. Argoff, MD, CPE

This interactive session explores how our actions as practitioners may play an important role in reducing undesirable events as a consequence of untreated or poorly treated pain. Several patient scenarios are presented demonstrating that how we act determines whether we may be able to reduce or, conversely, actually facilitate unwanted results in the management of pain. These scenarios include, for example, an approach to acute pain that may limit the development of chronic pain (a desirable effect), or a migraine headache treatment that may inadvertently lead to a more difficult headache problem (an untoward event). The management of chronic pain with opioids is an area in which it has been increasingly clear how vital the practitioner’s role is in helping to reduce (or not) the risk associated with this treatment approach.

Wednesday/9.7
2:00 PM - 2:55 PM

Gary W. Jay, MD, DAAPM, FAAPM

This course describes various types of primary headache disorders and differentiates between migraine headache and other kinds of headache disorders. The presentation details diagnosis, acute treatment, and prophylactic measures that can reduce pain in patients who experience migraine headaches.

Friday/9.9
7:30 AM - 8:25 AM

Mary Lynn McPherson, PharmD, BCPS, CPE

Assessing a pain complaint is a critically important step in pain management, and is a major consideration in drug therapy selection. Participants in this session learn about the pathogenesis and clinical presentation of pain in a variety of advanced illnesses including cancer, cardiovascular disease, neuromuscular disorders, respiratory disease, and other common causes of advanced illness.

Friday/9.9
4:30 PM - 5:25 PM

Mary Lynn McPherson, PharmD, BCPS, CPE

Pain is a common symptom associated with advanced illness, and is frequently complex in presentation and management. This session reviews the management of pain associated with both cancer and noncancer advanced illness, with emphasis on how to craft rational polypharmacy regimens, and how to adjust therapy based on patient response.

Saturday/9.10
10:00 AM - 12:00 PM

Mary Lynn McPherson, PharmD, BCPS, CPE

Patients with advanced illnesses may experience a wide range of symptoms in addition to pain. Participants in this session will learn about the management of cardiorespiratory symptoms (dypsnea, secretions, cough), genitourinary symptoms (urinary incontinence and retention, bladder spasms), and gastrointestinal symptoms (nausea/vomiting, constipation, diarrhea, anorexia/cachexia).

Saturday/9.10
3:05 PM - 4:00 PM

Robert D. Sproul, PharmD

A basic principle of palliative care is to embrace the concept (goal) of optimal patient comfort by addressing a patient’s emotional, physical, social, and spiritual needs through appropriate global assessment and symptoms management. Neuropsychiatric symptoms at end of life—such as anxiety, depression, and delirium—may significantly impact or undermine a clinician's efforts to achieve the goals of comfort and quality of life in the patient's final days. Pharmacologic management is an important component of treating neuropsychiatric symptoms at the end of life and is the emphasis of this training. However, it is essential to use a holistic approach with the necessary psychosocial and spiritual support systems in place to best serve the needs of our end-of-life patients.

Friday/9.9
10:00 AM - 12:00 PM

Howard A. Heit, MD, FACP, FASAM; Douglas L. Gourlay, MD, MSc, FRCPC, FASAM

Urine Drug Testing (UDT) is playing an increasing role in the management of risk in clinical care. Unfortunately, drug testing in general suffers from several shortcomings, especially when relied on to identify problematic use of controlled substances, including drug diversion. UDT is the preferred tool in patient centered care. It can offer clinicians valuable insight into the identification, treatment, and monitoring of their patients while providing objective data in risk evaluation and minimization strategies necessary for responsible clinical care. Drs. Heit and Gourlay present a two-hour session that gives attendees the unique experience of examining several interactive UDT cases. Through a combination of didactic and case-based learning, this session helps participants explore UDT in a defensible, rational, and compassionate fashion.

Friday/9.9
2:00 PM - 4:00 PM

Howard A. Heit, MD, FACP, FASAM; Douglas L. Gourlay, MD, MSc, FRCPC, FASAM

The concept of “therapeutic trial of therapy” has been an important part of clinical medicine, never more so than with the recent increased use of agonist classes of drugs such as opioids and benzodiazepines. The notion that “those who don’t need these agents come off them easily” has failed miserably as a clinically useful concept. Those who struggle are often mislabeled as “addicted,” while those who don’t struggle are sometimes presumed to be diverting the prescribed agent. In fact, physical dependency, withdrawal, and tolerance are all subject to intrapersonal and interpersonal variability. Drs. Heit and Gourlay present a two-hour session that gives attendees a rational look at tapering, substitution, and ultimate discontinuation of several common, dependency-producing agents. This session emphasizes the concept of abandoning the molecule, not the patient, in a manner that is defensible, rational, and compassionate.

Wednesday/9.7
8:35 AM - 9:30 AM

Michael J. Brennan, MD

This symposium reviews the necessity for the FDA-mandated Risk Evaluation and Mitigation Strategies (REMS) and its components. Faculty will also review a model of a Transmucosal Immediate Release Fentanyl (TIRF) REMS system using an approved REMS and will provide practical guidance and resources for implementing REMS into your practice. Time will be allotted for Q&A at the end of the symposium.

Sponsored by Cephalon Ready For REMS.

