Beyond the Evidence Base in Opioid Therapy
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This educational activity is intended to review best practice in the use of opioid analgesics to treat chronic pain.
Pain specialists, anesthesiologists, physiatrists, neurologists, palliative care specialists, primary care physicians, nurse practitioners, pharmacists, allied health professionals, fellows, and residents.
Needs Assessment and Learner’s Gap
Chronic pain is an enormous public health problem, affecting an estimated 1 in 5 patients.1 Reflecting its complex biopsychosocial etiology, chronic pain requires carefully focused multimodal therapy comprising pharmacologic and nonpharmacologic components. Opioid analgesics are highly effective pharmacologic options, and their use has increased dramatically in recent years, driven in part by a lack of other potent analgesics. For example, from 1997 to 2005 the incidence of long-term opioid use increased by 16% to 87% across patient subgroups.2 A parallel trend, however, has been the rise in opioid misuse, abuse, and diversion, highlighting the need for careful patient screening and counseling.3 Guidelines on opioid analgesic therapy are available but numerous gaps in the evidence base exist, particularly regarding comparative effectiveness and risks during long-term treatment.4 The following key questions can provide insight into whether to proceed with a trial of opioid therapy: What is conventional practice? Are there other therapies with an equal or better therapeutic index? What is the risk of adverse drug effects? What is the risk of aberrant drug behaviors? Finally, clinicians should monitor multiple functional and clinical outcomes, adjusting therapy as needed; it is acceptable to discontinue opioid therapy at any time if there is no convincing benefit despite efforts to optimize therapy.
- Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization study in primary care. JAMA.1998;280:147-151.
- Campbell CI, Weisner C, LeResche L, et al. Age and gender trends in long-term opioid analgesic use for noncancer pain. Am J Public Health. 2010;100:2541-2547.
- Compton WM, Volkow ND. Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend. 2006;83:S4-S7.
- Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-130.
At the conclusion of this presentation, you will be able to:
- Describe the prevalence of chronic pain.
- Apply evidence-based strategies for responsible opioid therapy to patients with chronic pain.
- Formulate an analgesic regimen based on current standards of care, efficacy and risks of available options, and patient risk of nonmedical opioid use.
Russell K. Portenoy, MD, has served as a consultant for Afferent Pharmaceuticals, Inc., Ameritox, Cephalon, Inc., CNSBio, Grupo Ferrer, King Pharmaceuticals, NicOx, ProStrakan, Inc., Purdue Pharma, Shire plc, Solvay, Wyeth, and Xenon Pharmaceuticals; he has received research grants (to the Department of Pain Medicine and Palliative Care) from Archimedes Pharma Ltd., Baxter Healthcare Corporation, Calloway Labs, Cephalon, Inc., Endo Pharmaceuticals, Flamek Corporation, Fralex, GW Pharmaceuticals, King Pharmaceuticals, Pfizer, Inc., Purdue, Tempur-Pedic Corporation, United BioSource Corporation, and Wyeth.
Credit Designation designates this internet point-of-care activity for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no fees for participating in and receiving credit for this activity. Prior to viewing the webcasts, each participant must read the learning objectives and acknowledge receipt of the CME information. Additionally, each participant must also complete a prequestionnaire before beginning the activity. Upon completion of this prequestionnaire, the activity will commence. Once the final webcast is viewed, credit may be obtained by completing the posttest, program evaluation, and the attestation statement. Credit is available through July 7, 2012.
As herein stated, the term "Continuum Affiliates" means Beth Israel Medical Center, St. Luke's-Roosevelt Hospital Center, Long Island College Hospital, and the New York Eye & Ear Infirmary. Continuum Health Partners, Inc. is the parent company of each of the Continuum Affiliates.
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