PAINWeek 2012 Schedule

David M. Glick, DC, DAAPM, CPE, FASPE

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.

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

This presentation explores the use of both over-the-counter (OTC) and prescription medications in the context of the management of chronic pain. OTC medication statistics and safety issues in the United States will be discussed. This will be contrasted with the use of opioids in the US for the management of chronic pain along with guidelines and recommendations for their use as well as acetaminophen and NSAIDS.

Jennifer E. Bolen, JD

This presentation includes a chart of laboratory codes and the Clinical Laboratory Fee Schedule. It covers topics such as proper coding for CLIA-waived and moderate drug screening, and the distinctions between qualitative/general confirmation testing and quantitative drug testing. Please note that this is a prerequisite to the Medical Necessity course.

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

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

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.

Rebecca L. Curtis, ACC

Participants will learn how the patient’s focus on being cured contributes to an increase in the pain experience. Through an understanding of how negative thought patterns create a brain-body loop that accentuates pain, practitioners will learn techniques to guide patients to “rewire” their brains for a transformed experience with pain. Participants will learn the power gratitude has in building a pain-resistant ("teflon") brain, and the benefits of movement and relaxation for rewiring the chronic pain brain. Coaching techniques will enable practitioners to share these elements with chronic pain patients.

FACULTY

One-third of Americans are in pain. A majority of patients visiting pain centers have comorbid conditions. There is a complex interplay between pain, abuse, addiction, and comorbid conditions. Addiction and abuse are linked to the rate of brain entry with opioids. Is there an “ideal” mu opioid? And if there is, what might it look like? How can we treat patients across interdisciplinary boundaries to have the best results in terms of pain relief and lowest rates of abuse/addiction? Specifically, the program objectives are to enhance knowledge of latest thinking on interplays between pain, abuse, addiction, and comorbid diseases; increase perception of the future of opioid therapy; and provide insights on how to optimize care across multidisciplinary boundaries.

Sponsored by NEKTAR Pharmaceuticals. This activity is not certified for credit. Breakfast will be served.

Mel Pohl, MD

Chronic pain occurs as a complicated web of emotions and physical symptoms. Trauma history exacerbates the experience of chronic pain and may impede the recovery process. The most common way to treat pain is to use opioid medications, which actually complicate the course of chronic pain for many. For some individuals who develop chemical dependency/addiction to these medications, management and treatment for their condition can become much more complicated. This session will review the interactions of pain, suffering, trauma, and addiction as they interface in your patients, with suggestions for intervention and treatment.

Christopher M. Herndon, PharmD, BCPS, CPE

The treatment of pain continues to evolve as more is learned about this disorder. Evidence-based guidelines and practice recommendations have become abundant to assist the clinician in providing optimal patient care. A clear understanding of the pathogenesis of pain is vital to selecting rationale pharmacotherapy and adjuvant nonpharmacological interventions when developing a treatment plan for a patient. This 2-hour session will review neurophysiology, nociception, and the pharmacology of frequently used analgesics. Additionally, individual pain syndromes will be reviewed with evidence-based recommendations provided when available. Please note that the second hour of this course will begin at 11:10 am following the 10:30 am – 11:00 am break.

Gregory T. Carter, MD, MS
Steven D. Passik, PhD
Stephen J. Ziegler, PhD, JD

Marijuana remains a schedule I substance under the federal Controlled Substances Act (CSA). However, a number of states have passed their own laws that authorize medical marijuana for certain medical conditions, such as chronic pain. Although medical marijuana remains technically illegal under federal law, a growing number of physicians are nevertheless recommending it to their patients. A panel of experts will examine the clinical uses as well as concerns associated with its use.

FACULTY

Rachel M. Volk, HHC

This presentation will focus on stress and how it impacts pain in the body. We will also focus on and define adrenal fatigue. Primary foods will be defined, discussed, and illustrated. Methods and ideas for stress prevention and stress maintenance will be developed and demonstrated.

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

A 2011 Institute of Medicine report calls for "a cultural transformation in how the nation understands and approaches pain management and prevention.” The report stresses that improved care must include a combination of therapies and coping techniques. This presentation will include discussion on how to integrate evidence-based self-care modalities into your practice. The future is now!

Mel Pohl, MD

Much has been written and taught about chronic pain, a challenging condition resulting in disability, emotional upheaval, and family dysfunction. People concerned about someone with chronic pain suffer from characteristic dysfunctional behaviors that must be addressed if the person with chronic pain is to recover. Often families wonder whether the pain is “real” or not. We have a tendency to believe that pain based in emotions is less “valid” than physical pain. This session will review the emotional aspects of pain and suffering from a physiological and psychological standpoint and explain the basis of meditative techniques and the fundamentals of mindfulness practice.

Christopher M. Herndon, PharmD, BCPS, CPE

This session is the second half of PEF-03A.

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.

FACULTY

Chronic pain is a heterogeneous disease state that often defies simple classification, diagnosis, and treatment. Characterized by hyperactive nociceptive pathways and associated with numerous pathologic conditions, chronic pain affects an estimated 116 million adults in the United States with significant socioeconomic consequences.1 Although the precise determinants of chronicity have not been fully elucidated, the neuroplastic changes associated with chronic pain are thought to be progressive and often irreversible, underscoring the need for thorough assessment, timely diagnosis, and aggressive treatment.2 Importantly, the clinical presentation of chronic pain is markedly influenced by patient-specific biologic and psychosocial parameters, requiring comprehensive evaluations of all contributory factors and functional deficits associated with the pain experience.3 Advances in our understanding of pain mechanisms, improved assessment methodologies, and a growing evidence base supporting various therapeutic approaches have left clinicians better equipped to manage the growing population with chronic pain.4-7 This Interactive ShowCASE™ highlights recent scientific insights into pain pathophysiology and how they can be translated into practical chronic pain assessment and management strategies.

References

1. Transforming Prevention, Care, Education, and Research. Washington, DC: Institute of Medicine of the National Academies; 2011.
2. Woolf CJ. Anesthesiology. 2007;106:864-867
3. Gatchel RJ, et al. Psychol Bull. 2007;133:581-624.
4. Baron R, et al. Lancet Neurol. 2010;9:807-819
5. American Society of Anesthesiologists. Anesthesiology. 2010;112:810-833.
6. Chou R, et al. Ann Intern Med. 2007;147:478-491.
7. Smart KM, et al. Clin J Pain. 2011;27:655-663.

Learning Objectives

• Assess chronic pain phenomenology, including pain characteristics, associated symptomatology, functional consequences, and underlying neurobiologic mechanisms
• Perform initial and ongoing evaluations of patients with chronically painful conditions, including low back pain, osteoarthritis, peripheral neuropathies, and other pain syndromes
• Evaluate the clinical profiles of pharmacologic agents based on analgesic mechanisms of action, potential benefits, adverse effects, and risks of inappropriate use
• Tailor single-agent and multidrug pharmacologic regimens for chronic pain to maximize analgesia and functional gains and minimize adverse effects
• Implement and coordinate multidisciplinary care to address the full range of biopsychosocial symptoms associated with chronic pain

Jointly sponsored by Albert Einstein College of Medicine of Yeshiva University, Educational Review Systems, Asante Communications, LLC.

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

Paul J. Christo, MD, MBA

Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic noncancer pain continue to be a concern for physicians and patients. Compliance monitoring can be helpful in delivering proper opioid therapy, and urine drug testing is considered an important tool of adherence monitoring. We will discuss the role of urine drug testing in monitoring chronic opioid therapy along with assessing its limitations.

David M. Glick, DC, DAAPM, CPE, FASPE

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 overreliance on technology for basic clinical diagnosis. The purpose of this session is 2-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.

Gregory T. Carter, MD, MS

There are a growing number of studies indicating that chronic pain is a common symptom for the majority of people with various neuromuscular disorders (NMDs). Studies of adult persons with NMDs—including the facioscapulohumeral (FSHD), myotonic (MMD), and limb girdle (LGMD) forms of muscular dystrophy; spinal muscular atrophies (SMA); Charcot-Marie-Tooth (CMT) disease; and post-polio syndrome (PPS)—have shown reported rates of chronic pain ranging from 70% to 96%. Despite the negative impact of chronic pain on quality of life for NMD patients, there is almost no information on the relationship of chronic pain and burden of disease in this patient population. Future directions will be discussed in this lecture, including the need for studies addressing the degree to which chronic pain contributes to disease burden and how psychosocial factors causally influence pain. Better measurement tools for chronic pain, quality of life, and burden of disease are needed and could be utilized via NMD registries for these studies.

Peter A. Foreman, DDS, DAAPM

Temporomandibular disorders (TMD) are more common than temporomandibular joint disorders (TMJD), which are more likely to be seen by oral surgeons. Correct diagnosis is critical, as inaccurate diagnosis can lead to inappropriate treatments creating further problems. Treatment approaches differ, some are controversial, and not all treatments are evidence-based. Advances in understanding pain mechanisms also show that convergent afferent nociceptive transmission from nontrigeminal, extraoral cervical sources can enter the trigeminal system. TMD pain may also present as dental, sinus, and headache. Myofascial trigger points are a major source of pain that is often overlooked, and psychosocial factors also play a major role in the development and chronicity of TMD. This Master Class addresses some of the issues involved and looks at management approaches. Demonstrations and practical work in pairs will help consolidate the material presented.

FACULTY

Bruce D. Nicholson, MD

Treatments that may have direct central neuromodulatory effects can offer significant benefits for the appropriately selected patient. Intrathecal therapy should significantly improve functional status and decrease use of oral analgesic requirement. Patient selection is critical to the successful outcome when considering this therapy. Both cancer and chronic nonneuropathic pain as well as neuropathic pain may benefit from intrathecal therapy. This course addresses benefits and limitations, speaks to the importance of patients’ expectations and how they should be reviewed prior to entering into an intrathecal trial of opiates or ziconotide.

Gary W. Jay, MD, DAAPM, FAAPM

Pain without a purpose lasting for greater than 3 to 6 months is considered chronic pain. Patients that experience chronic pain in general have been trialed on multiple medications and nonpharmacologic therapies. This lecture will focus on the differences between acute and chronic pain and begin discussion regarding some common pain syndromes and clinical insights into therapeutic modalities used in its management.

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.

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Michael E. Schatman, PhD, CPE, DASPE

While all pain practitioners are faced with growing dilemmas in their practices, those treating pain patients in underserved rural areas struggle with limited resources and a particularly challenging patient population. This presentation identifies and addresses these challenges, offering specific strategies for working with suffering individuals in rural areas, emphasizing the imperative of “thinking outside of the box” in order to increase the treatment options available. Needs of providers as well as those of pain patients in rural areas are addressed.

Rachel M. Volk, HHC

This presentation will focus on obesity and how it relates to pain, stiffness, and swelling in the body. We will look at this from a holistic perspective to understand the implications of how diet and lifestyle determine health and risk of disease. An anti-inflammatory diet will be reviewed and explained in detail. We will discuss patient control over quality of life through daily food choices. The importance of patient accountability will also be explained.

Bruce D. Nicholson, MD

This lecture reviews the evaluation and treatment of persistent chronic neuropathic and nonneuropathic pain. Certain chronic pain profiles may not respond well to traditional mainstream medical and/or surgical management. Spinal cord stimulation therapy is most effective in treatment of neuropathic pain states such as monoradicular pain. Other conditions such as complex regional pain syndrome 1 and 2 may also benefit from spinal cord stimulation. When considering spinal cord stimulation therapy, patient selection is critical for a successful outcome. Therefore, the benefits and limitations as well as patient expectations should be completely reviewed with each patient prior to entering into a trial of spinal cord stimulation.

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE
Thomas B. Gregory, PharmD, BCPS, DASPE, CPE
Christopher M. Herndon, PharmD, BCPS, CPE

Chronic pain is a frequent cause for accessing healthcare resources, usually from a primary care setting. While great strides have been made to improve the education of frontline practitioners in appropriate pain management, a paucity of data exists to direct the creation of policies and procedures to manage these resource-intensive patients. In this program, insights will be shared from the gradual implementation over 5 years of a chronic pain management service within a large family medicine residency program.

Daniel B. Carr, MD, FABPM
Michael R. Clark, MD, MPH, MBA

Daniel B. Carr, MD, delivers the Keynote Address, entitled “A Public Health View of Pain Education: Have We Been Backwards, Upside Down, or Both?” Dr. Carr is founder and director of the interprofessional program in Pain Research, Education & Policy at Tufts University School of Medicine, and is widely published in pain research, evidence-based medicine, and the social and political aspects of pain relief.

Paul J. Christo, MD, MBA

By 2050, the number of older persons will exceed the number of young people for the first time in history. Persistent pain escalates with age and older adults are susceptible to specific pain conditions. This presentation will review age-associated changes in pain processing, discuss typical painful disorders that affect older adults, and summarize effective treatments.

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

Pain signals travel along the spinal cord into the brain where the signals are processed. Medications and nonpharmacologic treatments are used to alter the perception of pain. Using multiple medications can better alter the perception of pain, minimize side effects from other medications, and increase compliance with the treatment. This workshop will engage the active participant in discussion regarding multimodal analgesia, combination therapy, and when single agent therapy is appropriate.

Christopher M. Herndon, PharmD, BCPS, CPE

Adjuvants and co-analgesics are quickly becoming a mainstay of therapy for the treatment of persistent pain. Anesthetics, antidepressants, and anticonvulsants are a few of the pharmacotherapeutic options. While many of these agents have proven efficacious for pain, adverse effects are common and self-discontinuation of these agents by patients a frequent barrier to care. Here the most common adverse effects will be discussed to assist in the appropriate selection based on patient-specific variables. Monitoring and recommendations for discontinuation will also be discussed.

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Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE

This session will explore the basis for motivational interviewing as an effective style for initiating and facilitating change in a chronic pain patient. Many disease states require behavioral change by the patient to improve health outcomes. The principles and the process of motivational interviewing involve establishing a patient–provider relationship; setting an agenda; assessing importance, confidence, readiness; and helping patients and families with an action plan to effect those changes.

Deborah A. Ward, PharmD, BCOP, BCPS

Pain control in the pediatric setting can provide a number of challenges, ranging from pain assessment to drug dosing. In this case-based presentation, barriers to providing adequate pain control will be identified, and the influence of age on drug therapy selected to manage pain in this special patient population will be discussed.

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Forest Tennant, MD, MPH, DrPH

The most significant clinical understanding of recent times is that a peripheral nerve injury that causes pain may cause imprinting of pain’s memory in the central nervous system (CNS). This occurs when inflammatory mediators from the peripheral pain site enter the CNS and activate glial cells to produce inflammation. Practitioners are taught how to diagnose, treat, and prevent this condition. CNS inflammation is a progressive, tissue destructive process that requires treatment strategies that are relatively new to pain treatment.

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

Pain signals travel along the spinal cord into the brain where the signals are processed. Medications and nonpharmacologic treatments are used to alter the perception of pain. Using multiple medications can better alter the perception of pain, minimize side effects from other medications, and increase compliance with the treatment. This workshop will engage the active participant in discussion regarding multimodal analgesia, combination therapy, and when single agent therapy is appropriate.

Christopher M. Herndon, PharmD, BCPS, CPE

Adjuvants and co-analgesics are quickly becoming a mainstay of therapy for the treatment of persistent pain. Anesthetics, antidepressants, and anticonvulsants are a few of the pharmacotherapeutic options. While many of these agents have proven efficacious for pain, adverse effects are common and self-discontinuation of these agents by patients a frequent barrier to care. Here the most common adverse effects will be discussed to assist in the appropriate selection based on patient-specific variables. Monitoring and recommendations for discontinuation will also be discussed.

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE

This session will explore the basis for motivational interviewing as an effective style for initiating and facilitating change in a chronic pain patient. Many disease states require behavioral change by the patient to improve health outcomes. The principles and the process of motivational interviewing involve establishing a patient–provider relationship; setting an agenda; assessing importance, confidence, readiness; and helping patients and families with an action plan to effect those changes.

Rebecca L. Curtis, ACC

Participants will learn how the patient’s focus on being cured contributes to an increase in the pain experience. Through an understanding of how negative thought patterns create a brain-body loop that accentuates pain, practitioners will learn techniques to guide patients to “rewire” their brains for a transformed experience with pain. Participants will learn the power gratitude has in building a pain-resistant ("teflon") brain, and the benefits of movement and relaxation for rewiring the chronic pain brain. Coaching techniques will enable practitioners to share these elements with chronic pain patients.

FACULTY

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

Rachel M. Volk, HHC

This presentation will focus on stress and how it impacts pain in the body. We will also focus on and define adrenal fatigue. Primary foods will be defined, discussed, and illustrated. Methods and ideas for stress prevention and stress maintenance will be developed and demonstrated.

