Pain Treatment CME (Continuing Medical Education) Courses

Courses are listed in chronological order of their end (expiration) dates; newer courses are toward the top and those soon expiring are toward the bottom. To find courses pertaining to specific disciplines, press Control(Ctrl)+F and enter “Physicians,” “Pharmacists,” “Nurses,” etc. in the search box.

IMPORTANT: Courses are provided by the sponsoring organizations listed in the course descriptions; not by Pain-Topics.org. Questions regarding a particular course or credits should be directed to the sponsoring organization indicated in the course materials. Pain Treatment Topics has no financial interest in any of these offerings; see also, Disclaimer below.

To the extent possible, and in accord with the Pain Treatment Topics Open Access Policy, only courses are listed that allow free viewing of the contents, although there may be a cost from the sponsor organization (not Pain-Topics.org) to receive CME/CEU credits. Registration at the site to view documents may be required.

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Urine Drug Testing in Clinical Practice: The Art and Science of Patient Care

Access: http://www.pharmacomgroup.com/udt/udt5.pdf
Audience: Physicians, Nurse Practitioners, Physician Assistants, Nurses
Start/End: June 15, 2012 / June 15, 2014
Credits: Up to 2.0 AMA PRA Cat. 1 credits for physicians, nurse practitioners (accepted by AANP), physician assistants (accepted by AAPA), and nurses (accepted by ANCC).
Price: Free
Program Format: Monograph, 24 pages
Sponsor: Johns Hopkins University School of Medicine; supported by educational grants from Purdue Pharma LP and Quest Diagnostics Inc.
Presenter(s): Douglas L. Gourlay, MD, FRCPC, FASAM; Howard A. Heit, MD, FACP, FASAM; Yale H. Caplan, PhD, D-ABFT
Description: This educational activity was developed to provide practitioners with the latest information on appropriate individual strategies for urine drug testing (UDT) in each patient. The authors emphasize that healthcare providers need to: 1) understand the purpose of UDT and distinguish between monitoring adherence to a treatment regimen and the detection of illicit drug use, 2) understand methodology, instrumentation, and sensitivity/specificity of results, and 3) identify strategies to improve analysis and interpretation of results. A discussion of unexpected or confusing test results — positive or negative — includes current scientific understanding of possible medical explanations and interpretations. Advice on when and how to communicate with the testing laboratory or device manufacturer is also provided. Access checked September 19, 2012.

Comparative Effectiveness and Safety of Analgesics for Osteoarthritis: A Panel Discussion with Applications to Practice

Access: http://ce.effectivehealthcare.ahrq.gov/…Analgesics-for-Osteoarthritis
Audience: Physicians, Pharmacists, Nurses, Physician Assistants, Case Managers
Start/End: March 31, 2012 / March 31, 2014
Credits: Up to 1.5 AMA PRA Cat. 1 credits for physicians; 1.0 AMA PRA Cat. 1 credit accepted by AAPA for physician assistants; other healthcare professionals can receive 1.5 credit hours and should check the CME website for accrediting organizations
Price: Free
Program Format: Web-based Multimedia
Sponsor: PRIME Education, Inc.; Agency for Healthcare Research and Quality (AHRQ)
Presenter(s): Daniel Solomon, MD, MPH; Richard Mastrole, MD; Joel Zive, BS, PharmD
Description: Oral and topical treatments for osteoarthritis, a major cause of disability in an aging population, are reviewed in this panel discussion. The program includes a discussion of expert experience and recently-published evidence on the benefits and the growing list of risks for each drug. The importance of understanding the need to evaluate and balance the risks and benefits in several patient populations seen in various practice settings is explained. Studies evaluating the safety and efficacy of NSAIDs, acetaminophen, commonly-used supplements, and topical agents are described in the context of their ability to meet patient’s goals for treatment. Clinicians are encouraged to consider prophylactic therapies to help reduce gastrointestinal injury in patients who are taking oral NSAIDs. The presenters also emphasize the need to educate patients on potential additional risks when adding over-the-counter products to prescribed combination drugs. Access checked May 23, 2012.

Clinical Applications of Comparative Effectiveness of Noncyclic Chronic Pelvic Pain Therapies for Women

Access: http://ce.effectivehealthcare.ahrq.gov/…Noncyclic-Chronic-Pelvic-Pain-Therapies-for-Women
Audience: Physicians, Nurses, Physician Assistants, Case Managers, Medical Assistants, Health Educators
Start/End: March 31, 2012 / March 31, 2014
Credits: Up to 1.0 AMA PRA Cat. 1 credit for physicians and physician assistants; other healthcare professionals can receive 1.0 credit hours and should check the CME website for accrediting organizations
Price: Free
Program Format: Monograph
Sponsor: PRIME Education, Inc.; Agency for Healthcare Research and Quality (AHRQ)
Author(s): Amanda Yunker, DO, MSCR; Carolyn LePage, PhD, ARNP; Heidi Wynn Maloni, PhD, ANP-BC; Wanda Carter, MPH, CHES
Description: This educational program presents a review of published literature on the treatment efficacy of surgical, pharmacologic, and nonpharmacologic interventions for noncyclic chronic pelvic pain (CPP) in women — defined as severe localized pelvic pain persisting longer than 3 months. In a discussion of treatment options, the authors explore functional disability issues experienced by patients and explore potential comorbidities. Interventions for persistent or recurrent mixed noncyclic/cyclic CPP as well as further therapy following initial treatment failure are examined. Access checked May 23, 2012.