This activity is not certified for credit. Breakfast will be served.

Wednesday/9.7
9:30 AM - 7:30 PM

The Ready For REMS (Risk Evaluation and Mitigation Strategy) Resource Lounge features live “Meet the Expert” sessions, where attendees will hear firsthand about topics relating to REMS implementation. A schedule for “Meet the Expert” sessions will be posted throughout the hotel. General REMS and opioid safety information for HCPs and patients will also be available, as well as specific information on Transmucosal Immediate Release Fentanyl (TIRF) REMS to prepare you to implement REMS in your practice.

Stop by the Resource Lounge for a light snack and to pick up REMS materials to support you in the REMS era. The Lounge will be open throughout the day.

Sponsored by Cephalon Ready For REMS.

This activity is not certified for credit. Refreshments will be served.

Wednesday/9.7
3:05 PM - 4:00 PM

Mary Lynn McPherson, PharmD BCPS, CPE

Acetaminophen is one of the most widely used analgesic/antipyretic medications in the United States, with over 25 million doses sold each year. While acetaminophen is safe and effective when used according to directions on nonprescription and prescription labeling, patients and their healthcare professionals are often unaware of the sources of acetaminophen in combination drug products, or the total daily dose of acetaminophen patients are taking. This is particularly important for patients taking multiple medications including acetaminophen/opioid combinations chronically. Join us at this educational program where Mary Lynn McPherson, PharmD, BCPS, CPE, will review the prevalence of acetaminophen use in the US, efficacy data as an analgesic when used as monotherapy and in combination with other analgesics, clinical scenarios where acetaminophen does not contribute additional pain relief, and common toxicities associated with acetaminophen.

Sponsored by Zogenix, Inc.
This activity is not certified for credit. Breakfast will be served.

Thursday/9.8
8:35 AM - 9:30 AM

Michael J. Brennan, MD

Join your colleagues to hear Dr. Michael Brennan discuss considerations for appropriate use and prescribing of selected transdermal and oral extended-release opioid analgesics in the management of moderate-to-severe chronic pain in patients requiring a continuous, around-the-clock opioid for an extended period of time.

Sponsored by Purdue Pharma L.P.

This activity is not certified for credit. Breakfast will be served.

Friday/9.9
8:30 AM - 9:30 AM

Srinivas Nalamachu, MD; James Rho, MD

This program introduces a unique transmucosal fentanyl that has been shown to be effective for treating breakthrough cancer pain in opioid-tolerant patients. Patient cases will be presented both to highlight the safety and tolerability of sublingual fentanyl as well as to give healthcare providers insight into how this medication can be used effectively and appropriately in their own practice to manage breakthrough pain in patients with cancer.

Sponsored by ProStrakan, Inc.

This activity is not certified for credit. Breakfast will be served.

Friday/9.9
8:30 AM - 9:30 AM

Mary Lynn McPherson, PharmD BCPS, CPE

Acetaminophen is one of the most widely used analgesic/antipyretic medications in the United States, with over 25 million doses sold each year. While acetaminophen is safe and effective when used according to directions on nonprescription and prescription labeling, patients and their healthcare professionals are often unaware of the sources of acetaminophen in combination drug products, or the total daily dose of acetaminophen patients are taking. This is particularly important for patients taking multiple medications including acetaminophen/opioid combinations chronically. Join us at this educational program where Mary Lynn McPherson, PharmD, BCPS, CPE, will review the prevalence of acetaminophen use in the US, efficacy data as an analgesic when used as monotherapy and in combination with other analgesics, clinical scenarios where acetaminophen does not contribute additional pain relief, and common toxicities associated with acetaminophen.

Sponsored by Zogenix, Inc.
This activity is not certified for credit. Breakfast will be served.

Friday/9.9
12:00 PM - 2:00 PM

Michael R. Clark, MD, MPH, MBA

Pain transmission and processing occurs in the peripheral and central nervous system. Acute pain serves as a warning to prevent damage. Chronic pain is defined as pain that persists beyond acute pain or beyond the expected time of normal healing. This presentation will review pain pathways in the peripheral and central nervous system and the mechanisms leading to the development of chronic pain.

Sponsored by Lilly USA, LLC.

This activity is not certified for credit. Lunch will be served.

Saturday/9.10
8:00 AM - 10:15 AM

Lynn R. Webster, MD, FACPM, FASAM

This interactive program is framed around the principles of the NIPC® Critical Thinking Model for Chronic Opioid Therapy. Integrating these principles into your practice can aid in responsibly and appropriately prescribing opioids, fostering compliance with state and federal regulations, and optimizing analgesia for your patients. This symposium will utilize audience response technology (ARS) to encourage ongoing interaction between you, the expert faculty, and your colleagues.

This independent medical education activity is sponsored by the American Pain Foundation (APF) and supported through an educational grant from Endo Pharmaceuticals.

This activity is not certified for credit. Breakfast will be served.

Wednesday/9.7
7:30 AM - 8:25 AM

David M. Glick, DC, DAAPM, CPE

In order to successfully clinically manage pain, it is essential to begin with an understanding of the underlying mechanisms responsible for its generation. A skillful approach based on solid knowledge of the anatomical structures, pathways, and events that result in pain is more likely than a single standard approach to lead to effective clinical management of pain. The presentation includes an overview of medication classes typically considered for pain and the pathways they affect.