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Charles F. Cichon

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.

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

Pain signals travel along the spinal cord into the brain where the signals are processed. Medications and nonpharmacologic treatments are used to alter the perception of pain. Using multiple medications can better alter the perception of pain, minimize side effects from other medications, and increase compliance with the treatment. This workshop will engage the active participant in discussion regarding multimodal analgesia, combination therapy, and when single agent therapy is appropriate.

-->

Christopher M. Herndon, PharmD, BCPS, CPE

Adjuvants and co-analgesics are quickly becoming a mainstay of therapy for the treatment of persistent pain. Anesthetics, antidepressants, and anticonvulsants are a few of the pharmacotherapeutic options. While many of these agents have proven efficacious for pain, adverse effects are common and self-discontinuation of these agents by patients a frequent barrier to care. Here the most common adverse effects will be discussed to assist in the appropriate selection based on patient-specific variables. Monitoring and recommendations for discontinuation will also be discussed.

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE

This session will explore the basis for motivational interviewing as an effective style for initiating and facilitating change in a chronic pain patient. Many disease states require behavioral change by the patient to improve health outcomes. The principles and the process of motivational interviewing involve establishing a patient–provider relationship; setting an agenda; assessing importance, confidence, readiness; and helping patients and families with an action plan to effect those changes.

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

This presentation discusses the issue of medication safety in the United States. Specific issues discussed focus on medical errors, and drug-drug interactions within the context of chronic pain management. Recommendations detail practical clinical practice points that can help avoid errors and increase medication safety with respect to pain management.

FACULTY

Ted W. Jones, PhD
Steven D. Passik, PhD

Paul J. Christo, MD, MBA

As the population ages, chronic conditions, especially pain, will increase in prevalence. Understanding the unique physiological changes that occur with age is important in selecting specific analgesics. This activity reviews the pharmacokinetic and pharmacodynamic changes accompanying older adulthood, then provides an update on the American Geriatrics Society recommendations for medical therapy along with evidence for procedural interventions that may be useful for pain relief.

Charles F. Cichon

In addition to establishing qualifications for licensure, Medical Boards are responsible for investigating complaints against licensees and for taking action against the license of those who fail to maintain their state's high standards of medical care delivery, or who break the laws governing licensure. This presentation will examine: 1) What kind of complaints result in discipline, 2) What happens when the board conducts an investigation, 3) How long does the complaint process usually take, and 4) What should you do if a regulatory or criminal complaint is filed against you.

Barbara L. Kornblau, JD, OTR/L, CPE, DASPE
Susan K. McNulty, OTD, OTR/L
Scott M. Robertson

Autistic individuals may present unique situations for pain practitioners. Neurological differences may cause autistic people to perceive pain differently. Clinicians may find they also communicate this atypical pain perception differently from other pain patients. Other sensory-related challenges, such as tactile sensitivity, may require clinicians to alter their standard routine examination. This session presents clinical traits of autism, accompanying sensory perception, and practice tips to treat autistic people who experience pain.

FACULTY

Individual genetic differences in medication metabolism can impact the efficacy, side-effect profile, and drug-drug interactions of medication therapy in pain care. Genetic differences may help to explain suboptimal pain control, medication interactions, adverse effects, the need for higher or lower dosing, and unexpected urine drug test results. This session will introduce the clinical value of pharmacogenetic testing (PGT), a new diagnostic tool that identifies an individual patient’s ability to metabolize medications commonly used in pain management. PGT results may help prescribers optimize choice of effective medication therapy while potentially minimizing side effects and drug-drug interactions. Case studies will be presented that highlight the value of pharmacogenetic testing and discuss the clinical application of an individual’s metabolism profile as it relates to personalized medication therapy.

Sponsored by Millennium Laboratories. This activity is not certified for credit. Lunch will be served.

FACULTY

Chronic pain is a heterogeneous disease state that often defies simple classification, diagnosis, and treatment. Characterized by hyperactive nociceptive pathways and associated with numerous pathologic conditions, chronic pain affects an estimated 116 million adults in the United States with significant socioeconomic consequences.1 Although the precise determinants of chronicity have not been fully elucidated, the neuroplastic changes associated with chronic pain are thought to be progressive and often irreversible, underscoring the need for thorough assessment, timely diagnosis, and aggressive treatment.2 Importantly, the clinical presentation of chronic pain is markedly influenced by patient-specific biologic and psychosocial parameters, requiring comprehensive evaluations of all contributory factors and functional deficits associated with the pain experience.3 Advances in our understanding of pain mechanisms, improved assessment methodologies, and a growing evidence base supporting various therapeutic approaches have left clinicians better equipped to manage the growing population with chronic pain.4-7 This Interactive ShowCASE™ highlights recent scientific insights into pain pathophysiology and how they can be translated into practical chronic pain assessment and management strategies.

References

1. Transforming Prevention, Care, Education, and Research. Washington, DC: Institute of Medicine of the National Academies; 2011.
2. Woolf CJ. Anesthesiology. 2007;106:864-867
3. Gatchel RJ, et al. Psychol Bull. 2007;133:581-624.
4. Baron R, et al. Lancet Neurol. 2010;9:807-819
5. American Society of Anesthesiologists. Anesthesiology. 2010;112:810-833.
6. . Chou R, et al. Ann Intern Med. 2007;147:478-491.
7. Smart KM, et al. Clin J Pain. 2011;27:655-663.

Learning Objectives

• Assess chronic pain phenomenology, including pain characteristics, associated symptomatology, functional consequences, and underlying neurobiologic mechanisms
• Perform initial and ongoing evaluations of patients with chronically painful conditions, including low back pain, osteoarthritis, peripheral neuropathies, and other pain syndromes
• Evaluate the clinical profiles of pharmacologic agents based on analgesic mechanisms of action, potential benefits, adverse effects, and risks of inappropriate use
• • Tailor single-agent and multidrug pharmacologic regimens for chronic pain to maximize analgesia and functional gains and minimize adverse effects
• Implement and coordinate multidisciplinary care to address the full range of biopsychosocial symptoms associated with chronic pain

Jointly sponsored by Albert Einstein College of Medicine of Yeshiva University, Educational Review Systems, Asante Communications, LLC.

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

Lisa McElhaney

In the last decade, the escalation of calls to law enforcement made by healthcare providers has been alarming. The root causes of many calls can be eliminated by the healthcare provider simply applying proactive prevention measures in their business. This segment is a structured review of basic principles that every healthcare provider should implement into their practice to limit the possibility of becoming a victim of circumstance.

Ronald J. Rapoport, MD, FACR

There are many causes for inflammation of the joints, and the differentiation among these conditions is necessary for proper treatment. This presentation will describe the common and uncommon inflammatory arthropathies, discuss diagnostic methods, and prepare practitioners to better care for those in pain.

Michael B. Ellner, CHt, MSH

If your practice includes assisting individuals in pursuit of relief, this program is for you. Dan Cleary has lived with pain for over 30 years and has dedicated his life to teaching simple relief techniques that work. Whatever your specialty, you will find quick and easy ways to shift patient awareness and increase compliance. If you are one of the many who also experience chronic painful signals, sit up front and get ready to feel better. *This course is not certified for credit.

Philip Getson, DO
R. Norman Harden, MD

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. The first half of this course discusses the fundamentals of CRPS, its clinical manifestations and basic treatment. The second half discusses diagnostic testing, followed by treatment modalities with particular attention on ketamine infusion therapy. Interspersed will be case presentations and atypical signs and symptoms of CRPS.

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

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

FACULTY

Ted W. Jones, PhD

Current commonly used risk assessment measures are brief paper and pencil inventories to be completed by patients. These tools have limitations, however, and clinicians often need to follow-up with a clinical interview. This session will introduce participants to a validated risk assessment method that relies on interview data. This new risk assessment method will be reviewed in detail and data will be presented to show that it is a valid method of assessing risk in more depth than many current screening measures provide.

Presented by the Journal of Family Practice.

Jennifer D. Carpenter

While the vast majority of prescribers are legitimate, unfortunately there are some that are operating “illegally” and drug trafficking, according to law enforcement criteria. With prescription drug diversion reaching epidemic levels, law enforcement is taking action against the “illegal prescribers.” This course will help identify the illegal prescriber, outline the steps necessary to prevent becoming an illegal prescriber, and explain the coordination between law enforcement and healthcare professionals to combat the prescription drug diversion epidemic.

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

Participants in this session will apply principles discussed in the session on Instructional Design and develop, critique, and suggest improvements for peer and patient education materials on pain management.

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.

FACULTY

Mission: Pain Management – The Efficient First Visit is a novel interactive IDEAL® Clinical Encounter forum in which participants have the opportunity to put their knowledge into practice. This activity, designed to help the pain team focus their efforts on maximizing their time with the patient, allows attendees to participate in the diagnosis and management of a live “programmed” patient. Experts will interact with the patient, discussing his history and current situation. They will then review management choices and appropriate treatments with the participants, based upon the information and “clinical pearls” revealed earlier in the program. Participants will have the opportunity to provide interactive feedback and monitor their learning progress. Throughout the activity, the experts will provide evidence-based information that can be implemented immediately to enhance your patient care.

Learning Objectives

• Differentiate the underlying pathophysiology and pain transmission mechanisms associated with nociceptive, neuropathic, and centrally-mediated chronic pain
• Compare nonpharmacologic and pharmacologic treatment options for chronic pain and contrast relative risks and benefits in the management of chronic pain
• Illustrate barriers to the optimal use of opioid analgesics in patients with chronic pain and formulate strategies to address such barriers
• Assess therapeutic management methods, including titration for safety and efficacy, for screening and risk mitigation in the initial and follow-up care of patients with chronic pain

Jointly Sponsored by the University of Cincinnati, Advancing Knowledge in Healthcare, and Educational Awareness Solutions.

Supported by educational grants provided by Purdue Pharma L.P. and Mallinckrodt, the pharmaceuticals business of Covidien.

Rachel M. Volk, HHC

This presentation will focus on obesity and how it relates to pain, stiffness, and swelling in the body. We will look at this from a holistic perspective to understand the implications of how diet and lifestyle determine health and risk of disease. An anti-inflammatory diet will be reviewed and explained in detail. We will discuss patient control over quality of life through daily food choices. The importance of patient accountability will also be explained.

Kimberly S. New, BSN, JD

Drug diversion is universal among institutions in the United States, and is a primary reason for discipline of nurses across the country. Drug diversion is a serious crime that can often result in patient endangerment and abuse. When patient care is entrusted to an impaired provider, the patient may fall victim to negligent care. A patient may languish in pain when a diverting provider steals pain medication intended for the patient or substitutes saline for injectable controlled substances. Nurses who divert risk their professional credentials, job, family, and even their personal freedom. Having a robust diversion surveillance and investigation process is vital for protecting patients from the potentially disastrous consequences of diversion. Prompt recognition of diversion allows for early intervention with the professional involved. Common methods of drug diversion will be explored, and reporting requirements will be detailed. Actual cases of nursing diversion will be presented including cases of patient harm due to substitution or tampering. Proactive measures to prevent diversion will be covered.

John F. Peppin, DO, FACP

Opioids are an important mode of treatment for many patients who suffer from acute and chronic pain. However, many opioids at therapeutic levels are associated with a spectrum of side effects that can limit quality of life and contribute to unintentional overdose death. Constipation, somnolence, urinary retention, pruritis, nausea, vomiting, confusion, dysphoria, euphoria, and other side effects are among the most common problems associated with mu opioid agonists. Recent research has focused on designing opioid-like molecules that have fewer side effects, including less risk for abuse and addiction. Delta and kappa opioid agonists are new chemical entities that are opioid-like and may have less respiratory depression than mu agonists but are equally effective as analgesics. These agonists have different properties than mu agonists and may provide an advantage in the treatment of pain. For example, it has been reported that delta opioid agonists have an antidepressant effect. This could be associated with both clinical benefits and untoward positive effects. Kappa opioids may have increased analgesia with much less abuse potential that traditional mu agonists. Several new delta and kappa agonist chemical entities are currently being investigated that may add to the clinician’s armamentarium in treating pain. This program discusses drugs in development that work primarily on delta and kappa receptors.

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

This presentation discusses the movement of medicine into a Digital Age. The status of implementation of EMRs in the United States is discussed, along with future vision about the uptake and use. The implications of the digitalization of medical records and management of chronic pain will be addressed, as well as the potential for improvement in the delivery and tracking of chronic pain management.

Jennifer D. Carpenter
Aaron M. Gilson, MS, MSSW, PhD
John F. Peppin, DO, FACP
Stephen J. Ziegler, PhD, JD

FACULTY

Poster authors are available for questions and feedback during the reception.

Michael M. Bottros, MD

Peripheral artery disease (PAD) is a common comorbidity in diabetics. According to the World Health Organization 2004 report, there will be a total of nearly 366 million people with diabetes by 2030, thus making it necessary to understand and evaluate the presence of PAD and critical limb ischemia. While atherosclerotic plaques do not differ histologically between diabetic and nondiabetic individuals, the clinical features differ in anatomical localization, spread, calcification extent, and severity. Smoking, age, hypertension, and lack of glycemic control are reported positive risk factors, whereas HDL and apolipoprotein A-1 exert protective effects. Foot examination correlates poorly to the diagnosis of PAD, whereas the ankle-brachial index measurement is considered the most accurate noninvasive diagnostic method when evaluating PAD. The coexistence of significant neuropathy and arterial calcifications are primary determinants for underdiagnosing PAD. Pharmacological management includes antiplatelet therapy of aspirin or the use of clopidogrel for those individuals who are sensitive to aspirin. Patients who have had bypass surgery or cardiac stent placement require dual antiplatelet therapy per ACC/AHA guidelines. Treatment with beta-blockers and ACE inhibitors is appropriate pharmacotherapy to treat PAD. Other FDA-approved medications such as Cilostazol and Pentoxifylline are also used in the treatment of pain associated with intermittent claudication.

Deborah A. Ward, PharmD, BCOP, BCPS

When safely prescribed, NSAIDS and other anti-inflammatory drugs can provide analgesia in a variety of clinical settings. In this case-based presentation, the clinical situations and challenges of providing safe and effective use of these drugs will be discussed.

Robert D. Gerwin, MD, FAAN

This course looks at the relationship between fibromyalgia and myofascial pain. The reasons for the controversy over whether these are unique or related conditions will be examined. The distinct features of each of these conditions and their similarities are presented, emphasizing biochemistry and physiology, with a concluding discussion of their relationship and how it affects treatment decisions.

Roger B. Fillingim, PhD
Mark S. Wallace, MD

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

Opioids have been used in one form or another for over 4,000 years. Still today we are continuing to discover new and improved opiates with better patient tolerance and decreased side effects comparatively. This lecture will focus on the families of opiates and how they differ from each other, review patient characteristics that make certain opiates more desireable than others, and discuss management of side effects.

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

Feeling stressed? Bored with the daily grind? Want to put fun and joy back into your practice, home, and/or play? Then this 2-hour interactive/experiential presentation is just what the good doctor ordered. Discover how applied mindfulness can promote feeling better and being more effective at whatever you are doing. *This course is not certified for credit.

Forest Tennant, MD, MPH, DrPH

This course primarily explains how and under what circumstances pain may alter the endocrine system. Complications of these alterations will be taught. Testing and hormone replacement is becoming a standard procedure in severe chronic pain patients, particularly those who must take opioid drugs. Practitioners who treat centralized pain will need to know the neurogenic and neuroprotective hormones that show considerable clinical promise in treating this condition.

FACULTY

This session presents posters selected for oral presentations.

FACULTY

A panel will discuss a peer-reviewed article on the consensus of urine drug monitoring recommendations addressing test selection, test frequency, interpretation of results, and how to handle discrepancies based on specific results. The recommendations are meant to begin to provide a framework for standardizing practices for urine drug monitoring in the treatment of chronic pain. The intent of this program is to inform primary care physicians and pain management specialists about the expert consensus recommendations regarding the appropriate use of urine drug monitoring.

Sponsored by Ameritox, Inc. This activity is not certified for credit. Lunch will be served.

FACULTY

This program will provide a forum for both didactic and interactive education regarding the burden of disease of opioid-induced constipation (OIC), disease mechanisms, and clinical considerations associated with the treatment and management of OIC.

Learning Objectives

• Recognize the burden and impact of OIC on patients, healthcare providers, and society
• Identify patients at risk for OIC
• Explain the unique pathophysiology leading to OIC
• Discuss the benefits and limitations of current and emerging treatment options for OIC

This activity is jointly sponsored by AccreditEd and the University of Kentucky Colleges of Medicine, Pharmacy, and Nursing. This activity was made possible by an unrestricted educational grant provided by Salix Pharmaceuticals, Inc.