Pain Management: Focus on Function

Access: http://elearning.pharmacist.com/…/AugustCEReviews_FINAL_PT.pdf
Audience: Pharmacists
Start/End: August 15, 2011 / March 26, 2014
Credits: Up to 2.0 ACPE CE credits (0.2 CEUs)
Price: Free access to article; testing is free to APA members, $15 for nonmembers
Program Format: Monograph
Sponsor: American Pharmacists Association; supported by educational grants from Endo Pharmaceuticals Inc. and Purdue Pharma, L.P.
Author(s): Kathyrn Hahn, PharmD, CPE, DAAPM; Daniel Kennedy, BSPharm, FAPhA
Description: The management of chronic pain is addressed on several levels; topics include the selection of appropriate patients for opioid therapy, managing risk, and the importance of helping each patient identify their individual functional and analgesic treatment goals. Practitioners are reminded to use the 4 A’s — Analgesia, Activities, Adverse effects, Aberrant Behavior — to monitor patient response to therapy. Access checked August 23, 2011.

A Case-Based Approach to Chronic Pain and Long-Term Opioid Therapy

Access: http://cme.dannemiller.com/sections/professional/cme_slide_presentations/orlando

(free registration required)

Audience: Physicians, Physician Assistants, Nurse Practitioners, Nurses
Start/End: November 2011 / October 31, 2013
Credits: Up to 2.0 AMA PRA Cat. 1 credits for physicians and physician assistants; 2.0 AANP contact hours (no hours in pharmacology) for nurse practitioners; 2.4 contact hours from the California Board of Registered Nursing
Price: Free
Program Format: Web-based Multimedia
Sponsor: Dannemiller Education Center; supported by an educational grant from Purdue Pharma, L.P.
Author(s): Paul J. Christo, MD; Steven D. Passik, PhD
Description: This educational activity addresses the challenges of providing appropriate opioid therapy while reducing the risk of abuse and misuse. The program includes a review of patient evaluation practices, then reinforces the need for regular patient reassessment to identify changes in physiology or psychosocial issues that may affect the patient’s need for analgesia. The presenters review various agents and how they affect pain pathways. Case studies are used to examine a multimodal approach to manage pain. Definitions of terms — dependence, tolerance, addiction, misuse, and abuse — differentiate one from another in terms of a patient’s biological, psychiatric, or social risk for inappropriate opioid use. A discussion of risk reduction includes a review of the specific characteristics of several opioid agents that could alter prescribing decisions. Access checked February 16, 2012.

Safe Prescribing for Pain

Access: http://www.medscape.org/viewarticle/770687
Audience: Physicians, Nurses
Start/End: September 26, 2012 / September 26, 2013
Credits: Up to 1.25 AMA PRA Cat. 1 credit hour; 1.25 AACC contact hours (no hours in pharmacology) for nurses
Price: Free
Program Format: Monograph (full document can be printed by clicking the “Print” link near the top of the program; print-out includes all text and graphic components)
Sponsor: Medscape Education, Women’s Health
Author(s): Gayathri Dowling, PhD; Richard A. Denisco, MD
Description: Appropriate pain management requires that practitioners have a working knowledge of the necessary skills and available tools needed to screen and monitor patients for prescription opioid misuse. This educational activity describes effective patient communication practices, risk assessment tools, patient treatment agreements, good monitoring practices, and strategies for identifying patients who require close monitoring. Links are provided for additional risk management resources. Access checked October 4, 2012.

Managing Pain Patients Who Abuse Prescription Drugs

Access: http://www.medscape.org/viewarticle/770440
Audience: Physicians, Nurses
Start/End: September 26, 2012 / September 26, 2013
Credits: Up to 1.75 AMA PRA Cat. 1 credit hour; 1.75 AACC contact hours (1.75 hours in pharmacology) for nurses
Price: Free
Program Format: Monograph (full document can be printed by clicking the “Print” link near the top of the program; print-out includes all text and graphic components)
Sponsor: Medscape Education, Women’s Health
Author(s): Gayathri Dowling, PhD; Richard A. Denisco, MD
Description: This educational activity uses a case study approach to learning the techniques for identifying signs and symptoms of opioid addiction. Communication strategies and the “5 A’s of Intervention” are examined for their use in screening and addressing prescription drug abuse or addiction. The “4 A’s of Opioid Therapy” — sufficient Analgesia to engage in Activities of daily living while avoiding Adverse events and Aberrant medication-related behaviors — are explained in the context of designing the most appropriate pain management plan on a patient-by-patient basis. Links are provided for additional risk management resources. Access checked October 4, 2012.

Opioid-Induced Androgen Deficiency: Approaches to Diagnosis and Management

Access: http://www.cmeuniversity.com/course/disclaimer/108491 (free registration required)
Audience: Physicians
Start/End: August 24, 2012 / September 16, 2013
Credits: Up to 1.25 AMA PRA Cat. 1 credits for physicians
Price: Free
Program Format: Monograph
Sponsor: Postgraduate Institute for Medicine and Miller Medical Communications LLC; supported by an educational grant from Endo Pharmaceuticals Inc.
Presenter(s): Michael J. Brennan, MD; Andre T. Guay, MD, FACP, FACE, IF; Abraham Morgentaler, MD, FACS
Description: This educational activity is based on a satellite symposium that was presented in conjunction with the American Academy of Pain Medicine’s Annual Meeting in February, 2012. The effects of opioid use on the male endocrine system — primarily hypogonadism — has been long-recognized. The authors review the physiological role of testosterone on men’s health, the importance of screening patients on long-term opioid therapy, and the potential consequences of hypogonadism. The importance of maintaining normal levels of testosterone in patients prescribed long-term opioid therapy is emphasized in light of the relationship between hypogonadism and other chronic diseases like metabolic syndrome, insulin resistance, diabetes, hypertension, and hyperlipidemia. Approaches to diagnosis, patient counseling, and the range of evidence-based treatment options for male patients who could potentially benefit from testosterone replacement are all explored. Unwarranted fears and evidence related to concerns regarding a possible link between prostate cancer and testosterone replacement therapy are explored in detail. Access checked September 27, 2012.

