Comprehensive Pain Management in Palliative Care

Faculty

Anthony J. Lembo, MD
Associate Professor of Medicine
Harvard Medical School
Director, GI Motility Laboratory
Division of Gastroenterology
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Michael J. Brennan, MD
The Pain Center of Fairfield
Fairfield, Connecticut
Assistant Medical Director
Chronic Pain and Recovery Center
Silver Hill Hospital
New Canaan, Connecticut
Senior Attending Physician
Department of Medicine
Bridgeport Hospital
Bridgeport, Connecticut

April M. Zehm, MD
Instructor, Harvard Medical School
Assistant in Medicine
Division of Palliative Care
Massachusetts General Hospital
Boston, Massachusetts

Target Audience

The educational design of this activity addresses the needs of palliative care clinicians who manage patients on opioid-based pain regimens.

Statement of Need/Program Overview

As the United States population ages, an increasing number of individuals will suffer from significant pain as they approach end of life.¹ Despite advances in our understanding of pain physiology and available treatment modalities, pain associated with life-threatening illnesses is often untreated or undertreated.² This results in part from side effects of commonly prescribed analgesics. For example, opioids have long been the cornerstone treatment for pain associated with cancer or other terminal conditions.^3,4 The most frequent side effect of prescription opioids is constipation, which ranks as the third most commonly reported symptom in palliative care.^5,6 Unaddressed opioid-induced constipation (OIC) can have markedly deleterious effects on patient function and quality of life.^7,8 With an overall goal of improving comprehensive pain management in patients receiving palliative care, this Evidence-Based Best Practices program will examine the pathophysiology of opioid-induced bowel dysfunction, prophylactic treatment regimens for OIC, assessment strategies to identify and monitor affected patients, and new therapeutic approaches that mitigate OIC effectively and safely.

References

1. Robinson CL. Health Prog. 2007;88(1):48-53.
2. Deandrea S, et al. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol. 2008;19(12):1985-1991.
3. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Version 2.2016.
4. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatr Soc. 2009;57(8):1331-1346.
5. Coyne KS, et al. Clinicoecon Outcomes Res. 2014;6:269-281.
6. Gatti A, Sabato AF. Clin Drug Investig. 2012;32(5):293-301.
7. Holzer P. Expert Opin Investig Drugs. 2007;16(2):181-194.
8. Rao SS. Gastroenterol Clin North Am. 2007;36(3):687-711.

Educational Objectives

After completing this activity, the participant should be better able to:

• Evaluate baseline and ongoing bowel function in palliative care patients who need opioid-based pain management
• Describe the mechanisms of action, published evidence, and prescribing considerations for FDA-approved medications in the treatment of OIC
• Incorporate prophylactic bowel regimens and newer OIC therapies into comprehensive palliative care plans
• Communicate with opioid-treated palliative care patients and their caregivers to facilitate bowel assessment efforts and shared decision-making about OIC treatment options

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation

Global Education Group designates this enduring activity for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Education

Global Education Group is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA.

This educational activity for 0.50 contact hour is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioner Continuing Education

Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121. This activity is accredited for 0.50 contact hour(s) which includes 0.1 hour(s) of pharmacology.

Activity ID 2306E.

This activity was planned in accordance with AANP CE Standards and Policies.

Global Contact Information

For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score a 70% or better on the posttest.

System Requirements

PC
Microsoft Windows 2000 SE or above.
Flash Player Plugin (v7.0.1.9 or greater)
Internet Explorer (v5.5 or greater), or Firefox
Adobe Acrobat Reader*

MAC
MAC OS 10.2.8
Flash Player Plugin (v7.0.1.9 or greater)
Safari
Adobe Acrobat Reader*
Internet Explorer is not supported on the Macintosh.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Anthony J. Lembo, MD: Consultant/Independent Contractor: Alkermes plc, Ardelyx, Inc., Forest Laboratories, Inc., Ironwood Pharmaceuticals, Inc., Prometheus Laboratories Inc., Salix Pharmaceuticals, Inc.; Grant/Research Support: Prometheus Laboratories Inc.

Michael J. Brennan, MD: Consultant/Independent Contractor: AstraZeneca, Cara Therapeutics Inc., Collegium Pharmaceutical Inc., Depomed,Inc., Progenics Pharmaceuticals, Inc., Purdue Pharma L.P., Teva Pharmaceuticals USA Inc.; Honoraria: AstraZeneca, Collegium Pharmaceutical Inc., Depomed, Inc.,Progenics Pharmaceuticals, Inc., Purdue Pharma L.P., Teva Pharmaceuticals USA Inc.; Stockholder: Cara Therapeutics Inc.

April M. Zehm, MD: Nothing to disclose

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Kristen Delisi  Nothing to disclose
Andrea Funk  Nothing to disclose
Laura Gilsdorf  Nothing to disclose
Ashley Marostica, RN, MSN  Nothing to disclose
Rose O’Connor, PhD  Nothing to disclose
Jim Kappler, PhD   Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.