Wednesday/9.7
10:00 AM - 10:55 AM

Michael R. Clark, MD, MPH, MBA

Effective clinical interviewing and pain assessment are critical to the appropriate diagnosis and management of pain. In this presentation, the clinician learns how to apply principles of effective communication and also ascertain how to evaluate available assessment tools.

Wednesday/9.7
11:05 AM - 12:00 PM

David M. Glick, DC, DAAPM, CPE

Diagnostic testing is an integral component of differential diagnosis. In routine clinical practice, examinations have tended to become more cursory, largely because of increased demands on practitioners’ time, compounded by patient expectations of technological advances. The end result may lead to an over-reliance on technology for basic clinical diagnosis. The purpose of this session is two-fold: (1) to provide a review (for some, an introduction) to basic structural and functional studies used for the diagnosis of pain-related problems, and (2) to call attention to the limitations of such studies and the importance of establishing clinical relevance to their findings. Factors that adversely affect clinical management, potentially resulting in failed treatment, will be discussed, along with best practices for utilizing studies to help enhance clinical outcomes for treatment.

Wednesday/9.7
2:00 PM - 2:55 PM

Christopher M. Herndon, PharmD, BCPS, CPE

The treatment of pain, while multifaceted, often centers on the rational use of multiple pharmacotherapeutic options. Opioids, co-analgesics, and adjuvant analgesics are efficacious treatment options; however, a sound understanding of the patient specific use of these medications is paramount. In this session, clinical pearls—focusing on selection of pharmacotherapy for pain using case-based learning—are shared.

Wednesday/9.7
4:30 PM - 5:25 PM

Thomas B. Gregory, PharmD, BCPS, CGP, CPE

Chronic pain affects millions of patients around the world. Unlike acute injury or insult that subsides with time and treatment, chronic pain lingers long after the initial injury. Those lingering effects impact not only the patient’s physiological but also their psychological well-being. This course presents evidence related to chronic pain syndromes, along with a case-based approach, to incorporate that information into daily practice.

Wednesday/9.7
5:35 PM - 6:30 PM

Barbara L. Kornblau, JD, OTR/L, CPE

Medication, surgery, heat, cold, and injections are not enough. People who live with pain must learn to redesign their lives to manage their pain and learn how to do things in a different way. This session explains how occupational therapists work with people—within their own environments, doing their own tasks—to effect lifestyle alteration in order to maximize participation and improve quality of life. Learn what occupational therapists do. Through case studies, determine when to refer to occupational therapy, and what patients and their providers can expect from it.

Thursday/9.8
7:30 AM - 8:25 AM

Marcia J. Jackson, PhD, FACME

Health literacy describes a patient’s ability to read, understand, and act on health information, and by doing so, learn to function successfully. Health literacy is especially important to a pain educator, since the patients you think you are educating may be struggling to understand your instructions, unable to fill out your forms, or incapable of reading prescription labels or self-care instructions. Poor compliance is not only dangerous to the patient but also presents legal ramifications for the pain educator. Patient education materials should be prepared in such a way that they enhance the likelihood of patient understanding, yet many examples of current materials fall short. This session presents strategies for providers to support patients with low health literacy. Providers can do this by learning how to prepare materials at an appropriate reading level, by using effective communication methods, and by recognizing cultural differences that may contribute to low health literacy. The session also gives participants the opportunity to practice several of these strategies.

Thursday/9.8
10:00 AM - 10:55 AM

Michael E. Schatman, PhD, CPE

This presentation focuses on three models for improving chronic pain management in primary care: (1) a collaborative model, (2) a utilization of nurse practitioners and physician assistants model, and (3) a solo practitioner person centered pain treatment model. Strengths and weaknesses of each model are discussed, along with appropriate situations in which to consider them. Considerable emphasis is placed on strategies for primary care providers (PCPs) practicing in underserved areas including rural settings. The challenges of individual PCPs providing biopsychosocial treatment are outlined, with discussion of the use of Brief Motivational Interviewing within primary care as a compliance enhancing tool for pain patients.

Thursday/9.8
11:05 AM - 12:00 PM

Marcia J. Jackson, PhD, FACME

Knowing something and applying it in practice are two different outcome responses to an educational activity. The foundation for planning and assessing the outcomes of educational activities is an accurate description of the learning gap. This leads directly to the statement(s) of intended, measurable outcomes—which in turn leads to succinct learning objectives and appropriate activity plans. In this session, participants learn how to: identify levels of educational outcomes; differentiate knowledge-outcomes statements from application-outcomes statements; describe the instructional design links between outcomes, objectives, and activity design; and practice writing in both knowledge-outcomes and application-outcomes statements.

Thursday/9.8
2:00 PM - 2:55 PM

Barbara L. Kornblau, JD, OTR/L, CPE

The motivational interview is an approach developed by psychologists Miller and Rollnick to treat alcoholism and substance abuse. This session explores how to assess and enhance a patient’s willingness, ability, and readiness to embrace behavior change. Specifically, participants learn about Motivational Interviewing, which has been shown to have better outcomes than traditional care, including the ineffective “should”–ing of a patient.