New Diagnostic and Treatment Approaches for Fibromyalgia: Implications for Primary Care

Access: http://www.fibromyalgiahcp.org/fibro_new/
Audience: Physicians
Start/End: August 29, 2012 / August 28, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credits for physicians
Price: Free
Program Format: Web-based Multimedia
Sponsor: Albert Einstein College of Medicine; National Fibromyalgia Association; and M2 Communications
Presenter(s): Don Goldenberg, MD; Roland Staud, MD, Daniel Clauw, MD
Description: This multimedia program was developed for primary care providers and begins with a discussion of the barriers to effective fibromyalgia treatment—such as reports of symptoms without objective signs and the varied approaches to treatment decisions. The presentations include an explanation of 1) the differences between the American College of Rheumatology (ACR) 1990 and 2010 criteria for fibromyalgia classification, 2) possible mimics of fibromyalgia, and 3) the importance of identifying trigger points and possible myofascial pain. Graphic elements help to explain the neural influences on pain and sensory processing and a table defines the efficacy of specific agents in 4 different classes of drugs. Data on the evidence for the effectiveness of nonpharmacologic strategies includes strong support for exercise, cognitive-behavioral therapy and patient education, plus modest evidence for other interventions like acupuncture, biofeedback, and tai-chi. The presenters provide guidance on the appropriate rationale for referring patients for more extensive testing or a rheumatology consult. Access checked September 27, 2012.

Safety of Biologics in Rheumatoid Arthritis

Access: http://www.medscape.org/viewarticle/768769
Audience: Physicians
Start/End: August 15, 2012 / August 15, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (full document can be printed by clicking the “Print” icon near the top right side of the program; file includes all text and graphic components)
Sponsor: Medscape Education, Rheumatology
Author(s): Sarah C. Horton, MBChB, MRCP; Jackie L. Nam, MBBCh, FCP; Maya H. Buch, MBChB, PhD
Description: Since several biologic agents are now available for RA, it is important for clinicians to understand the differences in structure and mechanism of action as these relate to prescribing considerations and safety. This educational activity evaluates recent evidence of adverse events associated with biological therapies and discusses several areas of concern: 1) relative risk of bacterial infection, 2) incidence of reactivation of latent infections like tuberculosis, 3) potential for increased risk of viral infections, and 4) the associated risk of malignancy. Hypersensitivities, infusion reactions, common adverse effects, and specific patient conditions that require precaution when using biologics are reviewed. Access checked September 13, 2012.

Is Untreated Pain a Disease? (CSA Pain Management Module 2)

Access: http://www.csahq.org/cme2/course.module.php?course=3&module=16&terms=show
Audience: Physicians
Start/End: Reviewed/Reapproved June 2010 / July 27, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit
Price: Free for CSA members, $25 per credit hour for non-members
Program Format: Brief article
Sponsor: California Society of Anesthesiologists (CSA)
Author(s): Joshua P. Prager, MD, MS
Description: This module examines experimental study results that show evidence of structural changes in the spinal cord with long-term symptoms of neuropathic pain or nerve injury. Additional studies of chronic pain show noticeable receptive field changes in the brain that have a more far-reaching effect on a person’s overall health. The author proposes that these changes signify disease and, therefore, clinicians should attempt to treat acute pain to prevent a chronic condition. Access checked August 14, 2010.

Achieving Competence in Treat-to-Target for Patients with Rheumatoid Arthritis

Access: http://primeinc.org/cme/online/512/…Rheumatoid_Arthritis
Audience: Physicians, Physician Assistants, Nurse Practitioners, Nurses
Start/End: July 18, 2012 / July 17, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit for physicians; 1.0 AMA PRA Cat. 1 credit accepted by AAPA for physician assistants; 1.0 AANP contact hour (0.5 hour in pharmacology) for nurse practitioners; 1.0 ANCC CE contact hours for nurses
Price: Free
Program Format: Web-based Multimedia
Sponsor: PRIME Education, Inc.
Presenter(s): Betty Loflin, RN, MSN, FNP-BC, CCD; Frank Urbano, MD, FACP
Description: Early treatment and long-term management of rheumatoid arthritis (RA) — a chronic, systemic, autoimmune inflammatory disease — has changed dramatically in the past 2 decades. This educational program reviews updated 2012 American College of Rheumatology (ACR) recommendations, examines criteria for low, medium, and high disease activity, and offers an in-depth analysis of the many tools available for outcomes measurement. New evidence on adapting therapy to achieve a target of remission or low disease activity is presented and includes a discussion of barriers to treatment, comorbidities, and adverse effects of specific agents. Emphasis is placed on the need for ongoing monitoring of disease activity, multidisciplinary treatment, and patient education as a way to maximize adherence to prescribed therapies. Access checked August 15, 2012.

Pain Report #13 – End-of-Life Care: The Management of Pain in Palliative Medicine

Access: http://cme.dannemiller.com/sections/professional/cme_article/accreditation.cfm?id=329

(free registration required)

Audience: Physicians, Physician Assistants, Pharmacists, Nurse Practitioners, Nurses
Start/End: June 2011 / June 30, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit for physicians and physician assistants; 1.0 ACPE CE credit (0.1 CEUs) for pharmacists; 1.0 AANP contact hours (0.5 hour in pharmacology) for nurse practitioners; 1.2 contact hours from the California Board of Registered Nursing
Price: Free
Program Format: Monograph
Sponsor: Dannemiller Education Center; supported by an educational grant from Purdue Pharma, L.P.
Author(s): Alexander Peralta, Jr., MD
Description: This activity addresses the challenges involved in providing compassionate palliative care while relieving symptoms, including the management of pain in patients with advanced disease. The guidelines developed by the National Consensus Project for Quality Palliative Care are reviewed and the undertreatment of pain is discussed. An examination of the challenges and barriers to effective pain management includes a discussion of various therapeutic options for the primary types of end-of-life pain commonly experienced by patients. The concepts of central sensitization, neuroplasticity and neurogenesis are reviewed. The author emphasizes the need for clinicians to understand the pharmacology of opioids, including the management of poly-opioid therapy and the use of opioids in episodic pain. Access checked December 16, 2011.