Michael M. Bottros, MD

Diabetes is a complex disease associated with several changes in the gastrointestinal tract with symptoms such as bloating, nausea, vomiting, diarrhea, constipation, and abdominal pain. While the exact pathogenesis of these symptoms is still not clearly understood, there is an increasing interest in the role of the enteric nervous system (ENS) and its neurotransmitters in this disease state. Recent studies have elucidated changes in inhibitory and excitatory neurons associated with the ENS as well as oxidative stress, advanced glycation end products, apoptosis, and overall neuronal loss. Inflammation-associated neurodegeneration can lead to motility problems in diabetic patients. Potential therapy includes antioxidants to prevent or treat these problems.

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Mark J. Tramo, MD, PhD

Music therapy exploits connections between the central auditory system on the one hand, and multimodal, supramodal, and autonomic systems on the other, to modulate our individual experiences of pain. Anatomical, physiological, chemical, and functional features of these systems and their interrelationships are explored. Also reviewed will be randomized-controlled clinical trials demonstrating beneficial effects of music on pain, and ways to incorporate music into pain management protocols.

Charles E. Argoff, MD, CPE

Acute and chronic pain accompanies many disorders of the central nervous system (CNS) including multiple sclerosis, infections, spinal cord injury, and traumatic brain injury. Following both an interactive didactic and patient-based approach, this session focuses on the assessment and treatment of the varied types of pain that can be associated with a variety of CNS disorders. Participants are encouraged to bring their own patient presentations.

FACULTY

Charles E. Argoff, MD, CPE
Roger B. Fillingim, PhD
Beth Darnall, PhD

Opioids are the de facto treatment for noncancer chronic pain, despite this treatment pathway being fraught with social, medical, legal, and ethical consequences. Dr. Argoff will review the many misconceptions regarding long-term opioid use, and will argue for a judicious and measured approach to prescribing; he will also review the ethical burden inherent in prescribing opioids. Dr. Darnall will review evidence describing some of the specific risks and consequences of opioid therapy, and will propose that informed consent procedures must include discussion of the likely complications associated with long-term opioid use (by relevant age and sex). She will also discuss the limitations of opioid therapy and will argue for a treatment approach that addresses the behavioral, emotional, and cognitive aspects that drive much of the chronic pain experience.

Barbara L. Kornblau, JD, OTR/L, CPE, DASPE
Susan K. McNulty, OTD, OTR/L

Lifestyle Redesign is the process of acquiring healthy habits and routines and incorporating them into one’s daily life. It takes a person experiencing pain from where they are, to where they need to be. Then they can return to their routines of work and other meaningful and/or necessary activities in their lives. This session details how the process works, presents evidence of successful outcomes, and explains how it can help your patients.

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

John F. Mondanaro, MA, MT-BC, LCAT, CCLS

Medical practice in the treatment of the physiological, psychological, and emotional symptoms of pain may be enhanced through a greater understanding of music therapy as a nonpharmacological intervention. Currently, medical professionals are challenged to be fully informed about music therapy as a component of planning in the treatment of pain, and music therapists are challenged to practice from an integrative and continually informed perspective. The use of live musical components—to entrain to the breath and natural cycles of tension release which occur in the body during acute pain episodes—is the focus of a current randomized controlled study with patients undergoing spine surgery. Music therapy interventions focusing on tension release through active drumming, visualization, entrainment, and psychoemotional catharsis will be discussed and demonstrated.

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

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.

Robert D. Gerwin, MD, FAAN

This course introduces the concepts of viscerosomatic pain that originates in visceral organs and is manifest by both visceral organ symptoms and body wall referred pain symptoms. These syndromes are common, often arising from the gastrointestinal tract. However, they are particularly troublesome in the pelvic region, and are associated with endometriosis, interstitial cystitis, and irritable bowel syndrome. They are frequently seen in patients with fibromyalgia or with abdominal/pelvic myofascial pain syndromes. This presentation addresses the underlying mechanisms, clinical presentation, and long-term management.

FACULTY

This program addresses postherpetic neuralgia and the impact on patients’ lives, reviews current guidelines on the management of postherpetic neuralgia, and discusses the benefits and limitations of current treatment strategies. Information will also cover treatment options and opportunities for integration into clinical practice.

Sponsored by Depomed, Inc. This activity is not certified for credit. Lunch will be served.

FACULTY

This program will provide a forum for both didactic and interactive education regarding the burden of disease of opioid-induced constipation (OIC), disease mechanisms, and clinical considerations associated with the treatment and management of OIC.

Learning Objectives

• Recognize the burden and impact of OIC on patients, healthcare providers, and society
• Identify patients at risk for OIC
• Explain the unique pathophysiology leading to OIC
• Discuss the benefits and limitations of current and emerging treatment options for OIC

This activity is jointly sponsored by AccreditEd and the University of Kentucky Colleges of Medicine, Pharmacy, and Nursing. This activity was made possible by an unrestricted educational grant provided by Salix Pharmaceuticals, Inc.

Roger B. Fillingim, PhD
Jennifer A. Haythornthwaite, PhD

Abundant evidence demonstrates the important contributions of psychological factors to chronic pain. These findings suggest that psychological treatments should be an important component of chronic pain management. This presentation will discuss common psychological approaches to pain management, and the evidence regarding the efficacy of these treatments will be reviewed, with an emphasis on cognitive-behavioral approaches to pain management.

Charles E. Argoff, MD, CPE

Diabetic peripheral neuropathic pain (DPNP) is one of the most common types of neuropathic pain encountered by clinicians. Practical assessment and treatment strategies will be discussed in this interactive session. Recognizing that while evidence-based guidelines have been published regarding the management of DPNP, such guidelines may not adequately guide the clinician's care of individual patients. This session covers individualized assessment and treatment approaches to this common neuropathic pain condition recognizing the limits of current published guidelines. Participants are encouraged to bring their own patient presentations.

Steven D. Passik, PhD

The debate over whether or not opioids are appropriate in chronic noncancer pain management has featured intellectually dishonest arguments from both the pro and con side. The expanded use of opioids has come about with claims that have trivialized the risks of addiction, while the new growing avoidance of opioids is backed by claims suggesting the drugs are highly addictive and that hyperalgesia is virtually inevitable. This lecture will present the debate highlighting these arguments.

Srinivas Nalamachu, MD
Joseph V. Pergolizzi, MD

PAINWeek's Scientific Poster and Abstracts Committee Chairman, Joseph V. Pergolizzi, MD, will be joined by Rami Ben-Joseph, PhD; Frank Breve, PharmD, MBA; Keith Candotti, MD; Frederick A. Curro, DMD, PhD; Robert Glanzman, MD; Errol Gould, PhD; Stephen McMorn, PhD; Srinivas Nalamachu, MD; and Robert Taylor, MD, for a 2-hour plenary session on pain clinical trials. The expert panel speaks to FDA regulations and testing for pain products, analgesic preclinical testing, designing components of analgesic clinical trials, studies in analgesic drug development, and invetigator initiated trials. Please note that this session is not certified for credit.

David M. Glick, DC, DAAPM, CPE, FASPE

The prevalence of back pain continues in spite of the many treatments available, without any single treatment emerging as a panacea. In routine practice, clinical examinations have tended to become more cursory, the result of increasing demands on clinicians’ time and possible overreliance 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 clinicians' 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.

FACULTY

David W. Dodick, MD, FRCP-C, FACP
Roger B. Fillingim, PhD

Migraine is one of the most prevalent and disabling medical conditions on the planet. Approximately 12% of the world’s population suffers from migraine, while 3% to 5% experience daily or near-daily headaches and other neurological symptoms. Migraine sufferers experience a profoundly diminished quality of life and mental health as well as impaired physical, social, and occupational functioning. While migraine research has been massively underfunded and the disorder clinically dismissed as a “headache,” its genetic and biological basis is increasingly coming into focus as a result of considerable scientific advances. Migraine is considered a largely inherited disorder that is characterized by physiological and structural alterations in the brain that result in paroxysmal episodes of cortical spreading depression, abnormal activation of trigeminovascular nociceptive pathways, and abnormal processing of sensory stimuli. A new era of scientific discovery in the molecular biology and receptor pharmacology of migraine headache has occurred over the past 2 decades and these advances have led to the development of promising new selective compounds and therapies for both the acute and preventive treatment of migraine. This presentation reviews the genetic and pathophysiological basis of migraine and emerging therapies and their physiologic and receptor targets.

Ronald J. Rapoport, MD, FACR

The musculoskeletal manifestations of diabetes mellitus (DM) are both those that we recognize quite readily, and those that pose more of a diagnostic dilemma. This course reviews the clinical presentation, findings on physical examination, proposed etiology, and treatment of these very challenging conditions. Included in the review are diabetic hand syndrome, carpal tunnel syndrome, and frozen shoulder.

Andrew R. Rossetti, MMT

Causal relationships among emotional states, levels of state anxiety, and pain perception affect treatment outcomes. Music, when presented in a live psychotherapeutic context, involves the activation of sensory pathways that compete with pain pathways, stimulating emotional response, and enhancing engagement of cognitive attention. A working hypotheses on modulating the emotional content of pain perception will be explored. Music experientials that address theoretical and clinical aspects of live music interventions employed with patients who have cancer will be exemplified. Research on the impact of music when receiving external beam radiation therapy and chemotherapy and its capacity to ameliorate state anxiety and provide adjuvant nonmedication-based pain management strategies will be discussed. Participants will gain understanding of the impact that music therapy can provide on anxiety in patients newly diagnosed with cancer and undergoing simulation for radiation therapy.

Deborah A. Ward, PharmD, BCOP, BCPS

Adjuvant therapy with antidepressants and anticonvulsants is often indicated in order to provide effective analgesia in a variety of pain settings. The drug therapy used and the clinical situations that require their use will be discussed in this case-based presentation.

Presented by Clinician Reviews.

Yoram Shir, MD

The high prevalence of chronic pain has become an immense public health problem. Diet is one of the possible analgesic modalities currently explored within the growing field of complementary and alternative medicine. Unfortunately, while proven to play a crucial role in the prevention of multifactorial illnesses such as cancer and ischemic heart disease, only scarce scientific data on the analgesic properties of diet exist. Nevertheless, preclinical and clinical studies have associated certain dietary factors with analgesia, indicating that diet could potentially play a significant role in relieving both acute and chronic pain. This course reviews basic and clinical evidence supporting dietary-induced analgesia and suggests possible future research avenues to further expand our knowledge of this neglected area.

Joanne V. Loewy, DA, LCAT, MT-BC

Recent evidence suggests that pain in infants is not well-assessed, and that belief in its perceived occurrence is controversial. Pain in children is undertreated or ignored and its reported "validity" may be questioned, particularly in teenagers. Infants and children who experience pain in early life may show long-term effects in pain perception and altered neural responses that can negatively influence behaviors. Music therapists have the unique advantage of being in the dynamic moment of musical expression or resistance with infants, children, and teens. Using music as a psychotherapeutic informant—through assessment of crying in infants and clinical improvisation, song writing, and music visualization for children and teens—can inform healthcare professionals of the cultural and clinical aspects through the expression or repression of the pain experience. This course presents clinical examples of actual music and medicine cases that exemplify the influence of music psychotherapy as an informant of the disease experience. Musical expression as a means of treatment is demonstrated as a metaphoric mode of expression, comfort, and trust that can assist the child’s perception of fear and alter the cycle of pain and anxiety in acute, chronic, and procedural pain experiences.

Charles E. Argoff, MD, CPE

Recent scientific discoveries regarding peripheral pain mechanisms, specifically within the epidermis, have led to new pain assessment tools and the development of new treatments. These discoveries may enhance the manner in which a clinician can evaluate and treat patients with chronic pain of diverse types, both neuropathic and others. It has been recently noted that keratinocytes in the skin release a broad spectrum of neural-active substances, such as neurotransmitters, neuropeptides, neurohormones, and thus may play a significant role in pain assessment as well as pain treatment. The increasing role of "skin" in pain management will be discussed with specific attention to emerging trends in pain assessment and pain treatment as a result of recent discoveries

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

This presentation provides participants with information related to the Food and Drug Administration's (FDA) requirement for a shared Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioid medications. A brief background of REMS will be presented, detailing the chronology, rationale, and steps taken. An update of the status of REMS will be detailed, along with a review of the educational blueprint for REMS education proposed by the FDA.

Hal S. Blatman, MD, DAAPM, ABIHM

During the past few years we have learned many things about how diet and nutrition affect aging and many forms of chronic disease, including heart disease, diabetes, and depression. Indeed there are similarities with understanding how nutrition affects pain and fatigue. This lecture discusses how certain foods in our patients’ diets actually stop their bodies from healing, and get in the way of rehabilitation. Moreover, certain foods may increase pain for days or even weeks at a time from a single exposure. There are 3 main rules to nutrition that get people out of pain, and they are reviewed in a manner that is easy to understand. Suggestions will be made for specific nutrients that will augment healing and/or more quickly reduce pain.

Debra J. Drew, MS, ACNS-BC, RN-BC

Pain assessment and regular reassessment provides the foundation of good pain management and sets the stage for planning, implementation, and evaluation of care. Lack of pain assessment is a major cause of inadequate pain management. Pain in the acute care setting is difficult to assess in certain populations, such as ICU, pediatrics, substance abuse, and mental illness. This presentation covers the key elements of pain assessment and the available measurement tools to properly evaluate pain in the acute care setting.

Kathryn A. Walker, PharmD, BCPS, CPE

Understanding the fundamentals of pharmacokinetics and pharmacodynamics for common medications is paramount in palliative care. Given the complexity of care, palliative care clinicians are often managing many high-risk medications that have a potential to interact. This presentation will help illuminate the mechanisms and risk factors behind common drug interactions in palliative care patients. This course discusses how to assess drug interactions in practice and highlight common clinical presentations, implications, and management strategies.

Colleen M. Fitzgerald, MD

Pelvic pain affects about 25% of reproductive age women. However, science and medicine are just beginning to explore both the central and peripheral factors underlying various subtypes of female pelvic pain. Traditionally, diagnosis and treatment has focused on potential visceral causes of pelvic pain such as endometriosis, interstitial cystitis, and vulvodynia. Newer evidence has emerged suggesting the complex interplay of somatic structures such as the pelvic floor musculature in patients with visceral pelvic pain syndromes. This session focuses on the epidemiology and impact of female chronic pelvic pain (CPP), known pathophysiology, differential diagnosis, and the clinical diagnosis and treatment of CPP, specifically rehabilitation approaches. This session also addresses pregnancy related pelvic girdle pain, a common pelvic pain subtype. Current research in the field will be highlighted. The presentation is expected to help learners enhance their care of female pelvic pain patients.

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE
Jeremiah C. McKelvey, PharmD
Robert D. Sproul, PharmD

Robert A. Bonakdar, MD, FAAFP

Pain is the most common condition for which patients turn to complementary and alternative medicine (CAM). This session will review the prevalence, rationale, and most commonly utilized therapies as well as the approach to the patient considering CAM. Special focus will be placed on therapies that have been positively tested and/or placed in clinical guidelines for the treatment of pain.

Helen N. Turner, DNP, RN-BC, PCNS-BC, FAAN

Multimodal analgesia is discussed, along with the various classes of medications commonly used in pain management, and the conditions for which they are effective. Also included will be various nonpharmaceutical approaches known to be effective additions to multimodal pain relief.

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

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.

Benson Mathew, PharmD
Alisha M. Mutch, PharmD
Larry D. Owens, PharmD, BCPS, CACP

Abundant evidence suggests potentially important sex differences in the experience of pain, such that women are at greater risk for many chronic pain conditions and display increased pain sensitivity. Multiple factors contribute to these sex differences, including hormonal influences and psychosocial processes. Also, increasing evidence suggests that women and men may respond differently to some pain treatments, raising the possibility that future treatment may need to be tailored by gender

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE
Jeremiah C. McKelvey, PharmD
Robert D. Sproul, PharmD
Nancy Wiedemer, RN, MSN, CRNP

This session is a panel discussion based on materials presented in VHA-01A.

FACULTY

Prescription opioids are an established treatment option for select patients with chronic pain. Safe, rational prescribing is essential for treatment success. To combat prescription opioid abuse and prevent overdose, treatment plans must be structured and continually tailored based on risks for aberrant drug use. Clinical practice guidelines recommend drug screening to promote treatment adherence and reduce drug abuse and prescription opioid diversion. This symposium will discuss practical approaches to incorporating drug screening into comprehensive chronic pain and risk management plans. Legal and regulatory considerations for drug testing frequency, documentation, and the interpretation of results will also be addressed.