Thursday/9.8
4:30 PM - 5:25 PM

Mary Lynn McPherson, PharmD, BCPS, CPE; Thomas B. Gregory, PharmD, BCPS, CGP, CPE; Michelle A. Lamantia, MD, CPE; Christopher M. Herndon, PharmD, BCPS, CPE

The Certified Pain Educator (CPE) credential is being increasingly sought by practitioners who want to demonstrate achievement of a measurable level of competency in this important field. Participants in this session will learn about the process of fulfilling requirements that will qualify them to sit for the CPE examination. This panel of experts will also describe how the CPE credential allows and encourages practitioners to expand their practice opportunities in a variety of settings including inpatient, outpatient, and academia.

Thursday/9.8
5:35 PM - 6:30 PM

Mary Lynn McPherson, PharmD, BCPS, CPE

Pain educators are frequently asked to develop educational materials for patients and peers. This session covers how to conduct an audience needs assessment, craft learning objectives, develop educational materials, and devise assessment activities. Principles of adult learning and active learning strategies will be stressed.

Friday/9.9
7:30 AM - 8:25 AM

Kathryn L. Hahn, PharmD, DAAPM, CPE

Opioids are a mainstay of therapy for moderate-to-severe pain. Practitioners are fortunate to have the choice of numerous opioids and a wide variety of dosage formulations to best tailor treatment plans to individual patients. Participants in this program learn how to select from the opioids, based on drug-related and patient-related variables, including choosing between (or converting between) short-acting and long-acting opioids, and how to appropriately dose opioids for breakthrough pain.

Friday/9.9
10:00 AM - 10:55 AM

Mary Lynn McPherson, PharmD, BCPS, CPE

Many patients receiving opioids will need to switch from one opioid to another during therapy, or at least from one dosage formulation or route of administration to another. During this session, practitioners learn to recognize clinical situations in which opioid switching would be appropriate. Attendees will also work on a problem set designed to sharpen skills in opioid conversion calculation.

Friday/9.9
11:05 AM - 12:00 PM

Christopher M. Herndon, PharmD, BCPS, CPE

Alternative administration techniques for the delivery of analgesics and anesthetics are commonplace in the management of pain. Several new topical and transdermal analgesics have been recently approved or are in late-stage development. This session will review the physiology of the epidermis as it relates to drug delivery and the pharmacologic properties of analgesics or anesthetics commonly administered topically or transdermally.

Friday/9.9
2:00 PM - 2:55 PM

Thomas B. Gregory, PharmD, BCPS, CGP, CPE

Every pharmacologic agent used by modern medicine carries the risk of side effects, and opioids are no exception to this rule. One of the most widely known side effects is constipation; however, there are a multitude of other side effects ranging from those that are simply benign or annoying to those that are potentially severe or even life threatening. This course affords the participant a broader appreciation of the common and not-so-common side effects of opioids.

Saturday/9.10
7:30 AM - 8:25 AM

Mary Lynn McPherson, PharmD, BCPS, CPE

Magic, mystical, mysterious methadone is an excellent opioid that requires special handling. Participants in this program will learn about the unique pharmacokinetic and pharmacodynamic properties of methadone, how to initiate methadone therapy in an opioid-naïve patient, and how to switch patients from other opioids to methadone. Participants also learn appropriate titration strategies as well as how to monitor a patient converted from another drug to methadone.

Saturday/9.10
8:35 AM - 9:30 AM

Kathryn L. Hahn, PharmD, DAAPM, CPE

Extensive evidence demonstrates the analgesic efficacy of adjuvants, anti-inflammatories, and simple analgesics. The use of these classes of medications for chronic pain using rational polypharmacy may allow sparing of the use of opioids, but new studies question the safety of certain nonopioids. Therefore, knowledge of the pharmacology of nonopioids is important to ensure that analgesic treatment decisions are based on the best available information.

Saturday/9.10
2:00 PM - 2:55 PM

Robert D. Sproul, PharmD

Both within and outside the palliative care setting, novel approaches are being considered or implemented to manage severe neuropathic pain. Two such treatment modalities of interest are the off-label use of ketamine and lidocaine for analgesia rather than as an anesthetic or for rhythm control. The evidence base for use of these agents to treat severe pain is limited to small studies, weak evidence, anecdotal stories, and case reports. Additional research is necessary to corroborate the safety and efficacy of these medications for off-label uses. Granted, the utilization of ketamine or lidocaine as an analgesic for a select population of patients under a given set of conditions may be appropriate. However, practitioners must have the necessary education about the limitations and benefits of these medications to make informed decisions about whether and when to use them.

Saturday/9.10
3:05 PM - 4:00 PM

Mary Lynn McPherson, PharmD, BCPS, CPE

Medications are used extensively to manage pain and nonpain symptoms associated with advanced illness. It is imperative that practitioners be knowledgeable about new drugs and dosage formulations introduced to the market. Participants learn about the indications, dosing, adverse effects, drug interactions, and appropriate use of new analgesics and other medications used for palliative care in this fast paced discussion.