National Meeting Highlights from the American Pain Society 2012

Access: http://www.emergingsolutionsinpain.com/index.php?Itemid=304 (top item)
Audience: Physicians, Pharmacists, Physician Assistants, Nurses
Start/End: June 8, 2012 / June 8, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit for physicians and physician assistants; Up to 1.0 ACPE CE credits (0.1 CEUs) for pharmacists; 1.0 contact hour from the California Board of Registered Nursing for nurses
Price: Free
Program Format: Web-based Multimedia
Sponsor: Emerging Solutions in Pain in collaboration with the American Pain Society (supported by educational grants from Purdue Pharma LP, Endo Pharmaceuticals Inc., and others).
Presenter(s): Jeffrey A. Gudin, MD; Charles E. Inturrisi, PhD; Michael Schatman, PhD; Charles E. Argoff, MD; Lynn R. Webster, MD
Description: This educational activity contains the highlights of 5 key sessions presented by 5 pain experts who participated in the 31st Annual Scientific Meeting of the American Pain Society in 2012. The first session discusses the research and development of the Institute of Medicine’s (IOM) initiative known as “Relieving Pain in America — A Blueprint for Transforming Prevention, Care, Education, and Research”. Additional sessions focus on the emerging research in several areas of pain management; discussions include the results of long-term outcome studies in pain management, iatrogenic issues and adverse effects associated with opioid therapy in chronic pain, and ethical considerations related to patient knowledge of the risk-benefit ratio. Presenters stress that pain is an individual experience and encourage practitioners to improve communication with patients to help them become better informed and more active decision-makers. Access checked August 23, 2012.

Best Practices in the Assessment and Management of Chronic Pain

Access (Physicians): http://painclinician.com/education/activity/CPCompendium/
Access (Nurses): http://www.painclinician.com/…/best_practices_assessment_management_chronic_pain_nursing/
Audience: Physicians, Physician Assistants, Nurse Practitioners, Nurses
Start/End: June 5, 2012 / June 5, 2013
Credits: Up to 2.0 AMA PRA Cat. 1 credits for physicians and physician assistants; 2.0 ANCC CE contact hours for nurses
Price: Free
Program Format: Web-based Multimedia (or access the 80-page monograph by clicking on the PDF link below the video presentation)
Sponsor: PAINClinician.com
Author(s): Perry Fine, MD; Patricia Bruckenthal, PhD, APRN-BC, ANP; Susan Cochella, MD, MPH; April Hazard Vallerand, PhD, RN, FAAN; et al.
Description: This educational activity contains 8 easy-to-read chapters, each focusing on one aspect of assessment or treatment of chronic pain, a biopsychosocial condition that can be multi-faceted. Patient assessment topics include the importance of identifying pain mechanisms and the use of evidence-based assessment protocols for common chronic pain disorders like neuropathic pain, osteoarthritis, low back pain, and fibromyalgia.
Several aids are provided as tear-out sheets for printing and use during patient exams. The presenters emphasize the need for multimodal treatment approaches and long-term relationships with patients suffering from chronic pain. Additional discussions include principles for using multidrug therapy to achieve synergistic pain relief with reduced adverse effects and the treatment of comorbid disorders, including the psychological and behavioral components of chronic pain. Access checked July 19, 2012.

Practical Strategies for Improving the Diagnosis and Treatment of Fibromyalgia

Access: http://www.medscape.org/viewprogram/32468 (free registration required)
Audience: Physicians
Start/End: May 24, 2012 / May 24, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (full document can be printed by clicking the “Download PDF” link near the top of the program; file includes all text and graphic components)
Sponsor: Medscape Education, Rheumatology
Author(s): Kirsten R. Ambrose, MS; Lesley M. Arnold, MD; Don L. Goldenberg, MD; Richard H. Gracely, PhD
Description: This 3-part program begins with a review of the signs and symptoms characteristic of fibromyalgia. The section on pathophysiology includes a review of the history of fibromyalgia, the latest findings from brain imaging studies, and the impact of comorbidities. Patient assessment topics include changes in assessment criteria since 2010 and the use of diagnostic screening tools. Evidence-based pharmacologic and nonpharmacologic options are explored; the potential for symptom relief is explained for many of the strategies presented. Access checked June 21, 2012.

Medication Adherence in Patients with Rheumatoid Arthritis: A Critical Appraisal of the Existing Literature

Access: http://www.medscape.org/viewarticle/764055(free registration required)
Audience: Physicians
Start/End: May 21, 2012 / May 21, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (full document can be printed by clicking the “Print” link near the top of the program; print-out includes all graphic components)
Sponsor: Medscape Education, Women’s Health
Author(s): Bart J.F. van den Bemt, PharmD, PhD; Hanneke E. Zwikker, MSc; Cornelia H.M. van den Ende, PhD
Description: The authors of this educational activity state that adherence rates to prescribed drug therapy for people with rheumatoid arthritis vary from 30 to 80%. Program discussions include: 1) factors known to affect adherence rates, 2) the potential for improving treatment efficacy with better adherence, and 3) the increased risk associated with nonadherence. Strategies to improve medication adherence are presented and include a discussion of the need to tailor treatment interventions to patients’ preferences and goals. The complexities and challenges of identifying and measuring adherence are also explored. Access checked June 21, 2012.