Sponsored by Alere Toxicology. This activity is not certified for credit. Breakfast will be served.

Please note that the Pain Educators Forum (PEF) is sponsored by Global Education Group and supported by an educational grant from Purdue Pharma L.P.

Robert A. Bonakdar, MD, FAAFP

Dietary supplements are a $30 billion industry with a significant portion of use secondary to pain and pain-related diagnoses. This session will review the prevalence of supplement use in specific pain conditions, and important issues related to the topic including regulation and potential interactions. Special emphasis will be placed on supplements that have been positively tested and/or placed in clinical guidelines for the treatment of pain.

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE
Kathryn A. Walker, PharmD, BCPS, CPE

Complex medication decisions are an integral part of treating palliative care patients. Pharmacists have a unique perspective on using these medications creatively and effectively. This 1-hour session will flirt with tips and tricks on using medications appropriately for patients facing advanced diseases. Whether debriding a medication profile, aggressively treating symptoms, or strategizing a dosage formulation, it can be hard to commit to medication decisions. Three pharmacists will speed-date their way through 50 medication tips designed to highlight important and little known medication facts. Find a tip that you are compatible with that may just change your life.

Roger B. Fillingim, PhD

The York Hospital Pain Management Team (PMT) provides pain management consultations for inpatients experiencing uncontrolled pain. Utilizing a protocol-based collaborative practice agreement, PMT clinical pharmacists complete a comprehensive pain assessment and adjust pain regimens through addition or removal of analgesic medications, dosage titrations, route of administration conversions, adverse effect assessment and management, use of nonpharmacologic modalities, coordination of care with outpatient practitioners, and patient education. The PMT also serves as a resource for the promotion of safe medication use throughout the hospital via educational programs, the development of policies regarding analgesic use, and the management of high-risk drug therapies. The PMT provides support for pain-related research projects completed by pharmacy and medical residents. Physician and nursing support for the team’s work is evident in the increased utilization of services throughout the 10 years the team has been in practice.

Carri-Ann Gibson, MD
Ilene R. Robeck, MD

This session discusses evaluating and treating chronic pain in veterans following deployment in Iraq and Afghanistan. It will review common comorbidities associated with chronic pain postdeployment such as TBI, PTSD, and substance use disorder. A primary care, as well as specialty, approach to postdeployment pain will be discussed. The impact on community providers will also be reviewed as many of these patients and their families are seen in non-VA healthcare settings.

Presented by the Federal Practitioner.

FACULTY

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Lora McGuire, MS, RN

More than 73 million surgeries are performed in the United States each year, causing a great deal of pain. Acute postoperative pain is a serious problem for many patients. Nearly 50% of postoperative patients have moderate pain, and more than one-third suffer severe pain. There are serious consequences to unrelieved pain, both physically and psychologically. Pain can cause anxiety, stress, sleeplessness, and dissatisfaction with care. Pain also affects healing and recovery, reduces mobility, interferes with pulmonary function, and, if inadequately treated, leads to an increased risk for chronic pain. This session will cover statistics and incidence of pain in the surgical patient and components of preemptive analgesia. The management of postoperative pain will be reviewed including nonopioid, opioid, and adjuvant analgesics. Special delivery methods of pain control will also be reviewed, such as PCA, epidural, and peripheral local anesthesia infusions.

Srinivas Nalamachu, MD

Michael E. Schatman, PhD, CPE, DASPE

In the early days of medicine, patient care was a covenant between the patient and the physician, with this dyad considered sacred. Sadly, modern medicine, particularly in the American system, has changed to include numerous extraneous stakeholders outside of this dyad. In pain medicine, these stakeholders include the insurance, hospital, pharmaceutical, implantable device, and urine drug testing industry, as well as regulatory agencies. Rather than struggling for control over limited pain care resources, it is proposed that a pluralistic yet mutually cooperative system is not just a reality, but a necessity if the suffering of pain patients is to be ameliorated. An approach to this quandary emphasizing "rapprochement" is offered.

Lucile Burgo-Black, MD
Carri-Ann Gibson, MD
Stephen C. Hunt, MD, MPH
Luz S. Vasquez, MD

This session is a panel discussion based on materials presented in VHA-02A.

FACULTY

FACULTY

Chronic pain is a heterogeneous disease state that often defies simple classification, diagnosis, and treatment. Characterized by hyperactive nociceptive pathways and associated with numerous pathologic conditions, chronic pain affects an estimated 116 million adults in the United States with significant socioeconomic consequences.1 Although the precise determinants of chronicity have not been fully elucidated, the neuroplastic changes associated with chronic pain are thought to be progressive and often irreversible, underscoring the need for thorough assessment, timely diagnosis, and aggressive treatment.2 Importantly, the clinical presentation of chronic pain is markedly influenced by patient-specific biologic and psychosocial parameters, requiring comprehensive evaluations of all contributory factors and functional deficits associated with the pain experience.3 Advances in our understanding of pain mechanisms, improved assessment methodologies, and a growing evidence base supporting various therapeutic approaches have left clinicians better equipped to manage the growing population with chronic pain.4-7 This Interactive ShowCASE™ highlights recent scientific insights into pain pathophysiology and how they can be translated into practical chronic pain assessment and management strategies.

References

1. Transforming Prevention, Care, Education, and Research. Washington, DC: Institute of Medicine of the National Academies; 2011.
2. Woolf CJ. Anesthesiology. 2007;106:864-867
3. Gatchel RJ, et al. Psychol Bull. 2007;133:581-624.
4. Baron R, et al. Lancet Neurol. 2010;9:807-819
5. American Society of Anesthesiologists. Anesthesiology. 2010;112:810-833.
6. . Chou R, et al. Ann Intern Med. 2007;147:478-491.
7. Smart KM, et al. Clin J Pain. 2011;27:655-663.

Learning Objectives

• Assess chronic pain phenomenology, including pain characteristics, associated symptomatology, functional consequences, and underlying neurobiologic mechanisms
• Perform initial and ongoing evaluations of patients with chronically painful conditions, including low back pain, osteoarthritis, peripheral neuropathies, and other pain syndromes
• Evaluate the clinical profiles of pharmacologic agents based on analgesic mechanisms of action, potential benefits, adverse effects, and risks of inappropriate use
• Tailor single-agent and multidrug pharmacologic regimens for chronic pain to maximize analgesia and functional gains and minimize adverse effects
Implement and coordinate multidisciplinary care to address the full range of biopsychosocial symptoms associated with chronic pain

Jointly sponsored by Albert Einstein College of Medicine of Yeshiva University, Educational Review Systems, Asante Communications, LLC.

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

Hal S. Blatman, MD, DAAPM, ABIHM

Today’s women often face the stresses of managing a home and a career. By the time their children are in high school, they may suffer from sleep disturbance, adrenal fatigue, lack of libido, depression, anxiety, and various pain conditions from headache to pelvic pain. There is wonderful help that can be offered to these patients beyond anti-anxiety and antidepressant medication. Bio-identical hormone replacement, nutritional supplementation, herbal therapies, relaxation tools, and myofascial therapies offer a wide range of options for treatment, recovery, and body maintenance for a healthy and pain-free life.

Bill Paquin

The emergence of innovative mobile and Web applications, the passage of the Affordable Care Act, and a push toward evidence-based medicine have laid the groundwork for the “creative destruction” of medicine. This unsteady healthcare landscape may leave many providers with more questions than answers. However, Bill Paquin, CEO of Vertical Health, embraces this dynamic moment in the history of health care and explores the pivotal role that Web and mobile applications will play to both increase the efficiency of physician practices and improve patient outcomes. The course includes real-world case studies highlighting how other pain-related practices have implemented Doctor 2.0 strategies to improve their outcomes. *This course is not certified for credit.

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE
Kathryn A. Walker, PharmD, BCPS, CPE

Topical and transdermal analgesics are frequently used to provide an opioid-sparing effect, or serve to facilitate analgesic delivery by a nonoral route of administration. However, most practitioners are unaware of the role in therapy for these analgesics. Participants in this session will learn about the efficacy and toxicity of topical analgesics including commercially available products such as capsaicin, salicylates, counterirritants, nonsteroidal anti-inflammatory drugs, and lidocaine and compounded topical opioids for wound care pain. The appropriate use of transdermal buprenorphine and fentanyl will also be discussed. By using a case-based active-learning approach, participants will learn which patient scenarios are amenable to topical analgesic therapy.

Kevin Lancer
Edward S. Lee, MD
Tu A. Ngo, PhD, MPH

Patients with psychiatric comorbidities and chronic pain frequently represent a significant challenge as they may pose an increased risk of adverse events related to opiate therapy, have a higher rate of no-show and clinic cancellations to specialty services, and may use medications in a way not intended by the prescriber. Embedding mental health services in primary care can improve both patient and provider satisfaction with pain treatment with improved outcomes.

Gary W. Jay, MD, DAAPM, FAAPM

It has been hypothesized that migraine and tension-type headache were 2 ends of a headache spectrum. Understanding the pathophysiology of both headache entities reveals that this is not true and has no clinical ability to help in diagnosis or treatment. The differential diagnosis of migraine is significant in that it encompasses considerable issues of possible neurological damage associated with the diathesis. This Master Class addresses the differentiations between these 2 primary headache disorders.

FACULTY

Carol P. Curtiss, MSN, RN-BC

Balancing the provision of effective pain management while reducing the risk of misuse and diversion of medications are prime concerns of clinicians. This session will provide the opportunity to discuss key principles for effective pain assessment and management and identify current strategies to screen for risk of substance misuse and addiction in persons with pain. In addition, recommendations for treating pain in persons with or in recovery from substance use disorders will be presented.

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE
Kathryn A. Walker, PharmD, BCPS, CPE

Clinical issues are seldom black or white. In this lively session, 2 pharmacists will "duke it out" presenting both sides of the argument for and against opioid treatment agreements, and the role (if any) of inhaled cannabinoids. Listen to both sides of the debate before you make up your mind on these topics!

Peter A. Foreman, DDS, DAAPM

A typical odontalgia (AO) has traditionally been called “atypical facial pain” or “phantom tooth pain.” These are nonspecific descriptions. Dental odontalgias often present difficult diagnostic and treatment challenges. They may follow injury or deafferentation of trigeminal nerve fibers due to endodontia, dental extractions, implants, and oral surgery. The incidence may be 5% or more. Management is often poor and seldom involves interdisciplinary pain management, resulting in a worsening prognosis. Some of these orofacial neuropathies may be the result of neuroplastic changes and central nervous system sensitization. Understanding this is critical in avoiding failed treatments that may lead to further interventions and increasing pain.

Kevin Lancer
Edward S. Lee, MD
Stephen A. Mudra, MD
Tu A. Ngo, PhD, MPH

This is a panel discussion based on materials presented in VHA-03A.

Michael C. Barnes, JD

The 2011 conviction of Dr. Conrad Murray for the homicide of Michael Jackson and the prescription drug related death of Whitney Houston are just 2 of the recent headlines drawing increased public attention to prescription drug abuse in the United States. Lawmakers, regulators, prosecutors, and judges are eager to respond, and the implications are tremendous for pain care providers. This presentation provides a review of prescription drug abuse events over the past 12 months, and a discussion of their impact on healthcare providers treating people with pain. Topics will include noteworthy legal cases, congressional efforts to tie prescriber education to DEA registration and to limit medication supply and indications, and select state-level restrictions on practitioners and patients.

Lucile Burgo-Black, MD
Stephen C. Hunt, MD, MPH

This session will review services available for veterans and their families through the VHA Healthcare System. The VA is proud to partner with non-VA and VA providers to co-manage care for veterans who prefer to see private as well as VA providers. There are many unique services available at VA facilities throughout the country that can augment and improve care received in the private sector alone. These and the process for patients to access VA care will be reviewed.

Friday/9.7
8:10 AM - 9:10 AM

Roger B. Fillingim, PhD; Mark S. Wallace, MD

Less than 10% of the analgesics in clinical trials make it past phase II studies. There are many reasons for this, including the inability of animal models to predict efficacy in humans and the placebo response with analgesic trials. This presentation will cover the preclinical models used to study analgesics and the process of human studies ranging from phase I to postmarketing trials. Methods used to predict analgesic signals in phase I trials will be discussed, along with analgesic development challenges such as dealing with the placebo response and regulatory issues.

Friday/9.7
11:10 AM - 12:10 PM

Charles E. Argoff, MD, CPE; Roger B. Fillingim, PhD; Beth Darnall, PhD

Opioids are the de facto treatment for noncancer chronic pain, despite this treatment pathway being fraught with social, medical, legal, and ethical consequences. Dr. Argoff will review the many misconceptions regarding long-term opioid use, and will argue for a judicious and measured approach to prescribing; he will also review the ethical burden inherent in prescribing opioids. Dr. Darnall will review evidence describing some of the specific risks and consequences of opioid therapy, and will propose that informed consent procedures must include discussion of the likely complications associated with long-term opioid use (by relevant age and sex). She will also discuss the limitations of opioid therapy and will argue for a treatment approach that addresses the behavioral, emotional, and cognitive aspects that drive much of the chronic pain experience.

Friday/9.7
11:10 AM - 12:10 PM

Roger B. Fillingim, PhD; Jennifer A. Haythornthwaite, PhD

Abundant evidence demonstrates the important contributions of psychological factors to chronic pain. These findings suggest that psychological treatments should be an important component of chronic pain management. This presentation will discuss common psychological approaches to pain management, and the evidence regarding the efficacy of these treatments will be reviewed, with an emphasis on cognitive-behavioral approaches to pain management.

Friday/9.7
4:10 PM - 5:10 PM

David W. Dodick, MD, FRCP-C, FACP; Roger Fillingim, PhD

Migraine is one of the most prevalent and disabling medical conditions on the planet. Approximately 12% of the world’s population suffers from migraine, while 3% to 5% experience daily or near-daily headaches and other neurological symptoms. Migraine sufferers experience a profoundly diminished quality of life and mental health as well as impaired physical, social, and occupational functioning. While migraine research has been massively underfunded and the disorder clinically dismissed as a “headache,” its genetic and biological basis is increasingly coming into focus as a result of considerable scientific advances. Migraine is considered a largely inherited disorder that is characterized by physiological and structural alterations in the brain that result in paroxysmal episodes of cortical spreading depression, abnormal activation of trigeminovascular nociceptive pathways, and abnormal processing of sensory stimuli. A new era of scientific discovery in the molecular biology and receptor pharmacology of migraine headache has occurred over the past 2 decades and these advances have led to the development of promising new selective compounds and therapies for both the acute and preventive treatment of migraine. This presentation reviews the genetic and pathophysiological basis of migraine and emerging therapies and their physiologic and receptor targets.

Thursday/9.6
11:10 AM - 12:10 PM

Ted W. Jones, PhD; Steven D. Passik, PhD

It is becoming the standard of care in prescribing opioid medications that a risk assessment be conducted first. This course will review a brief history of risk assessment, recent literature, and anticipated future trends. It is proposed here that the field of risk assessment is about to enter a second generation as new methods and instruments are emerging that may offer increased predictive ability. Current risk assessment measures will be reviewed, compared, and discussed to help practitioners decide how best to incorporate them into their practice.

Thursday/9.6
4:10 PM - 5:10 PM

Ted W. Jones, PhD

Current commonly used risk assessment measures are brief paper and pencil inventories to be completed by patients. These tools have limitations, however, and clinicians often need to follow-up with a clinical interview. This session will introduce participants to a validated risk assessment method that relies on interview data. This new risk assessment method will be reviewed in detail and data will be presented to show that it is a valid method of assessing risk in more depth than many current screening measures provide.

Presented by the Journal of Family Practice.

Saturday/9.8
7:00 AM - 8:00 AM

Hal S. Blatman, MD, DAAPM, ABIHM

During the past few years we have learned many things about how diet and nutrition affect aging and many forms of chronic disease, including heart disease, diabetes, and depression. Indeed there are similarities with understanding how nutrition affects pain and fatigue. This lecture discusses how certain foods in our patients’ diets actually stop their bodies from healing, and get in the way of rehabilitation. Moreover, certain foods may increase pain for days or even weeks at a time from a single exposure. There are 3 main rules to nutrition that get people out of pain, and they are reviewed in a manner that is easy to understand. Suggestions will be made for specific nutrients that will augment healing and/or more quickly reduce pain.

Saturday/9.8
8:10 AM - 9:10 AM

Robert A. Bonakdar, MD, FAAFP

Pain is the most common condition for which patients turn to complementary and alternative medicine (CAM). This session will review the prevalence, rationale, and most commonly utilized therapies as well as the approach to the patient considering CAM. Special focus will be placed on therapies that have been positively tested and/or placed in clinical guidelines for the treatment of pain.