Thursday/9.8
6:00 PM - 7:30 PM

Joseph V. Pergolizzi, MD

Friday/9.9
7:30 AM - 8:25 AM

Joseph V. Pergolizzi, MD

Saturday/9.10
7:30 AM - 8:25 AM

Mark A. Young, MD, MBA, FACP

Knee and ankle pain are common regional causes of pain that pose diagnostic and treatment challenges to the clinician. Accurate evaluation of the multiple causes of these musculoskeletal conditions is based on a comprehensive knowledge of associated biomechanical and anatomical features. This lecture provides an overview of common pain conditions associated with the knee and ankle. An analysis of underlying kinesiologic and structural characteristics is highlighted.

Saturday/9.10
8:35 AM - 9:30 AM

Colleen M. Fitzgerald, MD

This session focuses on the epidemiology and impact of female chronic pelvic pain (CPP) including its known pathophysiology, differential diagnosis, and the clinical diagnosis and treatment of CPP along with specific rehabilitation approaches. This includes an interdisciplinary approach to CPP and current modalities utilized such as manual therapy; motor control training; joint/trigger point, sympathetic, botulinum-toxin injections; psychological interventions to reduce anxiety and catastrophizing; and the rational application of neuromodulatory pain medications including the controversial role of opioids. New research in the field will be highlighted. The presentation helps learners enhance their care of female CPP patients.

Friday/9.10
3:05 PM - 4:00 PM

R. Norman Harden, MD

Headache research is problematic due to the absence of animal models and sketchy diagnostic criteria. This session will delineate the “broad stroke” categories of head pain, with emphasis on neck pathology.

Saturday/9.10
11:05 AM - 12:00 PM

Mark A. Young, MD, MBA, FACP

Patient pain arising regionally in the hip and lower extremity often poses a diagnostic and therapeutic challenge to the treating clinician. Differentiation of the various etiologies associated with these conditions requires a thorough anatomical and biomechanical understanding of potential causes and exacerbating factors. This presentation offers a comprehensive overview of the gamut of musculoskeletal pain states and diagnoses responsible for regional lower extremity pain.

Friday/9.9
3:05 PM - 4:00 PM

Ronald J. Rapoport, MD, FACR

The differential diagnosis of a patient entering a healthcare provider’s office with monoarticular, oligoarticular, or polyarticular presentation can provide a daunting challenge. This session reviews a logical approach based on Dr. Rapoport’s clinical experience. Also included are a review of the literature and selected clinical studies.

Friday/9.9
4:30 PM - 5:25 PM

Ronald J. Rapoport, MD, FACR

The diagnosis of an older patient with musculoskeletal pain can be a true challenge for all of us. Take into consideration associated illnesses that pose an even greater threat, and all of our clinical skills are needed to point the care of the patient in the right direction. The presentation and clinical approach to polymyalgia rheumatica (PMR) and giant-cell arteritis (GCA) provide just such a challenge. Diagnosis, treatment, and further concerns are reviewed in this course.

Wednesday/9.7
10:00 AM - 10:55 AM

Roger B. Fillingim, PhD; Joseph L. Riley, III, PhD

Sex differences in pain have received increasing attention in recent years, and there has emerged a proliferation of both preclinical and clinical research on the topic. The goal of this session is to highlight important issues and to place sex differences in pain into the broader context of individual differences in pain. Quantitative sex differences refer to male-female differences in the numbers of persons visiting their providers about a condition (such as women more often reporting pain than men). In contrast, qualitative differences refer to sex differences in the mechanisms contributing to an outcome (for example, if a genetic marker were associated with pain responses in women but not in men). The relative importance of quantitative vs qualitative differences will be discussed. Additional conceptual issues discussed include between-group vs within-group differences and the potential practical significance of sex differences.

Wednesday/9.7
11:05 AM - 12:00 PM

Roger B. Fillingim, PhD; Joseph L. Riley, III, PhD

Abundant evidence suggests potentially important sex differences in the experience of pain. A large number of epidemiologic studies demonstrate increased prevalence of many forms of pain among women compared to men. The existing epidemiologic, clinical, and experimental literature addressing sex differences in pain are reviewed in this presentation. Additionally, the presenters examine patterns of sex differences across different types of pain (eg, back pain vs fibromyalgia, acute pain vs chronic pain).

Wednesday/9.7
2:00 PM - 2:55 PM

Roger B. Fillingim, PhD; Joseph L. Riley, III, PhD

While the presence of sex differences in pain is well documented, the mechanisms underlying these differences remain poorly understood. Existing evidence clearly indicates that a variety of biological and psychosocial factors contribute to sex differences in the experience of pain. For example, multiple lines of evidence suggest that gonadal hormones can substantially influence pain responses. Additionally, sex differences in the activation of pain inhibitory processes, such as the endogenous opioid system, have been reported. In addition, psychosocial factors such as gender roles, pain coping, and anxiety have been associated with sex differences in pain. This presentation discusses the mechanisms underlying sex differences in pain, using the biopsychosocial model of pain as the guiding framework for understanding this phenomenon. The potential interactions among biological and psychosocial factors are also points of discussion.