Identification and Management of Pain Medication Abuse and Misuse: Current State and Future Directions

Access: http://www.medscape.org/viewarticle/762603 (free registration required)
Audience: Physicians
Start/End: May 1, 2012 / May 1, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph
Sponsor: Medscape Education, Women’s Health
Author(s): Craig Hartrick, MD, FIPP; Robert Gatchel, PhD, ABPP; Sean Conroy, MD, FIPP
Description: This educational activity was developed to assist practitioners with strategies for evaluating complex patient risk factors and identifying potential concerns in patients who require long-term pain management. The authors emphasize that the evaluation of patient opioid misuse should not be based on one single assessment tool. The variations in available screening tools are explored briefly; the Pain Medication Questionnaire (PMQ) is described more thoroughly as a self-report instrument that has been shown to be reliable and consistent in several studies. A brief explanation of the design and monitoring value of the two primary methods of urine drug testing is presented. Access checked June 14, 2012.

Assessment and Management of Chronic Pain in the Older Adult

Access: http://elearning.pharmacist.com/…/assessment-and-management-of-chronic-pain-in-the-older-adult

Audience: Pharmacists
Start/End: May 1, 2010 / May 1, 2013
Credits: 2.0 ACPE contact hours (0.2 CEUs)
Price: Free access to article; testing is free to APA members, $15 for nonmembers
Program Format: Review article
Sponsor: American Pharmacists Association
Author(s): James W. Cooper, BPharm, PhD; Allison H. Burfield, RN, PhD
Description: This educational activity begins with a discussion of the causes of chronic pain in the older adult, including common comorbidities, and continues with a review of assessment techniques in the cognitively intact and impaired elder. The latest American Geriatrics Society guidelines are used as an outline for the selection of appropriate pharmacologic treatments — including agent and dosing schedule — for chronic pain older adults. The authors evaluate issues of risk and adverse drug reactions as well as inappropriate drugs and drug combinations of concern for older patients. Access checked July 9, 2010.

Pain Management in the Rheumatology Setting: Individualized Multimodal Therapies for Improved Patient Function

Access: http://www.medscape.org/viewprogram/32328
Audience: Physicians
Start/End: March 7, 2012 / March 7, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Web-based multimedia
Sponsor: Medscape Education, Women’s Health
Author(s): Charles Argoff, MD; Philip Mease, MD; Chaim Putterman, MD; Ronald Rapoport, MD, FACR
Description: This program begins with a review of the pathophysiologic mechanisms of pain and utilizes graphics to enhance the understanding of more complex concepts. The discussion of pain phenotypes includes recently acquired knowledge on the significance of genetic background, environmental factors, neurohormonal influences, and neuroplasticity. The presenters stress the fact that pain is frequently under-recognized and undertreated in patients with rheumatoid arthritis and provide a detailed discussion on the wide-ranging effects of chronic progressive pain. A case study and a review of recent trial outcomes enhance this learning activity. Access checked March 27, 2012.

Management of Noncardiac Chest Pain in Women

Access: http://www.medscape.org/viewarticle/759089
Audience: Physicians
Start/End: March 1, 2012 / March 1, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (full document can be printed by clicking the “Print” link near the top of the program; print-out includes all graphic components)
Sponsor: Medscape Education, Women’s Health
Author(s): Raghubinder Gill, Jo Collins, Nicolas Talley, MD, PhD
Description: Noncardiac chest pain (NCCP) in women is common, but diagnosis can be challenging because the origins of the pain may have a musculoskeletal, pulmonary, gastroenterological, neurological, or psychosomatic basis. The authors review the differential diagnosis of NCCP as well as statistics on the incidence of cardiac artery disease and several other causes of chest pain in women. After a discussion regarding the need for a full evaluation for coronary artery disease, an algorithm provides an approach to further evaluation of the patient with unexplained chest pain. In light of the fact that gastroesophageal reflux disease (GERD) is a common cause of NCCP, a review of pharmacologic and nonpharmacologic treatments is provided. Appropriate management and studies reporting efficacy of therapeutic options for nonreflux-associated NCCP are also presented. Access checked March 22, 2012.

Opioid-Based Treatment Strategies for Persistent and Breakthrough Cancer Pain

Access: http://painclinician.com/education/activity/tailoring_opioid_based_therapy…cancer_pain_physicians/
Audience: Physicians, Pharmacists, Nurses
Start/End: February 29, 2012 / February 28, 2013
Credits: Up to 2.0 AMA PRA Cat. 1 credits; 2.0 ACPE credits (0.2 CEU) for pharmacists; 2.0 contact hours approved by the Oncology Nursing Society for nurses
Price: Free
Program Format: Monograph (PDF option in lower left corner of HTML monograph)
Sponsor: PAINClinician.com
Author(s): Sanjiv S. Agarwala, MD; Keith D. Eaton, MD, PhD; Paul Glare, MD; Jeffrey A. Gudin, MD; et al.
Description: This 4-part educational activity addresses the complexities of evaluating and treating patients with persistent and breakthrough cancer pain. The presenters discuss assessment, differential diagnosis, and patient-specific treatment of breakthrough pain. Tailor-made opioid treatment strategies are based on pathophysiology and patient response—including pain episodes, predictability, the patient’s baseline opioid regimen, and an individualized risk-benefit evaluation. The monograph and video commentary sections review all aspects of opioid therapy, including pharmacology, routes of administration, formulations, and opioid rotation strategies. The PDF version includes tear-out pages containing pain assessment tools, an opioid risk tool, and a list of opioid analgesic agents. Access checked May 16, 2012.