Thursday/9.6
9:20 AM - 10:20 AM

Robert A. Bonakdar, MD, FAAFP

Dietary supplements are a $30 billion industry with a significant portion of use secondary to pain and pain-related diagnoses. This session will review the prevalence of supplement use in specific pain conditions, and important issues related to the topic including regulation and potential interactions. Special emphasis will be placed on supplements that have been positively tested and/or placed in clinical guidelines for the treatment of pain.

Saturday/9.8
2:10 PM - 3:10 PM

Hal S. Blatman, MD, DAAPM, ABIHM

Today’s women often face the stresses of managing a home and a career. By the time their children are in high school, they may suffer from sleep disturbance, adrenal fatigue, lack of libido, depression, anxiety, and various pain conditions from headache to pelvic pain. There is wonderful help that can be offered to these patients beyond anti-anxiety and antidepressant medication. Bio-identical hormone replacement, nutritional supplementation, herbal therapies, relaxation tools, and myofascial therapies offer a wide range of options for treatment, recovery, and body maintenance for a healthy and pain-free life.

Saturday/9.8
2:10 PM - 3:10 PM

Bill Paquin

The emergence of innovative mobile and Web applications, the passage of the Affordable Care Act, and a push toward evidence-based medicine have laid the groundwork for the “creative destruction” of medicine. This unsteady healthcare landscape may leave many providers with more questions than answers. However, Bill Paquin, CEO of Vertical Health, embraces this dynamic moment in the history of health care and explores the pivotal role that Web and mobile applications will play to both increase the efficiency of physician practices and improve patient outcomes. The course includes real-world case studies highlighting how other pain-related practices have implemented Doctor 2.0 strategies to improve their outcomes. *This course is not certified for credit.

Friday/9.7
7:00 AM - 8:00 AM

Michael M. Bottros, MD

Peripheral artery disease (PAD) is a common comorbidity in diabetics. According to the World Health Organization 2004 report, there will be a total of nearly 366 million people with diabetes by 2030, thus making it necessary to understand and evaluate the presence of PAD and critical limb ischemia. While atherosclerotic plaques do not differ histologically between diabetic and nondiabetic individuals, the clinical features differ in anatomical localization, spread, calcification extent, and severity. Smoking, age, hypertension, and lack of glycemic control are reported positive risk factors, whereas HDL and apolipoprotein A-1 exert protective effects. Foot examination correlates poorly to the diagnosis of PAD, whereas the ankle-brachial index measurement is considered the most accurate noninvasive diagnostic method when evaluating PAD. The coexistence of significant neuropathy and arterial calcifications are primary determinants for underdiagnosing PAD. Pharmacological management includes antiplatelet therapy of aspirin or the use of clopidogrel for those individuals who are sensitive to aspirin. Patients who have had bypass surgery or cardiac stent placement require dual antiplatelet therapy per ACC/AHA guidelines. Treatment with beta-blockers and ACE inhibitors is appropriate pharmacotherapy to treat PAD. Other FDA-approved medications such as Cilostazol and Pentoxifylline are also used in the treatment of pain associated with intermittent claudication.

Friday/9.7
9:20 AM - 10:20 AM

Michael M. Bottros, MD

Diabetes is a complex disease associated with several changes in the gastrointestinal tract with symptoms such as bloating, nausea, vomiting, diarrhea, constipation, and abdominal pain. While the exact pathogenesis of these symptoms is still not clearly understood, there is an increasing interest in the role of the enteric nervous system (ENS) and its neurotransmitters in this disease state. Recent studies have elucidated changes in inhibitory and excitatory neurons associated with the ENS as well as oxidative stress, advanced glycation end products, apoptosis, and overall neuronal loss. Inflammation-associated neurodegeneration can lead to motility problems in diabetic patients. Potential therapy includes antioxidants to prevent or treat these problems.

Friday/9.7
2:10 PM - 3:10 PM

Charles E. Argoff, MD, CPE

Diabetic peripheral neuropathic pain (DPNP) is one of the most common types of neuropathic pain encountered by clinicians. Practical assessment and treatment strategies will be discussed in this interactive session. Recognizing that while evidence-based guidelines have been published regarding the management of DPNP, such guidelines may not adequately guide the clinician's care of individual patients. This session covers individualized assessment and treatment approaches to this common neuropathic pain condition recognizing the limits of current published guidelines. Participants are encouraged to bring their own patient presentations.

Friday/9.7
4:10 PM - 5:10 PM

Ronald J. Rapoport, MD, FACR

The musculoskeletal manifestations of diabetes mellitus (DM) are both those that we recognize quite readily, and those that pose more of a diagnostic dilemma. This course reviews the clinical presentation, findings on physical examination, proposed etiology, and treatment of these very challenging conditions. Included in the review are diabetic hand syndrome, carpal tunnel syndrome, and frozen shoulder.

Thursday/9.6
7:00 AM - 8:00 AM

Paul J. Christo, MD, MBA

By 2050, the number of older persons will exceed the number of young people for the first time in history. Persistent pain escalates with age and older adults are susceptible to specific pain conditions. This presentation will review age-associated changes in pain processing, discuss typical painful disorders that affect older adults, and summarize effective treatments.

Thursday/9.6
11:10 AM - 12:10 PM

Paul J. Christo, MD, MBA

As the population ages, chronic conditions, especially pain, will increase in prevalence. Understanding the unique physiological changes that occur with age is important in selecting specific analgesics. This activity reviews the pharmacokinetic and pharmacodynamic changes accompanying older adulthood, then provides an update on the American Geriatrics Society recommendations for medical therapy along with evidence for procedural interventions that may be useful for pain relief.

Wednesday/9.5
8:10 AM - 10:10 AM

Rebecca L. Curtis, ACC

Participants will learn how the patient’s focus on being cured contributes to an increase in the pain experience. Through an understanding of how negative thought patterns create a brain-body loop that accentuates pain, practitioners will learn techniques to guide patients to “rewire” their brains for a transformed experience with pain. Participants will learn the power gratitude has in building a pain-resistant ("teflon") brain, and the benefits of movement and relaxation for rewiring the chronic pain brain. Coaching techniques will enable practitioners to share these elements with chronic pain patients.

Wednesday/9.5
11:10 AM - 12:10 PM

Rachel M. Volk, HHC

This presentation will focus on stress and how it impacts pain in the body. We will also focus on and define adrenal fatigue. Primary foods will be defined, discussed, and illustrated. Methods and ideas for stress prevention and stress maintenance will be developed and demonstrated.

Wednesday/9.5
5:20 PM - 6:20 PM

Rachel M. Volk, HHC

This presentation will focus on obesity and how it relates to pain, stiffness, and swelling in the body. We will look at this from a holistic perspective to understand the implications of how diet and lifestyle determine health and risk of disease. An anti-inflammatory diet will be reviewed and explained in detail. We will discuss patient control over quality of life through daily food choices. The importance of patient accountability will also be explained.

Thursday/9.6
8:10 AM - 10:10 AM

Rebecca L. Curtis, ACC

Participants will learn how the patient’s focus on being cured contributes to an increase in the pain experience. Through an understanding of how negative thought patterns create a brain-body loop that accentuates pain, practitioners will learn techniques to guide patients to “rewire” their brains for a transformed experience with pain. Participants will learn the power gratitude has in building a pain-resistant ("teflon") brain, and the benefits of movement and relaxation for rewiring the chronic pain brain. Coaching techniques will enable practitioners to share these elements with chronic pain patients.

Thursday/9.6
9:20 AM - 10:20 AM

Rachel M. Volk, HHC

This presentation will focus on stress and how it impacts pain in the body. We will also focus on and define adrenal fatigue. Primary foods will be defined, discussed, and illustrated. Methods and ideas for stress prevention and stress maintenance will be developed and demonstrated.

Thursday/9.6
5:20 PM - 6:20 PM

Rachel M. Volk, HHC

This presentation will focus on obesity and how it relates to pain, stiffness, and swelling in the body. We will look at this from a holistic perspective to understand the implications of how diet and lifestyle determine health and risk of disease. An anti-inflammatory diet will be reviewed and explained in detail. We will discuss patient control over quality of life through daily food choices. The importance of patient accountability will also be explained.

Friday/9.7
11:10 AM - 12:10 PM

Barbara L. Kornblau, JD, OTR/L, CPE, DASPE; Susan K. McNulty, OTD, OTR/L

Lifestyle Redesign is the process of acquiring healthy habits and routines and incorporating them into one’s daily life. It takes a person experiencing pain from where they are, to where they need to be. Then they can return to their routines of work and other meaningful and/or necessary activities in their lives. This session details how the process works, presents evidence of successful outcomes, and explains how it can help your patients.

Wednesday/9.5
8:10 AM - 9:10 AM

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

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

Wednesday/9.5
11:10 AM - 12:10 PM

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

A 2011 Institute of Medicine report calls for "a cultural transformation in how the nation understands and approaches pain management and prevention.” The report stresses that improved care must include a combination of therapies and coping techniques. This presentation will include discussion on how to integrate evidence-based self-care modalities into your practice. The future is now!

Day/9.6
2:10 PM - 4:10 PM

Michael B. Ellner, CHt, MSH

If your practice includes assisting individuals in pursuit of relief, this program is for you. Dan Cleary has lived with pain for over 30 years and has dedicated his life to teaching simple relief techniques that work. Whatever your specialty, you will find quick and easy ways to shift patient awareness and increase compliance. If you are one of the many who also experience chronic painful signals, sit up front and get ready to feel better. *This course is not certified for credit.

Friday/9.7
8:10 AM - 10:10 AM

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

Feeling stressed? Bored with the daily grind? Want to put fun and joy back into your practice, home, and/or play? Then this 2-hour interactive/experiential presentation is just what the good doctor ordered. Discover how applied mindfulness can promote feeling better and being more effective at whatever you are doing. *This course is not certified for credit.

Wednesday/9.5
4:10 PM - 5:10 PM

Bruce D. Nicholson, MD

Treatments that may have direct central neuromodulatory effects can offer significant benefits for the appropriately selected patient. Intrathecal therapy should significantly improve functional status and decrease use of oral analgesic requirement. Patient selection is critical to the successful outcome when considering this therapy. Both cancer and chronic nonneuropathic pain as well as neuropathic pain may benefit from intrathecal therapy. This course addresses benefits and limitations, speaks to the importance of patients’ expectations and how they should be reviewed prior to entering into an intrathecal trial of opiates or ziconotide.

Wednesday/9.5
5:20 PM - 6:20 PM

Bruce D. Nicholson, MD

Wednesday/9.5
6:30 PM - 7:30 PM

Daniel B. Carr, MD, FABPM; Michael R. Clark, MD, MPH, MBA

Daniel B. Carr, MD, delivers the Keynote Address, entitled “A Public Health View of Pain Education: Have We Been Backwards, Upside Down, or Both?” Dr. Carr is founder and director of the interprofessional program in Pain Research, Education & Policy at Tufts University School of Medicine, and is widely published in pain research, evidence-based medicine, and the social and political aspects of pain relief.

Wednesday/9.5
2:10 PM - 4:10 PM

Peter A. Foreman, DDS, DAAPM

Temporomandibular disorders (TMD) are more common than temporomandibular joint disorders (TMJD), which are more likely to be seen by oral surgeons. Correct diagnosis is critical, as inaccurate diagnosis can lead to inappropriate treatments creating further problems. Treatment approaches differ, some are controversial, and not all treatments are evidence-based. Advances in understanding pain mechanisms also show that convergent afferent nociceptive transmission from nontrigeminal, extraoral cervical sources can enter the trigeminal system. TMD pain may also present as dental, sinus, and headache. Myofascial trigger points are a major source of pain that is often overlooked, and psychosocial factors also play a major role in the development and chronicity of TMD. This Master Class addresses some of the issues involved and looks at management approaches. Demonstrations and practical work in pairs will help consolidate the material presented.

Wednesday/9.5
4:10 PM - 6:10 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.

Thursday/9.6
2:10 PM - 4:10 PM

Philip Getson, DO; R. Norman Harden, MD

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. The first half of this course discusses the fundamentals of CRPS, its clinical manifestations and basic treatment. The second half discusses diagnostic testing, followed by treatment modalities with particular attention on ketamine infusion therapy. Interspersed will be case presentations and atypical signs and symptoms of CRPS.

Friday/9.7
8:10 AM - 10:10 AM

Forest Tennant, MD, MPH, DrPH

This course primarily explains how and under what circumstances pain may alter the endocrine system. Complications of these alterations will be taught. Testing and hormone replacement is becoming a standard procedure in severe chronic pain patients, particularly those who must take opioid drugs. Practitioners who treat centralized pain will need to know the neurogenic and neuroprotective hormones that show considerable clinical promise in treating this condition.

Friday/9.7
2:10 PM - 4:10 PM

David M. Glick, DC, DAAPM, CPE, FASPE

The prevalence of back pain continues in spite of the many treatments available, without any single treatment emerging as a panacea. In routine practice, clinical examinations have tended to become more cursory, the result of increasing demands on clinicians’ time and possible overreliance 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 clinicians' 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/9.8
2:10 PM - 4:10 PM

Gary W. Jay, MD, DAAPM, FAAPM

It has been hypothesized that migraine and tension-type headache were 2 ends of a headache spectrum. Understanding the pathophysiology of both headache entities reveals that this is not true and has no clinical ability to help in diagnosis or treatment. The differential diagnosis of migraine is significant in that it encompasses considerable issues of possible neurological damage associated with the diathesis. This Master Class addresses the differentiations between these 2 primary headache disorders.

Wednesday/9.5
7:00 AM - 9:00 AM

Jennifer E. Bolen, JD

This presentation includes a chart of laboratory codes and the Clinical Laboratory Fee Schedule. It covers topics such as proper coding for CLIA-waived and moderate drug screening, and the distinctions between qualitative/general confirmation testing and quantitative drug testing. Please note that this is a prerequisite to the Medical Necessity course.

Wednesday/9.5
4:10 PM - 6:10 PM

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Thursday/9.6
7:00 AM - 8:00 AM

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Thursday/9.6
9:20 AM - 10:20 AM

Jennifer E. Bolen, JD

 

Friday/9.7
9:20 AM - 10:20 AM

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Friday/9.7
11:10 AM - 12:10 PM

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Saturday/9.8
11:20 AM – 12:20 PM

Jennifer E. Bolen, JD

This plenary session is a precursor to the breakout sessions by region over the next several days. This program presents a general overview of changes to federal and state laws and rules, as well as agency program activities, that will impact pain management practitioners nationwide. Also addressed will be top line information such as the FDA/REMS Blueprint. The main focus will be on the Prescription Drug Monitoring Programs (PDMPs) nationwide, the pain clinic laws cropping up in various states, and critical changes to licensing board rules impacting pain management.

Friday/9.7
9:20 AM - 10:20 AM

Mark J. Tramo, MD, PhD

Music therapy exploits connections between the central auditory system on the one hand, and multimodal, supramodal, and autonomic systems on the other, to modulate our individual experiences of pain. Anatomical, physiological, chemical, and functional features of these systems and their interrelationships are explored. Also reviewed will be randomized-controlled clinical trials demonstrating beneficial effects of music on pain, and ways to incorporate music into pain management protocols.

Friday/9.7
11:10 AM - 12:10 PM

John F. Mondanaro, MA, MT-BC, LCAT, CCLS

Medical practice in the treatment of the physiological, psychological, and emotional symptoms of pain may be enhanced through a greater understanding of music therapy as a nonpharmacological intervention. Currently, medical professionals are challenged to be fully informed about music therapy as a component of planning in the treatment of pain, and music therapists are challenged to practice from an integrative and continually informed perspective. The use of live musical components—to entrain to the breath and natural cycles of tension release which occur in the body during acute pain episodes—is the focus of a current randomized controlled study with patients undergoing spine surgery. Music therapy interventions focusing on tension release through active drumming, visualization, entrainment, and psychoemotional catharsis will be discussed and demonstrated.

Friday/9.7
4:10 PM - 5:10 PM

Andrew R. Rossetti, MMT

Causal relationships among emotional states, levels of state anxiety, and pain perception affect treatment outcomes. Music, when presented in a live psychotherapeutic context, involves the activation of sensory pathways that compete with pain pathways, stimulating emotional response, and enhancing engagement of cognitive attention. A working hypotheses on modulating the emotional content of pain perception will be explored. Music experientials that address theoretical and clinical aspects of live music interventions employed with patients who have cancer will be exemplified. Research on the impact of music when receiving external beam radiation therapy and chemotherapy and its capacity to ameliorate state anxiety and provide adjuvant nonmedication-based pain management strategies will be discussed. Participants will gain understanding of the impact that music therapy can provide on anxiety in patients newly diagnosed with cancer and undergoing simulation for radiation therapy.