Wednesday/9.7
4:30 PM - 5:25 PM

Roger B. Fillingim, PhD; Joseph L. Riley, III, PhD

In addition to recognizing sex differences in clinical and experimental pain, a substantial body of literature has addressed whether women and men respond differently to pain treatments. This session will address sex differences in responses to opioid analgesics, differences in responses to nonpharmacologic pain treatment, and whether predictors of response to pain treatment differ for women vs men. This session also devotes considerable discussion time to considering the clinical relevance of sex differences in pain and whether the existing literature justifies sex-specific tailoring of pain treatments.

Wednesday/9.7
7:30 AM - 8:25 AM

Kevin L. Zacharoff, MD, FACPE, FACIP, FAAP; Emil Chiauzzi, PhD

Drs. Chiauzzi and Zacharoff discuss specific challenges that exist in the course of managing chronic pain—challenges for the frontline practitioner as well as other important stakeholders. Periodic visits and re-assessments are important components of chronic pain management, as are approaches that help people deal with their pain between office visits. Specific techniques, such as reinforcement of shared decision-making, the importance of self-management, and the “Medical Home” model of care, are discussed. Data supporting the role of interventions that help improve self-management and the role of behavioral interventions in the treatment of the chronic pain patient are presented as well.

Wednesday/9.7
11:05 AM - 12:00 PM

Michael R. Clark, MD, MPH, MBA

Many factors have been identified as predictive of acute pain becoming chronic. Unfortunately, the number of factors and the lack of consistent algorithms make the prediction and prevention of chronic pain difficult. A patient centered approach to developing a risk profile for a patient in acute pain can decrease the likelihood of this patient developing chronic pain and experiencing its associated consequences. Specific examples are reviewed from each relevant domain or perspective of this approach.

Wednesday/9.7
4:30 PM - 5:25 PM

Barbara L. Kornblau, JD, OTR/L, CPE

By 2014, almost all of the provisions of the health reform law called the Affordable Care Act (ACA) will take effect. What does this mean for pain clinicians, their patients, and the nation’s pain policy? And what happens in the meantime? This session reviews key provisions of the ACA and their potential impact on pain practice and pain patients. The presentation discusses how ACA strengthens the nation’s pain policy and, in juxtaposition, the current threats and challenges to ACA's existence.

Thursday/9.8
7:30 AM - 8:25 AM

Kevin L. Zacharoff, MD, FACPE, FACIP, FAAP

This presentation details the background and chronology of the events leading up to the requirement by the FDA for a Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioids. The discussion examines potential clinical implications of the opioid REMS for the frontline practitioner, and also offers suggestions for healthcare practitioners to prepare for the future of chronic pain management with opioid therapy.

Thursday/9.8
8:35 AM - 9:30 AM

Joanne Loewy, DA, LCAT, MT-BC

Music affects and alters both the body and mind experiencing painful stimuli. Music has been used to treat pain in a multitude of ways arguably since the beginning of time—one example occurs as far back as the Old Testament story of Saul soothing David by playing the harp. Chronic pain can be of neuropathic origin and the cycle of one's pain experience can have severe ramifications on one's experience and quality of life. Music therapy and the alteration of pain are exemplified through live and case-study examples.

Thursday/9.8
10:00 AM - 10:55 AM

Stephen J. Ziegler, PhD, JD; Scott M. Fishman, MD; James C. Moeller, BS

In an effort to reduce the risk of overdose deaths and diversion associated with opioids, the state of Washington recently passed legislation that will require a pain consultation once a chronic, noncancer pain patient has reached 120 mg minimum effective dose per day (MED/day). Panelists discuss the extent of the national problem, how public policy is created, Washington state’s unique approach, and the need for increased collaboration between policymakers and prescribers.

Thursday/9.8
11:05 AM - 12:00 PM

Kevin L. Zacharoff, MD, FACPE, FACIP, FAAP; Salma Lemtouni, MD

Drs. Lemtouni and Zacharoff discuss the challenges of the medical treatment of chronic pain in the geriatric patient population. In addition to correlating the increasing incidence of geriatric pain with the “aging of America,” comparisons of risks and benefits of specific medical treatment approaches are made. Also addressed are the context of existing clinical guidelines and practice recommendations, as well as other factors that should be considered for safe use of medical therapy in this patient population.

Thursday/9.8
11:05 AM - 12:00 PM

Forest Tennant, MD, DrPH

This presentation discusses how peripheral pain, whether caused by injury or disease, may imprint itself permanently in the central nervous system (CNS). This profound discovery compels clinical practitioners to diagnose the presence of central pain and determine if the patient has central pain, peripheral pain, or a combination of the two. The hallmark of central pain is a history of constant pain and poor or nonresponse to peripheral pain treatments. Central pain occurs because of glial activation, after which follow neuroinflammation, tissue destruction, and cellular reformation. These CNS changes are associated with many clinical findings including hormone abnormalities, excess sympathetic discharge, and a variety of mental changes. Treatment of central pain optimally requires tissue regeneration.