Pain Report #12 – Optimizing Chronic Pain Management in Elderly Persons: Integrating Pharmacokinetics & Pharmacodynamics

Access: http://cme.dannemiller.com/sections/professional/cme_article/accreditation.cfm?id=309

(free registration required)

Audience: Physicians, Pharmacists, Nurse Practitioners, Nurses
Start/End: March 2010 / February 28, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit; 1.0 ACPE CE credit (0.1 CEUs) for pharmacists; 1.0 AANP contact hours (0.6 hour in pharmacology) for nurse practitioners; 1.2 contact hours from the California Board of Registered Nursing
Price: Free
Program Format: Monograph
Sponsor: Pain.com; supported by an educational grant from Purdue Pharma, L.P.
Author(s): Bernard M. Abrams, MD; John Kriak, PharmD
Description: This activity focuses on analgesic therapy in the rapidly growing population of senior adults. In addition to the challenges of pain assessment in some elderly patients, effective treatment due to altered pharmacokinetics can be a test of prescriber skills. The article reviews physiological changes in the older adult and includes a helpful summary table of common, relevant age-related changes. Practitioners are cautioned to perform a full health assessment and not treat patients primarily according to chronological age because overall health status varies greatly in this population. Two additional tables aid the selection of the most appropriate pharmacological agent according to etiology, physiology, and patient-specific areas of vulnerability. The authors compare and contrast different types of pain relief drugs and include information on the mechanisms of action, adverse effects, dosing recommendations, and special considerations. Access checked March 4, 2010.

Prevalence, Clinical Features, and Potential Therapies for Fibromyalgia in Primary Headaches: Possible Causes of Comorbidity Between Fibromyalgia & Primary Headaches

Access: http://www.medscape.org/viewarticle/758915
Audience: Physicians
Start/End: February 24, 2012 / February 24, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (Full document can be printed by clicking the “Print” link near the top of the program; print-out includes all graphic components)
Sponsor: Medscape Education, Women’s Health
Author(s): Marina de Tommaso, MD
Description: Comorbid fibromyalgia and chronic headache—primarily migraine and tension-type headaches—are not uncommon and the author begins with a discussion of the potential causes. While the etiology of fibromyalgia remains unknown, this monograph offers a review of the relationship of central sensitization in fibromyalgia and in migraine, as well as other potential pathophysiological relationships and commonalities. Discussions include variations in the clinical characteristics commonly presented by headache patients with fibromyalgia. Pharmacological and nonpharmacological treatment approaches reported in available primary study results for headache and fibromyalgia are reviewed. The authors state that most studies have not reported significant benefits for one treatment in both pain conditions and, therefore, encourage further studies. Access checked March 12, 2012.

Chronic Pain in Primary Care: Focus on Low Back Pain

Access: http://painclinician.com/education/activity/chronic_pain_in_primary_care_focus_on_low_back_pain/
Audience: Physicians
Start/End: February 21, 2012 / February 20, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit
Price: Free
Program Format: Monograph (PDF option in lower left corner of HTML monograph)
Sponsor: PAINClinician.com
Author(s): David Simpson, MD, FRCP, FAAN; Cynthia Koh-Knox, PharmD, RPh
Description: Chronic low back pain can be clinically complex and is a prevalent disorder causing patient suffering and lost productivity. This educational activity reviews the pathophysiologic processes of chronic pain and the need to assess the potential “red flags” of serious spinal pathology. The discussion on evaluation includes the value of testing and physical maneuvers to help identify the origin of patient symptoms. Emphasis is on patient awareness regarding the development of realistic goals for treatment, including consideration of biopsychosocial elements. The discussion on individualized multimodal therapy includes prior medical history, comorbidities, level of function, and the potential for drug adverse effects. Graphic elements and tables enhance the program. Access checked April 26, 2012.

A Review of the Evaluation of Pain Using a Variety of Pain Scales

Access: http://cme.dannemiller.com/sections/professional/cme_article/accreditation.cfm?id=318

(free registration required)

Audience: Physicians, Nurses
Start/End: January 2011 / January 31, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit for physicians; 1.2 contact hours from the California Board of Registered Nursing
Price: Free access to article; the testing fee is between $4 and $5.
Program Format: Monograph
Sponsor: Dannemiller Education Center
Author(s): Michael L. Whitworth, MD
Description: This monograph provides a wide range of assessment tools and techniques for evaluating and treating patients with multifactorial and challenging pain. The author reviews cultural, environmental, and physical conditions that can affect pain or its perception. Additionally, other factors can alter a patient’s ability to communicate verbally — such as sedation or ventilation, cognitive levels, or emotional state —leading to an underestimation of pain. Defining pain can be difficult for patients, so clinicians need to be able to help them effectively describe intensity, location, and pain character. Several less commonly used assessment scales are provided, including the Hochman scale which uses function or behavior as a way to assess pain, and the Comparative Pain Scale of the International Pudendal Neuropathy Association. Access checked December 16, 2011.

Persistent and Breakthrough Cancer Pain: An Expert Video Roundtable

Access: http://painclinician.com/education/activity/persistent_and_breakthrough_cancer_pain/
Audience: Physicians, Physician Assistants, Nurses
Start/End: January 25, 2012 / January 25, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit; other healthcare professionals should inquire about credit
Price: Free
Program Format: Web-based multimedia
Sponsor: PAINClinician.com
Author(s): Neal Slatkin, MD; Barbara Murphy, MD; Sharon Weinstein, MD; David Kaufman, MD
Description: Pain affects the quality of life for a high percentage of patients with advanced cancer and those receiving cancer treatment. Controlling persistent pain requires a structured course of opioid therapy plus periodic assessment — on psychosocial, disability, and functional levels — so that clinicians can select appropriate agents for breakthrough pain. This program includes a discussion of pain assessment and the differences in defining “functionality” from one patient to another. A review of the variations in cancer breakthrough pain versus other types of pain includes a definition of the subtypes of cancer breakthrough pain (eg, incident, spontaneous unpredictable, and end of dose failure) as well as an algorithm for ‘Multidimensional Pain Assessment for Improved Outcomes.’ Access checked February 29, 2012.