Friday/9.7
5:20 PM - 6:20 PM

Joanne V. Loewy, DA, LCAT, MT-BC

Recent evidence suggests that pain in infants is not well-assessed, and that belief in its perceived occurrence is controversial. Pain in children is undertreated or ignored and its reported "validity" may be questioned, particularly in teenagers. Infants and children who experience pain in early life may show long-term effects in pain perception and altered neural responses that can negatively influence behaviors. Music therapists have the unique advantage of being in the dynamic moment of musical expression or resistance with infants, children, and teens. Using music as a psychotherapeutic informant—through assessment of crying in infants and clinical improvisation, song writing, and music visualization for children and teens—can inform healthcare professionals of the cultural and clinical aspects through the expression or repression of the pain experience. This course presents clinical examples of actual music and medicine cases that exemplify the influence of music psychotherapy as an informant of the disease experience. Musical expression as a means of treatment is demonstrated as a metaphoric mode of expression, comfort, and trust that can assist the child’s perception of fear and alter the cycle of pain and anxiety in acute, chronic, and procedural pain experiences.

Thursday/9.6
9:20 AM - 10:20 AM

Charles F. Cichon

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/9.6
11:10 AM - 12:10 PM

Charles F. Cichon

In addition to establishing qualifications for licensure, Medical Boards are responsible for investigating complaints against licensees and for taking action against the license of those who fail to maintain their state's high standards of medical care delivery, or who break the laws governing licensure. This presentation will examine: 1) What kind of complaints result in discipline, 2) What happens when the board conducts an investigation, 3) How long does the complaint process usually take, and 4) What should you do if a regulatory or criminal complaint is filed against you.

Thursday/9.6
2:10 PM - 3:10 PM

Lisa McElhaney

In the last decade, the escalation of calls to law enforcement made by healthcare providers has been alarming. The root causes of many calls can be eliminated by the healthcare provider simply applying proactive prevention measures in their business. This segment is a structured review of basic principles that every healthcare provider should implement into their practice to limit the possibility of becoming a victim of circumstance.

Thursday/9.6
4:10 PM - 5:10 PM

Jennifer D. Carpenter

While the vast majority of prescribers are legitimate, unfortunately there are some that are operating “illegally” and drug trafficking, according to law enforcement criteria. With prescription drug diversion reaching epidemic levels, law enforcement is taking action against the “illegal prescribers.” This course will help identify the illegal prescriber, outline the steps necessary to prevent becoming an illegal prescriber, and explain the coordination between law enforcement and healthcare professionals to combat the prescription drug diversion epidemic.

Thursday/9.6
5:20 PM - 6:20 PM

Kimberly S. New, BSN, JD

Drug diversion is universal among institutions in the United States, and is a primary reason for discipline of nurses across the country. Drug diversion is a serious crime that can often result in patient endangerment and abuse. When patient care is entrusted to an impaired provider, the patient may fall victim to negligent care. A patient may languish in pain when a diverting provider steals pain medication intended for the patient or substitutes saline for injectable controlled substances. Nurses who divert risk their professional credentials, job, family, and even their personal freedom. Having a robust diversion surveillance and investigation process is vital for protecting patients from the potentially disastrous consequences of diversion. Prompt recognition of diversion allows for early intervention with the professional involved. Common methods of drug diversion will be explored, and reporting requirements will be detailed. Actual cases of nursing diversion will be presented including cases of patient harm due to substitution or tampering. Proactive measures to prevent diversion will be covered.

Thursday/9.6
8:10 AM - 9:10 AM

Debra J. Drew, MS, ACNS-BC, RN-BC

The most significant clinical understanding of recent times is that a peripheral nerve injury that causes pain may cause imprinting of pain’s memory in the central nervous system (CNS). This occurs when inflammatory mediators from the peripheral pain site enter the CNS and activate glial cells to produce inflammation. Practitioners are taught how to diagnose, treat, and prevent this condition. CNS inflammation is a progressive, tissue destructive process that requires treatment strategies that are relatively new to pain treatment.

Friday/9.7
9:20 AM - 10:20 AM

Debra J. Drew, MS, ACNS-BC, RN-BC

Acute and chronic pain accompanies many disorders of the central nervous system (CNS) including multiple sclerosis, infections, spinal cord injury, and traumatic brain injury. Following both an interactive didactic and patient-based approach, this session focuses on the assessment and treatment of the varied types of pain that can be associated with a variety of CNS disorders. Participants are encouraged to bring their own patient presentations.

Saturday/9.8
7:00 AM - 8:00 AM

Debra J. Drew, MS, ACNS-BC, RN-BC

Pain assessment and regular reassessment provides the foundation of good pain management and sets the stage for planning, implementation, and evaluation of care. Lack of pain assessment is a major cause of inadequate pain management. Pain in the acute care setting is difficult to assess in certain populations, such as ICU, pediatrics, substance abuse, and mental illness. This presentation covers the key elements of pain assessment and the available measurement tools to properly evaluate pain in the acute care setting.

Saturday/9.8
8:10 AM - 9:10 AM

Helen N. Turner, DNP, RN-BC, PCNS-BC, FAAN

Multimodal analgesia is discussed, along with the various classes of medications commonly used in pain management, and the conditions for which they are effective. Also included will be various nonpharmaceutical approaches known to be effective additions to multimodal pain relief.

Saturday/9.8
11:10 AM - 12:10 PM

Lora McGuire, MS, RN

More than 73 million surgeries are performed in the United States each year, causing a great deal of pain. Acute postoperative pain is a serious problem for many patients. Nearly 50% of postoperative patients have moderate pain, and more than one-third suffer severe pain. There are serious consequences to unrelieved pain, both physically and psychologically. Pain can cause anxiety, stress, sleeplessness, and dissatisfaction with care. Pain also affects healing and recovery, reduces mobility, interferes with pulmonary function, and, if inadequately treated, leads to an increased risk for chronic pain. This session will cover statistics and incidence of pain in the surgical patient and components of preemptive analgesia. The management of postoperative pain will be reviewed including nonopioid, opioid, and adjuvant analgesics. Special delivery methods of pain control will also be reviewed, such as PCA, epidural, and peripheral local anesthesia infusions.

Saturday/9.8
4:10 PM - 5:10 PM

Carol P. Curtiss, MSN, RN-BC

Balancing the provision of effective pain management while reducing the risk of misuse and diversion of medications are prime concerns of clinicians. This session will provide the opportunity to discuss key principles for effective pain assessment and management and identify current strategies to screen for risk of substance misuse and addiction in persons with pain. In addition, recommendations for treating pain in persons with or in recovery from substance use disorders will be presented.

Wednesday/9.5
9:20 AM - 10:20 AM

Mel Pohl, MD

Chronic pain occurs as a complicated web of emotions and physical symptoms. Trauma history exacerbates the experience of chronic pain and may impede the recovery process. The most common way to treat pain is to use opioid medications, which actually complicate the course of chronic pain for many. For some individuals who develop chemical dependency/addiction to these medications, management and treatment for their condition can become much more complicated. This session will review the interactions of pain, suffering, trauma, and addiction as they interface in your patients, with suggestions for intervention and treatment.

Wednesday/9.5
11:10 AM - 12:10 PM

Mel Pohl, MD

Much has been written and taught about chronic pain, a challenging condition resulting in disability, emotional upheaval, and family dysfunction. People concerned about someone with chronic pain suffer from characteristic dysfunctional behaviors that must be addressed if the person with chronic pain is to recover. Often families wonder whether the pain is “real” or not. We have a tendency to believe that pain based in emotions is less “valid” than physical pain. This session will review the emotional aspects of pain and suffering from a physiological and psychological standpoint and explain the basis of meditative techniques and the fundamentals of mindfulness practice.

Wednesday/9.5
2:10 PM - 3:10 PM

Paul J. Christo, MD, MBA

Therapeutic use, overuse, abuse, and diversion of controlled substances in managing chronic noncancer pain continue to be a concern for physicians and patients. Compliance monitoring can be helpful in delivering proper opioid therapy, and urine drug testing is considered an important tool of adherence monitoring. We will discuss the role of urine drug testing in monitoring chronic opioid therapy along with assessing its limitations.

Wednesday/9.5
8:25 AM - 9:55 AM

One-third of Americans are in pain. A majority of patients visiting pain centers have comorbid conditions. There is a complex interplay between pain, abuse, addiction, and comorbid conditions. Addiction and abuse are linked to the rate of brain entry with opioids. Is there an “ideal” mu opioid? And if there is, what might it look like? How can we treat patients across interdisciplinary boundaries to have the best results in terms of pain relief and lowest rates of abuse/addiction? Specifically, the program objectives are to enhance knowledge of latest thinking on interplays between pain, abuse, addiction, and comorbid diseases; increase perception of the future of opioid therapy; and provide insights on how to optimize care across multidisciplinary boundaries.

Sponsored by NEKTAR Pharmaceuticals. This activity is not certified for credit. Breakfast will be served.

Thursday/9.6
8:25 AM - 9:55 AM

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

Thursday/9.6
12:30 PM - 2:00 PM

Individual genetic differences in medication metabolism can impact the efficacy, side-effect profile, and drug-drug interactions of medication therapy in pain care. Genetic differences may help to explain suboptimal pain control, medication interactions, adverse effects, the need for higher or lower dosing, and unexpected urine drug test results. This session will introduce the clinical value of pharmacogenetic testing (PGT), a new diagnostic tool that identifies an individual patient’s ability to metabolize medications commonly used in pain management. PGT results may help prescribers optimize choice of effective medication therapy while potentially minimizing side effects and drug-drug interactions. Case studies will be presented that highlight the value of pharmacogenetic testing and discuss the clinical application of an individual’s metabolism profile as it relates to personalized medication therapy.

Sponsored by Millennium Laboratories. This activity is not certified for credit. Lunch will be served.

Friday/9.7
8:25 AM - 9:55 AM

A panel will discuss a peer-reviewed article on the consensus of urine drug monitoring recommendations addressing test selection, test frequency, interpretation of results, and how to handle discrepancies based on specific results. The recommendations are meant to begin to provide a framework for standardizing practices for urine drug monitoring in the treatment of chronic pain. The intent of this program is to inform primary care physicians and pain management specialists about the expert consensus recommendations regarding the appropriate use of urine drug monitoring.

Sponsored by Ameritox, Inc. This activity is not certified for credit. Lunch will be served.

Friday/9.7
12:30 PM - 2:00 PM

This program addresses postherpetic neuralgia and the impact on patients’ lives, reviews current guidelines on the management of postherpetic neuralgia, and discusses the benefits and limitations of current treatment strategies. Information will also cover treatment options and opportunities for integration into clinical practice.

Sponsored by Depomed, Inc. This activity is not certified for credit. Lunch will be served.

Saturday/9.8
8:25 AM - 9:55 AM

Prescription opioids are an established treatment option for select patients with chronic pain. Safe, rational prescribing is essential for treatment success. To combat prescription opioid abuse and prevent overdose, treatment plans must be structured and continually tailored based on risks for aberrant drug use. Clinical practice guidelines recommend drug screening to promote treatment adherence and reduce drug abuse and prescription opioid diversion. This symposium will discuss practical approaches to incorporating drug screening into comprehensive chronic pain and risk management plans. Legal and regulatory considerations for drug testing frequency, documentation, and the interpretation of results will also be addressed.

Sponsored by Alere Toxicology. This activity is not certified for credit. Breakfast will be served.

Please note that the Pain Educators Forum (PEF) is sponsored by Global Education Group and supported by an educational grant from Purdue Pharma L.P.

Saturday/9.8
12:30 PM - 2:55 PM

Wednesday/9.5
7:00 AM - 8:00 AM

Jennifer E. Bolen, JD

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/9.5
8:10 AM - 9:10 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/9.5
9:20 AM - 10:20 AM

Christopher M. Herndon, PharmD, BCPS, CPE

The treatment of pain continues to evolve as more is learned about this disorder. Evidence-based guidelines and practice recommendations have become abundant to assist the clinician in providing optimal patient care. A clear understanding of the pathogenesis of pain is vital to selecting rationale pharmacotherapy and adjuvant nonpharmacological interventions when developing a treatment plan for a patient. This 2-hour session will review neurophysiology, nociception, and the pharmacology of frequently used analgesics. Additionally, individual pain syndromes will be reviewed with evidence-based recommendations provided when available. Please note that the second hour of this course will begin at 11:10 am following the 10:30 am – 11:00 am break.

Wednesday/9.5
2:10 PM - 3:10 PM

David M. Glick, DC, DAAPM, CPE, FASPE

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 overreliance on technology for basic clinical diagnosis. The purpose of this session is 2-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/9.5
11:10 AM - 12:10 PM

Christopher M. Herndon, PharmD, BCPS, CPE

This session is the second half of PEF-03A.

Wednesday/9.5
4:10 PM - 5:10 PM

Gary W. Jay, MD, DAAPM, FAAPM

Pain without a purpose lasting for greater than 3 to 6 months is considered chronic pain. Patients that experience chronic pain in general have been trialed on multiple medications and nonpharmacologic therapies. This lecture will focus on the differences between acute and chronic pain and begin discussion regarding some common pain syndromes and clinical insights into therapeutic modalities used in its management.

Wednesday/9.5
5:20 PM - 6:20 PM

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE; Thomas B. Gregory, PharmD, BCPS, DASPE, CPE; Christopher M. Herndon, PharmD, BCPS, CPE

Chronic pain is a frequent cause for accessing healthcare resources, usually from a primary care setting. While great strides have been made to improve the education of frontline practitioners in appropriate pain management, a paucity of data exists to direct the creation of policies and procedures to manage these resource-intensive patients. In this program, insights will be shared from the gradual implementation over 5 years of a chronic pain management service within a large family medicine residency program.

Thursday/9.6
7:00 AM - 8:00 AM

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

Pain signals travel along the spinal cord into the brain where the signals are processed. Medications and nonpharmacologic treatments are used to alter the perception of pain. Using multiple medications can better alter the perception of pain, minimize side effects from other medications, and increase compliance with the treatment. This workshop will engage the active participant in discussion regarding multimodal analgesia, combination therapy, and when single agent therapy is appropriate.

Thursday/9.6
8:10 AM - 9:10 AM

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

Pain signals travel along the spinal cord into the brain where the signals are processed. Medications and nonpharmacologic treatments are used to alter the perception of pain. Using multiple medications can better alter the perception of pain, minimize side effects from other medications, and increase compliance with the treatment. This workshop will engage the active participant in discussion regarding multimodal analgesia, combination therapy, and when single agent therapy is appropriate.

Thursday/9.6
9:20 AM - 10:20 AM

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

Pain signals travel along the spinal cord into the brain where the signals are processed. Medications and nonpharmacologic treatments are used to alter the perception of pain. Using multiple medications can better alter the perception of pain, minimize side effects from other medications, and increase compliance with the treatment. This workshop will engage the active participant in discussion regarding multimodal analgesia, combination therapy, and when single agent therapy is appropriate.

Thursday/9.6
7:00 AM - 8:00 AM

Christopher M. Herndon, PharmD, BCPS, CPE

Adjuvants and co-analgesics are quickly becoming a mainstay of therapy for the treatment of persistent pain. Anesthetics, antidepressants, and anticonvulsants are a few of the pharmacotherapeutic options. While many of these agents have proven efficacious for pain, adverse effects are common and self-discontinuation of these agents by patients a frequent barrier to care. Here the most common adverse effects will be discussed to assist in the appropriate selection based on patient-specific variables. Monitoring and recommendations for discontinuation will also be discussed.

Thursday/9.6
8:10 AM - 9:10 AM

Christopher M. Herndon, PharmD, BCPS, CPE

Adjuvants and co-analgesics are quickly becoming a mainstay of therapy for the treatment of persistent pain. Anesthetics, antidepressants, and anticonvulsants are a few of the pharmacotherapeutic options. While many of these agents have proven efficacious for pain, adverse effects are common and self-discontinuation of these agents by patients a frequent barrier to care. Here the most common adverse effects will be discussed to assist in the appropriate selection based on patient-specific variables. Monitoring and recommendations for discontinuation will also be discussed.

Thursday/9.6
9:20 AM - 10:20 AM

Christopher M. Herndon, PharmD, BCPS, CPE

Adjuvants and co-analgesics are quickly becoming a mainstay of therapy for the treatment of persistent pain. Anesthetics, antidepressants, and anticonvulsants are a few of the pharmacotherapeutic options. While many of these agents have proven efficacious for pain, adverse effects are common and self-discontinuation of these agents by patients a frequent barrier to care. Here the most common adverse effects will be discussed to assist in the appropriate selection based on patient-specific variables. Monitoring and recommendations for discontinuation will also be discussed.