Thursday/9.8
2:00 PM - 2:55 PM

Michael E. Schatman, PhD, CPE

Chronic pain patients represent an extremely vulnerable population, particularly because of deficiencies in the quality of treatment they often receive, as well as medicolegal and reimbursement pitfalls. Theories regarding advocacy by clinicians have been posited, although there exists considerable disagreement regarding the extent to which advocacy is appropriate or even beneficial to patients. Ethical and practical implications of advocating for chronic pain patients are addressed from different perspectives.

Presented by Clinician Reviews.

Thursday/9.8
3:05 PM - 4:00 PM

Forest Tennant, MD, DrPH

This presentation discusses pain and opioids and their different effects on the endocrine system. Pain is the ultimate stressor. When pain is uncontrolled, the pituitary-adrenal axis secretes excessive amounts of cortisone and other hormones in an effort to heal the offending cause of pain. Over time, the pituitary, adrenals, and gonads may exhaust, causing a multitude of complications. Opioids commonly suppress the component of the pituitary that produces testosterone, so clinicians who prescribe opioids must be prepared to replace this important hormone. Opioids seldom suppress other hormones to the point that replacement is necessary. Certain hormones, particularly medroxyprogesterone and human chorionic gonadotropin, appear to have central nervous system regenerative capabilities and show early promise in treating intractable central pain.

Thursday/9.8
4:30 PM - 5:25 PM

Steven D. Passik, PhD

This presentation addresses the clinical phenomenon of chemical coping and focuses on a framework for working with patients who use this method to try to control their pain. The measurement of chemical coping will be highlighted as will motivational strategies. Specifically, this course covers diagnosis, offers structured treatment paradigms for the care of the chemical coper, and provides motivational strategies for working with this group of pain patients.

Friday/9.9
7:30 AM - 8:25 AM

Michael E. Schatman, PhD, CPE; John F. Peppin, DO, FACP; Ana Smith Iltis, PhD

This panel presents the conflict that exists in the treatment of chronic pain patients. Patients in pain clinics are frequently required to submit to a range of procedures such as pill counts, urine screens, and similar demoralizing testing, in a very paternalistic setting. Many times patients are discharged if they do not comply with requirements such as these. Conversely, autonomy is described as the foundation of the patient–physician encounter. How are these two apparent conflicting settings reconciled? This panel discusses this conflict and recommends potential resolutions.

Friday/9.9
10:00 AM - 10:55 AM

R. Norman Harden, MD

Postamputation pain is ubiquitous in amputees, but very poorly understood by those who treat these patients. This presentation discusses possible pathophysiology with an eye to therapeutic targets.

Presented by The Federal Practitioner.

Friday/9.9
11:05 AM - 12:00 PM

Sean Mackey, MD, PhD, CPE

Chronic pain affects millions of patients worldwide, costing billions of dollars in medical expenses. Only recently has the CNS been shown to play a pivotal role in the generation and maintenance of chronic pain. Investigators have used functional magnetic resonance imaging (fMRI) and other neuroimaging tools to open windows into the brain in order to better characterize the neural correlates of pain. They have discovered that certain brain regions involved with pain include the somatosensory cortex, prefrontal cortex, anterior cingulate cortex, and insular cortex. Other imaging technologies, such as structural imaging, magnetic resonance spectroscopy, and diffusion tensor imaging have provided insights into the anatomic, chemical, and connectivity changes, respectively, induced by pain. This session reviews the current neuroimaging data for pain and describes the abnormalities shown in the frontal and limbic brain systems. Also explained are the brain changes involved with both evoked stimuli in pain as well as changes seen in the resting brain. At the end of this lecture, participants will have a better appreciation of the neural plasticity involved with pain and its therapeutic implications.

Friday/9.9
2:00 PM - 2:55 PM

Sean Mackey, MD, PhD, CPE

With the dramatic increase in the amount of prescription opioids used for the treatment of pain, opioids have become the most commonly prescribed medication class in the United States. Vicoden® is the most prescribed medication, at 128 million prescriptions per year. Opioids remain the gold standard of treatment for moderate-to-severe acute and chronic pain. Despite this high usage, increasing evidence shows that chronic use of opioids has deleterious effects on the patient. In this session, we review the positive aspects of opioid use for chronic pain as well as the negative consequences. We specifically examine the current literature on opioid-induced hyperalgesia, opioid-induced androgen deficiency, and the effects of opioids on the immune system. Additionally, we present recent evidence from our lab demonstrating the effects of prescription opioids on the human brain.

Friday/9.9
2:00 PM - 4:00 PM

Joseph V. Pergolizzi, MD

PAINWeek’s Scientific Poster and Abstracts Committee Chairman Joseph V. Pergolizzi, MD, will be joined by Joseph W. Stauffer, DO; Robert Raffa, PhD; Rami Ben-Joseph, PhD; Edmundo Muniz, MD, PhD; Sri Nalamachu, MD; and Errol Gould, PhD; for a two-hour plenary session on pain clinical trials. The expert panel will speak to FDA regulations and testing for pain products, analgesic preclinical testing, designing components of analgesic clinical trials, HOPE (hospital visit is an opportunity for prevention) studies in analgesic drug development, and investigator initiated trials. The panel then offers a concluding discussion. Please note that this session is not certified for credit.