New Approaches in the Treatment of Rheumatoid Arthritis: Treating to Target

Access: http://www.medscape.org/viewarticle/756397
Audience: Physicians
Start/End: January 10, 2012 / January 10, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (Full document can be printed by clicking the “Print” link near the top of the program; print-out includes all graphic components)
Sponsor: Medscape Education, Women’s Health
Author(s): Roy M. Fleischmann, MD
Description: Approaches to the treatment of rheumatoid arthritis (RA) have become more complex in recent years. The author discusses important considerations in therapeutic decision-making and evaluates the appropriate choice of oral disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents for a patient with progressive RA. Discussions include: 1) the use of disease activity tools to evaluate a patient’s response to treatment, 2) the goal of minimizing complications, and 3) an examination of the definitions of disease remission and treatment failure. Published evidence on strategies for switching drugs when patients do not respond to anti-TNF agents is reviewed. Access checked January 31, 2012.

Clinical Year in Review 2011: Emerging Strategies to Achieve RA Treatment Success

Access: http://www.medscape.org/viewarticle/756083
Audience: Physicians
Start/End: January 09, 2012 / January 09, 2013
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Web-based multimedia
Sponsor: Medscape Education, Women’s Health
Author(s): Roy M. Fleischmann, MD; Arthur F. Kavanaugh, MD
Description: This program presents a discussion between two leading rheumatologists on the most recent evidence for effective rheumatoid arthritis (RA) treatment strategies from the year 2011. The discussion stresses the importance of continual assessment and the use of treat-to-target strategies. The presenters review the design and results of the OPTIMA study and an older longer-term trial, the PREMIER study, with an emphasis on variations in the timing of initial therapy and outcomes of the two studies regarding patient response in physical functionality and remission. Additional information includes comparisons of new drugs in development with older agents, plus considerations of drug safety and patient out-of-pocket costs for RA treatment. Access checked January 31, 2012.

Chronic Pain: Evidence for Multimodal Management (2-Part Program)

Access Programs:
Part 1 of 2 – Chronic Pain: Best Practices in Interdisciplinary Multimodal Management
http://painclinician.com/education/activity/…interdisciplinary_multimodal_management

Part 2 of 2 – Implementing Effective Collaborative Care in Patients with Complex Chronic Pain Conditions
http://painclinician.com/education/activity/…patients_with_complex_chronic_pain_conditions/
Audience: Physicians
Start/End: December 6, 2011 / December 6, 2012
Credits: Up to 1.0 AMA PRA Cat. 1 credit for Part 1; up to 0.75 AMA PRA Cat. 1 credit for Part 2
Price: Free
Program Format: Web-based multimedia
Sponsor: PAINClinician.com
Author(s): Charles E. Argoff, MD; Michael J. Brennan, MD; Paul P. Doghramji, MD; Mark S. Wallace, MD; Douglas C. Schottenstein, MD; Deanna M. Janora, MD
Description: This educational activity was designed for physicians practicing in all areas of pain management and is comprised of 2 parts that can be completed independently of each other for credit. In part 1, the authors review the mechanisms of pain, then present techniques for the multi-dimensional patient assessment of chronic pain and, finally, examine the options for multimodal treatment. Part 2 uses case studies to focus on the use of drug treatments based on patient-specific pathophysiologic pain mechanisms as well as the patient’s functional and psychosocial needs. The authors incorporate a discussion of the need to integrate the use of nonpharmacologic therapies that address the biopsychosocial issues that contribute to the severity, chronicity, intensity, and functional issues for each patient. Access checked January 11, 2012.

Chronic Pain: Translating Evidence into Treatment Strategies (2-Part Program)

Access Programs:
Part 1 of 2 – Translating Population-Based Clinical Studies into Patient-Specific Treatment Strategies http://painclinician.com/education/activity/interaction/part_1_of_2…clinical_studies/

Part 2 of 2 – Translating Evidence to the Clinic: Assessing and Treating Chronic Neuropathic Pain
http://painclinician.com/education/activity/part_2_of_2_chronic_pain_translating_evidence_to_the_clinic/

Audience: Physicians
Start/End: November 8, 2011 / November 8, 2012
Credits: Up to 1.0 AMA PRA Cat. 1 credit for Part 1; up to 0.5 AMA PRA Cat. 1 credit for Part 2
Price: Free
Program Format: Web-based multimedia
Sponsor: PAINClinician.com
Author(s): Jeffrey Gudin, MD; Steven Stanos, DO; Penny Tenzer, MD, FAAFP; David M. Kaufman, MD
Description: This educational activity, designed for primary care physicians, is comprised of 2 parts that can be completed independently of each other for credit. In Part 1, the authors review the mechanisms of pain, including inflammatory, neuropathic, and dysfunctional pain. Additional instruction focuses on the pathophysiology of spinal pain and a video component demonstrates physical testing techniques on a patient with low back pain as part of a comprehensive chronic pain assessment. Part 2 presents a patient case study to explore evidence for the appropriate treatment of chronic neuropathic pain. Discussions on pharmacotherapeutic options include the safe use of over-the-counter analgesics and the consideration of specific patient needs, including comorbidities, functional needs, and overall personal treatment goals. Access checked January 11, 2012.

Osteoarthritis: From Biomarkers to Strategies for Pain Management

Access: http://www.medscape.org/viewarticle/750179
Audience: Physicians
Start/End: October 17, 2011 / October 17, 2012
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (Full document can be printed by clicking the “Print This” link near the top of the program; print-out includes all graphic components)
Sponsor: Medscape Education, Women’s Health; supported by an educational grant from Endo Pharmaceuticals
Author(s): F. Michael Gloth III, MD; Virginia Byers Kraus, MD; Marc C. Hochberg, MD
Description: This monograph, developed for a March 2011 symposium of the same name, presents the most recent advances in our scientific understanding of the complex etiology of osteoarthritis (OA). Greater knowledge of the structural and inflammatory changes within the joint has provided more specific insight into the changes that cause the pain and functional limitation experienced by the patient. Discussions include the application of OA biomarkers as well as the risks and benefits of using opioids to manage arthritis pain. The authors provide a list of evaluation questions to assess the appropriate use of opioids as it relates to the patient and the medical practice. Access checked November 2, 2011.