Thursday/9.6
7:00 AM - 8:00 AM

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE

This session will explore the basis for motivational interviewing as an effective style for initiating and facilitating change in a chronic pain patient. Many disease states require behavioral change by the patient to improve health outcomes. The principles and the process of motivational interviewing involve establishing a patient–provider relationship; setting an agenda; assessing importance, confidence, readiness; and helping patients and families with an action plan to effect those changes.

Thursday/9.6
8:10 AM - 9:10 AM

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE

This session will explore the basis for motivational interviewing as an effective style for initiating and facilitating change in a chronic pain patient. Many disease states require behavioral change by the patient to improve health outcomes. The principles and the process of motivational interviewing involve establishing a patient–provider relationship; setting an agenda; assessing importance, confidence, readiness; and helping patients and families with an action plan to effect those changes.

Thursday/9.6
2:10 PM - 4:10 PM

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

This session will explore the basis for motivational interviewing as an effective style for initiating and facilitating change in a chronic pain patient. Many disease states require behavioral change by the patient to improve health outcomes. The principles and the process of motivational interviewing involve establishing a patient–provider relationship; setting an agenda; assessing importance, confidence, readiness; and helping patients and families with an action plan to effect those changes.

Thursday/9.6
2:10 PM - 4:10 PM

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

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

Thursday/9.6
4:10 PM - 5:10 PM

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

Participants in this session will apply principles discussed in the session on Instructional Design and develop, critique, and suggest improvements for peer and patient education materials on pain management.

Friday/9.7
7:00 AM - 8:00 AM

Deborah A. Ward, PharmD, BCOP, BCPS

When safely prescribed, NSAIDS and other anti-inflammatory drugs can provide analgesia in a variety of clinical settings. In this case-based presentation, the clinical situations and challenges of providing safe and effective use of these drugs will be discussed.

Friday/9.7
8:10 AM - 9:10 AM

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

Opioids have been used in one form or another for over 4,000 years. Still today we are continuing to discover new and improved opiates with better patient tolerance and decreased side effects comparatively. This lecture will focus on the families of opiates and how they differ from each other, review patient characteristics that make certain opiates more desireable than others, and discuss management of side effects.

Friday/9.7
11:10 AM - 12:10 PM

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

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/9.7
4:10 PM - 5:10 PM

Deborah A. Ward, PharmD, BCOP, BCPS

Adjuvant therapy with antidepressants and anticonvulsants is often indicated in order to provide effective analgesia in a variety of pain settings. The drug therapy used and the clinical situations that require their use will be discussed in this case-based presentation.

Presented by Clinician Reviews.

Friday/9.7
5:20 PM - 6:20 PM

Charles E. Argoff, MD, CPE

Recent scientific discoveries regarding peripheral pain mechanisms, specifically within the epidermis, have led to new pain assessment tools and the development of new treatments. These discoveries may enhance the manner in which a clinician can evaluate and treat patients with chronic pain of diverse types, both neuropathic and others. It has been recently noted that keratinocytes in the skin release a broad spectrum of neural-active substances, such as neurotransmitters, neuropeptides, neurohormones, and thus may play a significant role in pain assessment as well as pain treatment. The increasing role of "skin" in pain management will be discussed with specific attention to emerging trends in pain assessment and pain treatment as a result of recent discoveries

Saturday/9.8
7:00 AM - 8:00 AM

Kathryn A. Walker, PharmD, BCPS, CPE

Understanding the fundamentals of pharmacokinetics and pharmacodynamics for common medications is paramount in palliative care. Given the complexity of care, palliative care clinicians are often managing many high-risk medications that have a potential to interact. This presentation will help illuminate the mechanisms and risk factors behind common drug interactions in palliative care patients. This course discusses how to assess drug interactions in practice and highlight common clinical presentations, implications, and management strategies.

Saturday/9.8
8:10 AM - 9:10 AM

Deborah A. Ward, PharmD, BCOP, BCPS

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/9.8
9:20 AM - 10:20 AM

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE; Kathryn A. Walker, PharmD, BCPS, CPE

Complex medication decisions are an integral part of treating palliative care patients. Pharmacists have a unique perspective on using these medications creatively and effectively. This 1-hour session will flirt with tips and tricks on using medications appropriately for patients facing advanced diseases. Whether debriding a medication profile, aggressively treating symptoms, or strategizing a dosage formulation, it can be hard to commit to medication decisions. Three pharmacists will speed-date their way through 50 medication tips designed to highlight important and little known medication facts. Find a tip that you are compatible with that may just change your life.

Saturday/9.8
2:10 PM - 3:10 PM

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE; Kathryn A. Walker, PharmD, BCPS, CPE

Topical and transdermal analgesics are frequently used to provide an opioid-sparing effect, or serve to facilitate analgesic delivery by a nonoral route of administration. However, most practitioners are unaware of the role in therapy for these analgesics. Participants in this session will learn about the efficacy and toxicity of topical analgesics including commercially available products such as capsaicin, salicylates, counterirritants, nonsteroidal anti-inflammatory drugs, and lidocaine and compounded topical opioids for wound care pain. The appropriate use of transdermal buprenorphine and fentanyl will also be discussed. By using a case-based active-learning approach, participants will learn which patient scenarios are amenable to topical analgesic therapy.

Saturday/9.8
4:10 PM - 5:10 PM

Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE; Kathryn A. Walker, PharmD, BCPS, CPE

Clinical issues are seldom black or white. In this lively session, 2 pharmacists will "duke it out" presenting both sides of the argument for and against opioid treatment agreements, and the role (if any) of inhaled cannabinoids. Listen to both sides of the debate before you make up your mind on these topics!

Thursday/9.6
6:30 PM - 8:30 PM

Faculty

Poster authors are available for questions and feedback during the reception.

Friday/9.7
8:10 AM - 10:10 AM

Srinivas Nalamachu, MD; Joseph V. Pergolizzi, MD; Kevin L. Zacharoff, MD, FACPE, FACIP, FAAP

This session presents posters selected for oral presentations.

Friday/9.7
2:10 PM - 4:10 PM

Srinivas Nalamachu, MD; Joseph V. Pergolizzi, MD

PAINWeek's Scientific Poster and Abstracts Committee Chairman, Joseph V. Pergolizzi, MD, will be joined by Rami Ben-Joseph, PhD; Frank Breve, PharmD, MBA; Keith Candotti, MD; Frederick A. Curro, DMD, PhD; Robert Glanzman, MD; Errol Gould, PhD; Stephen McMorn, PhD; Srinivas Nalamachu, MD; and Robert Taylor, MD, for a 2-hour plenary session on pain clinical trials. The expert panel speaks to FDA regulations and testing for pain products, analgesic preclinical testing, designing components of analgesic clinical trials, studies in analgesic drug development, and invetigator initiated trials. Please note that this session is not certified for credit.

Saturday/9.8
7:00 AM - 8:00 AM

Colleen M. Fitzgerald, MD

Pelvic pain affects about 25% of reproductive age women. However, science and medicine are just beginning to explore both the central and peripheral factors underlying various subtypes of female pelvic pain. Traditionally, diagnosis and treatment has focused on potential visceral causes of pelvic pain such as endometriosis, interstitial cystitis, and vulvodynia. Newer evidence has emerged suggesting the complex interplay of somatic structures such as the pelvic floor musculature in patients with visceral pelvic pain syndromes. This session focuses on the epidemiology and impact of female chronic pelvic pain (CPP), known pathophysiology, differential diagnosis, and the clinical diagnosis and treatment of CPP, specifically rehabilitation approaches. This session also addresses pregnancy related pelvic girdle pain, a common pelvic pain subtype. Current research in the field will be highlighted. The presentation is expected to help learners enhance their care of female pelvic pain patients.

Saturday/9.8
11:10 AM - 12:10 PM

Srinivas Nalamachu, MD

There is a dramatic increase in the upper extremity painful conditions in the last 2 decades because of the exponential increase in the usage of technology such as computers and hand-held devices. This course presents a comprehensive review of the most common painful conditions of arm and hand, along with various tendonitis and nerve entrapment conditions involving hand and elbow. Course materials will also review diagnosis and treatment options of these painful conditions, and discuss new pharmacologic and nonpharmacologic options.

Saturday/9.8
4:10 PM - 5:10 PM

Peter A. Foreman, DDS, DAAPM

A typical odontalgia (AO) has traditionally been called “atypical facial pain” or “phantom tooth pain.” These are nonspecific descriptions. Dental odontalgias often present difficult diagnostic and treatment challenges. They may follow injury or deafferentation of trigeminal nerve fibers due to endodontia, dental extractions, implants, and oral surgery. The incidence may be 5% or more. Management is often poor and seldom involves interdisciplinary pain management, resulting in a worsening prognosis. Some of these orofacial neuropathies may be the result of neuroplastic changes and central nervous system sensitization. Understanding this is critical in avoiding failed treatments that may lead to further interventions and increasing pain.

Thursday/9.6
2:10 PM - 3:10 PM

Ronald J. Rapoport, MD, FACR

There are many causes for inflammation of the joints, and the differentiation among these conditions is necessary for proper treatment. This presentation will describe the common and uncommon inflammatory arthropathies, discuss diagnostic methods, and prepare practitioners to better care for those in pain.

Thursday/9.6
4:10 PM - 5:10 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/9.5
7:00 AM - 8:00 AM

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

This presentation explores the use of both over-the-counter (OTC) and prescription medications in the context of the management of chronic pain. OTC medication statistics and safety issues in the United States will be discussed. This will be contrasted with the use of opioids in the US for the management of chronic pain along with guidelines and recommendations for their use as well as acetaminophen and NSAIDS.

Wednesday/9.5
9:20 AM - 10:20 AM

Gregory T. Carter, MD, MS; Steven D. Passik, PhD; Stephen J. Ziegler, PhD, JD

Marijuana remains a schedule I substance under the federal Controlled Substances Act (CSA). However, a number of states have passed their own laws that authorize medical marijuana for certain medical conditions, such as chronic pain. Although medical marijuana remains technically illegal under federal law, a growing number of physicians are nevertheless recommending it to their patients. A panel of experts will examine the clinical uses as well as concerns associated with its use.

Wednesday/9.5
11:10 AM - 12:10 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.

Day/9.5
2:10 PM - 3:10 PM

Gregory T. Carter, MD, MS

There are a growing number of studies indicating that chronic pain is a common symptom for the majority of people with various neuromuscular disorders (NMDs). Studies of adult persons with NMDs—including the facioscapulohumeral (FSHD), myotonic (MMD), and limb girdle (LGMD) forms of muscular dystrophy; spinal muscular atrophies (SMA); Charcot-Marie-Tooth (CMT) disease; and post-polio syndrome (PPS)—have shown reported rates of chronic pain ranging from 70% to 96%. Despite the negative impact of chronic pain on quality of life for NMD patients, there is almost no information on the relationship of chronic pain and burden of disease in this patient population. Future directions will be discussed in this lecture, including the need for studies addressing the degree to which chronic pain contributes to disease burden and how psychosocial factors causally influence pain. Better measurement tools for chronic pain, quality of life, and burden of disease are needed and could be utilized via NMD registries for these studies.

Wednesday/9.5
4:10 PM - 6:10 PM

Michael E. Schatman, PhD, CPE, DASPE

Thursday/9.6
7:00 AM - 8:00 AM

Deborah A. Ward, PharmD, BCOP, BCPS

Pain control in the pediatric setting can provide a number of challenges, ranging from pain assessment to drug dosing. In this case-based presentation, barriers to providing adequate pain control will be identified, and the influence of age on drug therapy selected to manage pain in this special patient population will be discussed.

Thursday/9.6
9:20 AM - 10:20 AM

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

This presentation discusses the issue of medication safety in the United States. Specific issues discussed focus on medical errors, and drug-drug interactions within the context of chronic pain management. Recommendations detail practical clinical practice points that can help avoid errors and increase medication safety with respect to pain management.

Thursday/9.6
11:10 AM - 12:10 PM

Barbara L. Kornblau, JD, OTR/L, CPE, DASPE; Susan K. McNulty, OTD, OTR/L; Scott M. Robertson

Autistic individuals may present unique situations for pain practitioners. Neurological differences may cause autistic people to perceive pain differently. Clinicians may find they also communicate this atypical pain perception differently from other pain patients. Other sensory-related challenges, such as tactile sensitivity, may require clinicians to alter their standard routine examination. This session presents clinical traits of autism, accompanying sensory perception, and practice tips to treat autistic people who experience pain.

Thursday/9.6
5:20 PM - 6:20 PM

John F. Peppin, DO, FACP

Opioids are an important mode of treatment for many patients who suffer from acute and chronic pain. However, many opioids at therapeutic levels are associated with a spectrum of side effects that can limit quality of life and contribute to unintentional overdose death. Constipation, somnolence, urinary retention, pruritis, nausea, vomiting, confusion, dysphoria, euphoria, and other side effects are among the most common problems associated with mu opioid agonists. Recent research has focused on designing opioid-like molecules that have fewer side effects, including less risk for abuse and addiction. Delta and kappa opioid agonists are new chemical entities that are opioid-like and may have less respiratory depression than mu agonists but are equally effective as analgesics. These agonists have different properties than mu agonists and may provide an advantage in the treatment of pain. For example, it has been reported that delta opioid agonists have an antidepressant effect. This could be associated with both clinical benefits and untoward positive effects. Kappa opioids may have increased analgesia with much less abuse potential that traditional mu agonists. Several new delta and kappa agonist chemical entities are currently being investigated that may add to the clinician’s armamentarium in treating pain. This program discusses drugs in development that work primarily on delta and kappa receptors.

Thursday/9.6
5:20 PM - 6:20 PM

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

This presentation discusses the movement of medicine into a Digital Age. The status of implementation of EMRs in the United States is discussed, along with future vision about the uptake and use. The implications of the digitalization of medical records and management of chronic pain will be addressed, as well as the potential for improvement in the delivery and tracking of chronic pain management.

Thursday/9.6
5:20 PM - 6:20 PM

Jennifer D. Carpenter; Aaron M. Gilson, MS, MSSW, PhD; John F. Peppin, DO, FACP; Stephen J. Ziegler, PhD, JD

The primary goal of any governmental intervention in prescribing should balance ensuring access to controlled substances while preventing their abuse. To what extent are laws created to achieve this end, and what impact could these efforts have on patients, prescribers, and diversion? A panel of medico-legal experts will discuss the potential impact of recent legislative and regulatory efforts, prescription monitoring programs (PMPs), and ways providers can participate in future reform.

Friday/9.7
7:00 AM - 8:00 AM

Robert D. Gerwin, MD, FAAN

This course looks at the relationship between fibromyalgia and myofascial pain. The reasons for the controversy over whether these are unique or related conditions will be examined. The distinct features of each of these conditions and their similarities are presented, emphasizing biochemistry and physiology, with a concluding discussion of their relationship and how it affects treatment decisions.

Friday/9.7
11:10 AM - 12:10 PM

Robert D. Gerwin, MD, FAAN

This course introduces the concepts of viscerosomatic pain that originates in visceral organs and is manifest by both visceral organ symptoms and body wall referred pain symptoms. These syndromes are common, often arising from the gastrointestinal tract. However, they are particularly troublesome in the pelvic region, and are associated with endometriosis, interstitial cystitis, and irritable bowel syndrome. They are frequently seen in patients with fibromyalgia or with abdominal/pelvic myofascial pain syndromes. This presentation addresses the underlying mechanisms, clinical presentation, and long-term management.

Friday/9.7
4:10 PM - 5:10 PM

Yoram Shir, MD

The high prevalence of chronic pain has become an immense public health problem. Diet is one of the possible analgesic modalities currently explored within the growing field of complementary and alternative medicine. Unfortunately, while proven to play a crucial role in the prevention of multifactorial illnesses such as cancer and ischemic heart disease, only scarce scientific data on the analgesic properties of diet exist. Nevertheless, preclinical and clinical studies have associated certain dietary factors with analgesia, indicating that diet could potentially play a significant role in relieving both acute and chronic pain. This course reviews basic and clinical evidence supporting dietary-induced analgesia and suggests possible future research avenues to further expand our knowledge of this neglected area.

Friday/9.7
2:10 PM - 3:10 PM

Steven D. Passik, PhD

The debate over whether or not opioids are appropriate in chronic noncancer pain management has featured intellectually dishonest arguments from both the pro and con side. The expanded use of opioids has come about with claims that have trivialized the risks of addiction, while the new growing avoidance of opioids is backed by claims suggesting the drugs are highly addictive and that hyperalgesia is virtually inevitable. This lecture will present the debate highlighting these arguments.