Saturday/9.10
7:30 AM - 8:25 AM

Yvonne D'Arcy, MS, CRNP

This presentation discusses all aspects of acute pain management using an evidence-based format. Many practices continue in acute pain management although there may not be adequate research support. This presentation looks at acute pain management treatments and includes a discussion of the evidence that supports their use. Discussed will be pain management techniques such as preemptive analgesia, safe patient controlled analgesia (PCA), and regional analgesic blocks.

Saturday/9.10
11:05 AM - 12:00 PM

Yvonne D'Arcy, MS, CRNP

Using a case-based approach, several patient profiles are presented for discussion. In each case the patient presents with a complaint of pain and the presentation focuses on diagnosis and treatment options. The audience is invited to participate and discuss treatment choices and alternate options for pain management. This approach is particularly helpful for practitioners who see large numbers of patients in a general practice.

Saturday/9.10
2:00 PM - 2:55 PM

John F. Peppin, DO, FACP; John J. Coleman, MA, MS, PhD

This session discusses the history and development of REMS up to the recent failed submission by the FDA of a class-wide REMS. It reviews the weaknesses of REMS and discusses why we currently do not have a class-wide REMS for long-acting opioids. It also reviews current REMS for ultra-short–acting opioids. This panel will review published recommendations for a REMS that would address the FDA’s own goal terms, which included reduction of “abuse, misuse, addiction, and overdose deaths.”

Saturday/9.10
3:05 PM - 4:00 PM

Joanne Loewy, DA, LCAT, MT-BC

Wednesday/9.7
12:00 PM - 1:30 PM

Paul Glare, MD; Jeffrey A. Gudin, MD; Barbara A. Murphy, MD; Neal E. Slatkin, MD, DABPM; Sharon M. Weinstein, MD, FAAHPM

This activity will provide clinicians with an interactive forum to review evidence-based and best practice guidelines on the recognition, assessment, diagnosis, and management of persistent and breakthrough cancer pain. Led by an expert faculty panel, the program will include practical insights into the available evidence and allow participants to share their clinical decision-making using interactive video case studies and iPod touch technology.

This activity is supported by an independent educational grant from Cephalon, Inc.

This activity is certified for credit. Lunch will be served.

Thursday/9.8
12:00 PM - 1:30 PM

Charles Argoff, MD; Michael Brennan, MD; Paul Doghramji, MD, FAAFP; Douglas Schottenstein, MD

This activity is supported by educational grants from Janssen Pharmaceuticals, Inc., administered by Janssen Scientific Affairs, LLC. and Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

This activity is certified for credit. Lunch will be served.

Saturday/9.10
10:00 AM - 10:55 AM

Daniel B. Carr, MD, FABPM; Melanie Thernstrom

The increasingly sophisticated nature of pain research has allowed examination and analysis of complex, subtle processes inaccessible to earlier investigators. Such processes include reconstruction of others’ subjective experience through premotor “mirror” neurons, activation of limbic circuitry during empathy, neuroendocrine effects upon cognition, provision of and patient satisfaction with pain care as a social process, and the impact of social isolation or nurturing on the affective correlates of nociception. The widening of scope parallels broader developments in postmodern science and mathematics, deepens our understanding of the intersubjective and biopsychosocial qualities of pain, and emphasizes the importance of qualitative and narrative approaches to studying and educating others about the topic of pain. These recent developments in pain research make it clear that pain education requires more than simply a description of the machinery of nociception. Pain educators have begun to design curricula that supplement neuroanatomy and pharmacology with (in Murinson’s words) “socio-emotional experiences.” This presentation surveys these challenges and the efforts of Tufts’ decade-old program in pain research, education, and policy to inform its approach to interdisciplinary pain education through the incorporation of these recent insights.

Saturday/9.10
11:05 AM - 12:00 PM

Richard Glickman-Simon, MD

The successful management of a complex problem like chronic pain almost always depends on a multidisciplinary strategy equal to the task. As evidence continues to mount in support of this observation, pain educators are beginning to recognize the value of creating interprofessional partnerships across educational programs and institutions that have overlapping missions. Dr. Glickman-Simon reviews the potential benefits and risks associated with these collaborative initiatives and discusses in some detail one such innovative alliance between Tufts University School of Medicine and the New England School of Acupuncture. The session concludes with a consideration of how emerging educational methodologies and innovations can broaden alliances across disciplines and geographical locations.

Saturday/9.10
2:00 PM - 2:55 PM

Ylisabyth Bradshaw, DO, MS

The human social instincts of empathy and compassion underlie the entire healing enterprise. This session explores how to construct pain-related curricula that both convey objective knowledge and also create communities of engaged learners who support each other through a shared sense of collegiality rather than professional rivalry. These professionals’ compassion for patients is deliberately sustained and fostered by the curriculum and the context within which it is provided as well as the role models who epitomize this paradigm.

Saturday/9.10
3:05 PM - 4:00 PM

Carol P. Curtiss, MSN, RN-BC

Sociocultural, ethical, and organizational values and beliefs produce different expectations about pain and pain relief among individuals and organizations. Education alone in this area rarely produces practice changes. This session discusses challenges and opportunities inherent when integrating biopsychosocial, cultural, and ethical aspects of pain and pain management into education and everyday practice. Strategies to promote organizational change to improve pain care are also discussed.