Safety of Biologic Therapy in Rheumatoid Arthritis

Access: http://www.medscape.org/viewarticle/750810
Audience: Physicians
Start/End: October 11, 2011 / October 11, 2012
Credits: Up to 1.0 AMA PRA Cat. 1 credit hour
Price: Free
Program Format: Monograph (Full document can be printed by clicking the “Print This” link near the top of the program; print-out includes all graphic components)
Sponsor: Medscape Education, Women’s Health; Nature Reviews Rheumatology
Author(s): Robert S. Woodrick, MD; Eric M. Ruderman, MD
Description: This monograph presents a summary of information collected from post-marketing studies reporting toxicity and safety concerns with the use of biologic agents in patients treated for rheumatic diseases. The authors review one of the most important risks associated with biologic therapies — an increased incidence of atypical, sometimes serious, viral and bacterial infections. Recent data on earlier concerns over the increased risk of malignancies is also reviewed. Data on the incidence of unique adverse conditions that relate to specific biologic agents are discussed; including cardiovascular disease, hyperlipidemia, cytopenias, gastrointestinal perforations, demyelinating conditions, and changes in liver function. This information can assist the clinician in patient risk evaluation and long-term follow-up for patients on biologic therapies. Access checked November 21, 2011.

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Expired Courses, Still Accessible

Online education courses of interest often are accessible beyond their expiration dates; however, credits may not be available. Courses are listed in chronological order of their end (expiration) dates; recently expired courses are listed toward the top and those with the oldest expiration date are toward the bottom.

Pain Management: The American Medical Association Online Series

Access: http://www.ama-cmeonline.com/pain_mgmt/ [LINK TEMPORARILY DISABLED by AMA]
Audience: Physicians
Start/End: September 2007 / March 2012 RECERTIFICATION EXPECTED LATER in 2012
Credits: Up to 1.0 AMA PRA Cat. 1 credit per module
Price: Free
Program Format: 12 individual monographs
Sponsor: American Medical Association (supported by a grant from Purdue Pharma L.P.)
Description: This comprehensive 12-module program on pain management offers an opportunity to choose individual modules of interest. Topics covered include pathophysiology, overall pain management options, barriers to treatment, substance abuse concerns, treating elderly and pediatric patients, treating persistent nonmalignant pain, neuropathic pain, and 3 modules on the assessment and treatment of cancer pain. Access checked May 22, 2010.

Mechanisms & Neuroplasticity of Pain: Clinical Implications

Access: http://cme.medscape.com/viewprogram/31339 (free Medscape registration required)
Audience: Physicians
Start/End: August 10, 2010 / EXPIRED
Credits: Up to 1.25 AMA PRA Cat. 1 credit
Price: Free
Program Format: 6-part Web-based Multimedia (all parts required for course credit)
Sponsor: MedscapeCME
Author(s): Lynn Webster, MD; Charles Argoff, MD; Sean Mackey, MD; Bruce Nicholson, MD
Description: Note: this program includes neurobiological discussions that are advanced and still somewhat theoretical. The program consists of symposia lectures by pain experts who presented at the annual meetings of the American Academy of Pain Medicine and the American Pain Society in February 2010 and May 2010, respectively. Chronic pain and opioid therapy guidelines are reviewed and interdisciplinary treatment approaches are discussed. The experts present recent research that supports developing theories showing correlations between unresolved acute pain attacks and chronic pain, along with influences of neuroplasticity [the ability of all areas of the nervous system to reorganize by forming new neural connections as a result of experiences or new situations]. Gold standard treatments and emerging agents are examined in the context of changing levels of knowledge on the neurobiological mechanisms of chronic pain. Access checked August 31, 2010.

What Do I Need to Know About Gout?

Access: http://www.jfponline.com/supplements.asp?id=8724
Audience: Physicians
Start/End: June 1, 2010 / EXPIRED
Credits: Up to 1.0 AMA PRA Cat. 1 credit
Price: Free
Program Format: Journal article
Sponsor: Journal of Family Practice
Author(s): Michael A. Becker, MD; Gary E. Ruoff, MD
Description: This educational activity focuses on the diagnosis and treatment of gout in patients visiting primary care practitioners. Course content includes a discussion of comorbidities that contribute to the exacerbation of acute gout flares. Treatment approaches for pain relief in acute gout attacks and chronic gout are reviewed in detail. Data are presented regarding the type of patients who have been shown to benefit from urate-lowering medications like allopurinol, probenecid, and febuxostat. Case study examples and a patient care plan enhance this learning experience. Access checked May 28, 2011.

Pharmacist’s Role in the Appropriate Selection of a Nonprescription Product for Pain Relief

Access: http://www.uspharmacist.com/continuing_education/ceviewtest/lessonid/105845/

Audience: Pharmacists; Pharmacist Technicians
Start/End: September 1, 2008 / EXPIRED
Credits: 2.0 ACPE credit hours (0.20 CEUs)
Price: Free; registration is required for CE testing and credit
Program Format: Monograph
Sponsor: U.S. Pharmacist (Professional journal)
Author(s): W. Steven Pray, PhD, DPh
Description: Counseling opportunities are common in pharmacy practice and, as a member of a multi-disciplinary pain management team, it is important to be aware of nonprescription analgesic products that are currently available. Over-the-counter drugs and devices, including external analgesics, cryotherapy, and thermotherapy products, are discussed in terms of patient selection and guidelines for use. Techniques are recommended for assisting patients in weighing the pros and cons of products before purchase. Access checked June 23, 2009.

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