Friday/9.7
5:20 PM - 6:20 PM

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

This presentation provides participants with information related to the Food and Drug Administration's (FDA) requirement for a shared Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioid medications. A brief background of REMS will be presented, detailing the chronology, rationale, and steps taken. An update of the status of REMS will be detailed, along with a review of the educational blueprint for REMS education proposed by the FDA.

Saturday/9.8
9:20 AM - 10:20 AM

Roger B. Fillingim, PhD

The York Hospital Pain Management Team (PMT) provides pain management consultations for inpatients experiencing uncontrolled pain. Utilizing a protocol-based collaborative practice agreement, PMT clinical pharmacists complete a comprehensive pain assessment and adjust pain regimens through addition or removal of analgesic medications, dosage titrations, route of administration conversions, adverse effect assessment and management, use of nonpharmacologic modalities, coordination of care with outpatient practitioners, and patient education. The PMT also serves as a resource for the promotion of safe medication use throughout the hospital via educational programs, the development of policies regarding analgesic use, and the management of high-risk drug therapies. The PMT provides support for pain-related research projects completed by pharmacy and medical residents. Physician and nursing support for the team’s work is evident in the increased utilization of services throughout the 10 years the team has been in practice.

Saturday/9.8
8:10 AM - 9:10 AM

Benson Mathew, PharmD; Alisha M. Mutch, PharmD; Larry D. Owens , PharmD, BCPS, CACP

Abundant evidence suggests potentially important sex differences in the experience of pain, such that women are at greater risk for many chronic pain conditions and display increased pain sensitivity. Multiple factors contribute to these sex differences, including hormonal influences and psychosocial processes. Also, increasing evidence suggests that women and men may respond differently to some pain treatments, raising the possibility that future treatment may need to be tailored by gendern

Saturday/9.8
11:10 AM - 12:10 PM

Michael E. Schatman, PhD, CPE, DASPE

In the early days of medicine, patient care was a covenant between the patient and the physician, with this dyad considered sacred. Sadly, modern medicine, particularly in the American system, has changed to include numerous extraneous stakeholders outside of this dyad. In pain medicine, these stakeholders include the insurance, hospital, pharmaceutical, implantable device, and urine drug testing industry, as well as regulatory agencies. Rather than struggling for control over limited pain care resources, it is proposed that a pluralistic yet mutually cooperative system is not just a reality, but a necessity if the suffering of pain patients is to be ameliorated. An approach to this quandary emphasizing "rapprochement" is offered.

Saturday/9.8
5:20 PM - 6:20 PM

Michael C. Barnes, JD

The 2011 conviction of Dr. Conrad Murray for the homicide of Michael Jackson and the prescription drug related death of Whitney Houston are just 2 of the recent headlines drawing increased public attention to prescription drug abuse in the United States. Lawmakers, regulators, prosecutors, and judges are eager to respond, and the implications are tremendous for pain care providers. This presentation provides a review of prescription drug abuse events over the past 12 months, and a discussion of their impact on healthcare providers treating people with pain. Topics will include noteworthy legal cases, congressional efforts to tie prescriber education to DEA registration and to limit medication supply and indications, and select state-level restrictions on practitioners and patients.

Wednesday/9.5
12:30 PM - 2:00 PM

Chronic pain is a heterogeneous disease state that often defies simple classification, diagnosis, and treatment. Characterized by hyperactive nociceptive pathways and associated with numerous pathologic conditions, chronic pain affects an estimated 116 million adults in the United States with significant socioeconomic consequences.1 Although the precise determinants of chronicity have not been fully elucidated, the neuroplastic changes associated with chronic pain are thought to be progressive and often irreversible, underscoring the need for thorough assessment, timely diagnosis, and aggressive treatment.2 Importantly, the clinical presentation of chronic pain is markedly influenced by patient-specific biologic and psychosocial parameters, requiring comprehensive evaluations of all contributory factors and functional deficits associated with the pain experience.3 Advances in our understanding of pain mechanisms, improved assessment methodologies, and a growing evidence base supporting various therapeutic approaches have left clinicians better equipped to manage the growing population with chronic pain.4-7 This Interactive ShowCASE™ highlights recent scientific insights into pain pathophysiology and how they can be translated into practical chronic pain assessment and management strategies.

References

1. Transforming Prevention, Care, Education, and Research. Washington, DC: Institute of Medicine of the National Academies; 2011.
2. Woolf CJ. Anesthesiology. 2007;106:864-867
3. Gatchel RJ, et al. Psychol Bull. 2007;133:581-624.
4. Baron R, et al. Lancet Neurol. 2010;9:807-819
5. American Society of Anesthesiologists. Anesthesiology. 2010;112:810-833.
6. . Chou R, et al. Ann Intern Med. 2007;147:478-491.
7. Smart KM, et al. Clin J Pain. 2011;27:655-663.

Learning Objectives

• Assess chronic pain phenomenology, including pain characteristics, associated symptomatology, functional consequences, and underlying neurobiologic mechanisms
• Perform initial and ongoing evaluations of patients with chronically painful conditions, including low back pain, osteoarthritis, peripheral neuropathies, and other pain syndromes
• Evaluate the clinical profiles of pharmacologic agents based on analgesic mechanisms of action, potential benefits, adverse effects, and risks of inappropriate use
• Tailor single-agent and multidrug pharmacologic regimens for chronic pain to maximize analgesia and functional gains and minimize adverse effects
Implement and coordinate multidisciplinary care to address the full range of biopsychosocial symptoms associated with chronic pain

Jointly sponsored by Albert Einstein College of Medicine of Yeshiva University, Educational Review Systems, Asante Communications, LLC.

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

Thursday/9.6
12:30 PM - 2:00 PM

Chronic pain is a heterogeneous disease state that often defies simple classification, diagnosis, and treatment. Characterized by hyperactive nociceptive pathways and associated with numerous pathologic conditions, chronic pain affects an estimated 116 million adults in the United States with significant socioeconomic consequences.1 Although the precise determinants of chronicity have not been fully elucidated, the neuroplastic changes associated with chronic pain are thought to be progressive and often irreversible, underscoring the need for thorough assessment, timely diagnosis, and aggressive treatment.2 Importantly, the clinical presentation of chronic pain is markedly influenced by patient-specific biologic and psychosocial parameters, requiring comprehensive evaluations of all contributory factors and functional deficits associated with the pain experience.3 Advances in our understanding of pain mechanisms, improved assessment methodologies, and a growing evidence base supporting various therapeutic approaches have left clinicians better equipped to manage the growing population with chronic pain.4-7 This Interactive ShowCASE™ highlights recent scientific insights into pain pathophysiology and how they can be translated into practical chronic pain assessment and management strategies.

References

1. Transforming Prevention, Care, Education, and Research. Washington, DC: Institute of Medicine of the National Academies; 2011.
2. Woolf CJ. Anesthesiology. 2007;106:864-867
3. Gatchel RJ, et al. Psychol Bull. 2007;133:581-624.
4. Baron R, et al. Lancet Neurol. 2010;9:807-819
5. American Society of Anesthesiologists. Anesthesiology. 2010;112:810-833.
6. . Chou R, et al. Ann Intern Med. 2007;147:478-491.
7. Smart KM, et al. Clin J Pain. 2011;27:655-663.

Learning Objectives

• Assess chronic pain phenomenology, including pain characteristics, associated symptomatology, functional consequences, and underlying neurobiologic mechanisms
• Perform initial and ongoing evaluations of patients with chronically painful conditions, including low back pain, osteoarthritis, peripheral neuropathies, and other pain syndromes
• Evaluate the clinical profiles of pharmacologic agents based on analgesic mechanisms of action, potential benefits, adverse effects, and risks of inappropriate use
• Tailor single-agent and multidrug pharmacologic regimens for chronic pain to maximize analgesia and functional gains and minimize adverse effects
Implement and coordinate multidisciplinary care to address the full range of biopsychosocial symptoms associated with chronic pain

Jointly sponsored by Albert Einstein College of Medicine of Yeshiva University, Educational Review Systems, Asante Communications, LLC.

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit www.lillygrantoffice.com.

Thursday/9.6
4:10 PM - 6:10 PM

Mission: Pain Management – The Efficient First Visit is a novel interactive IDEAL® Clinical Encounter forum in which participants have the opportunity to put their knowledge into practice. This activity, designed to help the pain team focus their efforts on maximizing their time with the patient, allows attendees to participate in the diagnosis and management of a live “programmed” patient. Experts will interact with the patient, discussing his history and current situation. They will then review management choices and appropriate treatments with the participants, based upon the information and “clinical pearls” revealed earlier in the program. Participants will have the opportunity to provide interactive feedback and monitor their learning progress. Throughout the activity, the experts will provide evidence-based information that can be implemented immediately to enhance your patient care.

Learning Objectives

• Differentiate the underlying pathophysiology and pain transmission mechanisms associated with nociceptive, neuropathic, and centrally-mediated chronic pain
• Compare nonpharmacologic and pharmacologic treatment options for chronic pain and contrast relative risks and benefits in the management of chronic pain
• Illustrate barriers to the optimal use of opioid analgesics in patients with chronic pain and formulate strategies to address such barriers
• Assess therapeutic management methods, including titration for safety and efficacy, for screening and risk mitigation in the initial and follow-up care of patients with chronic pain

Jointly Sponsored by the University of Cincinnati, Advancing Knowledge in Healthcare, and Educational Awareness Solutions.

Supported by educational grants provided by Purdue Pharma L.P. and Mallinckrodt, the pharmaceuticals business of Covidien.

Friday/9.7
8:25 AM - 9:55 AM

This program will provide a forum for both didactic and interactive education regarding the burden of disease of opioid-induced constipation (OIC), disease mechanisms, and clinical considerations associated with the treatment and management of OIC.

Learning Objectives

• Recognize the burden and impact of OIC on patients, healthcare providers, and society
• Identify patients at risk for OIC
• Explain the unique pathophysiology leading to OIC
• Discuss the benefits and limitations of current and emerging treatment options for OIC

This activity is jointly sponsored by AccreditEd and the University of Kentucky Colleges of Medicine, Pharmacy, and Nursing. This activity was made possible by an unrestricted educational grant provided by Salix Pharmaceuticals, Inc.

Friday/9.7
12:30 PM - 2:00 PM

This program will provide a forum for both didactic and interactive education regarding the burden of disease of opioid-induced constipation (OIC), disease mechanisms, and clinical considerations associated with the treatment and management of OIC.

Learning Objectives

• Recognize the burden and impact of OIC on patients, healthcare providers, and society
• Identify patients at risk for OIC
• Explain the unique pathophysiology leading to OIC
• Discuss the benefits and limitations of current and emerging treatment options for OIC

This activity is jointly sponsored by AccreditEd and the University of Kentucky Colleges of Medicine, Pharmacy, and Nursing. This activity was made possible by an unrestricted educational grant provided by Salix Pharmaceuticals, Inc.

Saturday/9.8
12:30 PM - 2:00 PM

The idiosyncratic characteristics of persistent pain and breakthrough pain (BTP) present threshold challenges for time-constrained clinicians in achieving patient-specific treatment goals for subjective and dynamic clinical conditions associated with significant suffering. Comprehensive assessment is required to identify all contributory biopsychosocial factors and deleterious effects on physical, affective, cognitive, and work-related dimensions of life.1 Clinical findings must then be translated into individualized therapy, which, for select patients, may include opioid-based regimens. Concerns over prescription opioid abuse and overdose, however, complicate the use of these analgesics, despite significant clinical experience and a growing evidence base in various chronic pain conditions.2,3 Newer paradigms in opioid prescribing incorporate evaluations of pain pathophysiology, predefined treatment goals, and structured therapy with ongoing monitoring to ensure patient safety.3,4 Clinicians must also tailor therapy to address daily fluctuations in pain levels and functional disability, as well as life stressors that place the patient at greater risk for inappropriate drug use.5-7 This Interactive ShowCASE™ is designed to consolidate clinically relevant scientific studies and evidence-based guidelines into practical approaches to persistent pain and BTP assessment, responsible opioid prescribing, and repeated re-evaluation of patient outcomes.3,4,8

References

1. . Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. Psychol Bull. 2007;133(4):581-624.
2. Webster LR, Cochella S, Dasgupta N, et al. Pain Med. 2011;12(suppl 2):S26-S35.
3. . Chou R, Fanciullo GJ, Fine PG, et al. J Pain. 2009;10(2):113-130.
4. Management of Opioid Therapy for Chronic Pain Working Group. VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. Washington, DC: Department of Veterans Affairs, Department of Defense; 2010.
5. Mercadante S. Curr Pain Headache Rep. 2011;15(4):244-249.
6. Fine PG, Narayana A, Passik SD. Pain Med. 2010;11(7):1024-1036.
7. Chou R, Fanciullo GJ, Fine PG, et al. J Pain. 2009;10(2):131-146.
8. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. 2010.

Upon completing this CME/CE activity, participants will be better prepared to

Learning Objectives

• Describe the diagnostic criteria for BTP and clinical characteristics of its subtypes
• Comprehensively evaluate transient pain exacerbations in patients with chronic pain
• Individualize opioid therapy for persistent pain and BTP to reflect the temporal profile of pain, functional impairment, treatment-related risks, and adherence to the therapeutic plan
• • Coordinate multidisciplinary care to address the full range of biopsychosocial causes and symptoms associated with persistent pain and BTP
• Integrate principles of safe and responsible opioid prescribing for persistent pain and BTP to comply with medical standards of care, government agencies, and REMS

This activity is jointly sponsored by Albert Einstein College of Medicine of Yeshiva University,

Educational Review Systems, and Asante Communications, LLC.

This activity is supported by an educational grant from Teva Pharmaceutical Industries Ltd.

Saturday/9.8
7:00 AM - 8:00 AM

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE; Jeremiah C. McKelvey, PharmD; Robert D. Sproul, PharmD; Nancy Wiedemer, RN, MSN, CRNP

These presentations will focus on innovations in pain management in the medical home regarding complex patients. The innovations to be discussed in detail are: 1) pain school, 2) primary care-based pain teams, and 3) electronic consulting. The second half of this session consists of a panel discussion that will include audience input utilizing cases to review how to use each of these innovations to improve patient care and safety.

Saturday/9.8
8:10 AM - 9:10 AM

Sondra M. Adkinson, CRPh, BSPh, PharmD, DAAPM, CPE; Jeremiah C. McKelvey, PharmD; Robert D. Sproul, PharmD; Nancy Wiedemer, RN, MSN, CRNP

This session is a panel discussion based on materials presented in VHA-01A

Saturday/9.8
9:20 AM - 10:20 AM

Carri-Ann Gibson, MD; Ilene R. Robeck, MDaculty

This session discusses evaluating and treating chronic pain in veterans following deployment in Iraq and Afghanistan. It will review common comorbidities associated with chronic pain postdeployment such as TBI, PTSD, and substance use disorder. A primary care, as well as specialty, approach to postdeployment pain will be discussed. The impact on community providers will also be reviewed as many of these patients and their families are seen in non-VA healthcare settings.

Presented by the Federal Practitioner.

Saturday/9.8
11:10 AM - 12:10 PM

Lucile Burgo-Black, MD; Carri-Ann Gibson, MD; Stephen C. Hunt, MD, MPH; Luz S. Vasquez, MD

This session is a panel discussion based on materials presented in VHA-02A.

Saturday/9.8
2:10 PM - 3:10 PM

Kevin Lancer; Edward S. Lee, MD; Tu A. Ngo, PhD, MPH

Patients with psychiatric comorbidities and chronic pain frequently represent a significant challenge as they may pose an increased risk of adverse events related to opiate therapy, have a higher rate of no-show and clinic cancellations to specialty services, and may use medications in a way not intended by the prescriber. Embedding mental health services in primary care can improve both patient and provider satisfaction with pain treatment with improved outcomes.

Saturday/9.8
4:10 PM - 5:10 PM

Kevin Lancer; Edward S. Lee, MD; Tu A. Ngo, PhD, MPH

This is a panel discussion based on materials presented in VHA-03A.

Saturday/9.8
5:20 PM - 6:20 PM

Lucile Burgo-Black, MD; Stephen C. Hunt, MD, MPH

This session will review services available for veterans and their families through the VHA Healthcare System. The VA is proud to partner with non-VA and VA providers to co-manage care for veterans who prefer to see private as well as VA providers. There are many unique services available at VA facilities throughout the country that can augment and improve care received in the private sector alone. These and the process for patients to access VA care will be reviewed.