Chronic Pain in Cancer Survivors: Determinants, Assessment, and Treatment Strategies
- Credit Type
- CME
- Credit Amount
- 1
- Release Date
- 03/31/2010
- Expiration Date
- 03/31/2011
- Activity Type
- Webcast
Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications
This activity is supported by an educational grant from Cephalon, Inc.
Activity Goal
The goal of this activity is to disseminate best practices in the assessment, diagnosis, and opioid-based multimodal treatment of cancer survivors with persistent and breakthrough pain. This enduring Web-based program seeks to provide practical strategies to address pain management challenges in the growing population of cancer survivors.
Intended Audience
This activity is intended for pain specialists, neurologists, rheumatologists, physical medicine and rehabilitation specialists, family practitioners, oncologists, and internal medicine practitioners.
There are no prerequisites for this educational activity.
Statement of Need
Diagnostic and therapeutic advances have led to increased life expectancy and survival rates for many cancer patients. The growing population of cancer survivors was recently estimated to number more than 10.8 million people. This cohort can present continuing challenges for health care providers.1,2 Many of these patients in the extended or permanent phases of cancer survivorship experience chronic pain resulting from residual tissue damage related to disease and/or chemotherapeutic, radiologic, or surgical treatment.1 Diagnosis and management of chronic pain are difficult in cancer survivors, who often present with myalgic or neuropathic pain together with a range of associated medical and psychosocial issues.1,3,4 Therefore, as with other patients with chronic pain, comprehensive, continual assessment and multimodal treatment are essential to address the deleterious effects of pain on multiple functional dimensions, including affective, cognitive, physical, and work-related.5 Further, because daily fluctuations in pain levels are common, health care practitioners need to optimize therapy for persistent baseline pain while independently assessing and treating breakthrough pain. For each patient, clinicians should consider the potential benefits and risks of all available treatment modalities, including behavioral, pharmacologic, and interventional approaches.6-9 Opioids have long been considered the cornerstone of cancer pain treatment, and clinical experience and a growing evidence base suggest that these agents are an important analgesic option in appropriately selected patients with functionally impairing persistent and breakthrough noncancer pain.1,4,10 As a bridge between these patient populations, cancer survivors highlight the need for structured approaches to multidimensional assessment and opioid-based treatment, regardless of the pain diagnosis. Thus, selection of patients for opioid-based multimodal analgesic strategies necessitates careful consideration of potential etiologies, patient-specific treatment goals, risks related to opioid pharmacology, and the ability of the prescriber to structure therapy accordingly and monitor adherence to the pain management plan.11
Learner’s Gap
Chronic pain in cancer survivors is prevalent, underdiagnosed, often misdiagnosed, and undertreated.1,4,12 Evidence-based lectures and case-driven discussions about chronic pain in this growing population, supported by expert clinical experience, enable clinicians to better manage pain and improve outcomes for patients in extended and permanent cancer remission.
Learning Objectives
At the completion of this initiative, participants should be better prepared to:
- Select appropriate patients for opioid-based management of cancer- or treatment-related persistent and breakthrough pain
- Employ multimodal opioid-based therapies tailored to the multidimensional pain assessment of patients with persistent and breakthrough pain
- Explain the respective roles of long-acting, short-acting, and rapid-onset opioids in the management of persistent and breakthrough pain
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
Albert Einstein College of Medicine designates this educational activity for a maximum of
1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Conflict of Interest Statement
The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenter whose disclosed relationships
prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present.
Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.
Faculty of this activity have indicated the following disclosure information:
Michael J. Brennan, MD
Cephalon, Inc.; Eli Lilly and Company (speaker bureau); Endo Pharmaceuticals; King Pharmaceuticals, Inc.; Pfizer Inc; Purdue Pharma L.P. (consultant, speaker bureau)
David M. Kaufman, MD CCME Reviewer
Dr Kaufman has no conflict of interest to report.
Albert Einstein College of Medicine, CCME staff, and the staff of Asante Communications
have no conflicts of interest with commercial interests related directly or indirectly to this educational activity.
James Kappler, PhD, of Asante Communications, LLC, has no conflicts of interest with commercial interests related directly or indirectly to this educational activity.
Steven Jay Feld, of Albert Einstein College of Medicine, or a member of his household own securities in Bioheart, Inc., Chelsea Therapeutics, Inc., and Pharmacopeia, Inc.
Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period of October 20, 2009 to October 20, 2010, participants must (1) read the learning objectives and disclosure statements, (2) participate in the educational activity, (3) complete the post-test with a score of 70% or higher, (4) complete the activity evaluation form, and (5) complete the request for credit paperwork. Please refer to documents/instructions at the end of this activity for instructions on returning CME paperwork.
Copyright Information
Copyright © 2009 Albert Einstein College of Medicine and Montefiore Medical Center, and
Asante Communications. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.
References
- Levy MH, et al. Management of chronic pain in cancer survivors. Cancer J. 2008;14(6):401-409.
- Ries et al. SEER cancer statistics review, 1975-2000. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/csr/1975_2005. Based on November 2007 SEER data submission, posted to the SEER Web site, 2008.
- American Pain Society. Pain: Current understanding of assessment, management and treatments section I: background and significance. http://www.ampainsoc.org/ce/enduring.htm. Accessed March 2009.
- Burton, et al. Chronic pain in the cancer survivor: a new frontier. Pain Med. 2007;8(2):189-198.
- Gatchel RJ, et al. The biopsychosocial approach to chronic pain: scientific advances and future directions.Psychol Bull. 2007;133(4):581-624.
- Pergolizzi J, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone,morphine, oxycodone). Pain Pract. 2008;8(4):287-313
- De Leon-Casasola OA. Current developments in opioid therapy for management of cancer pain. Clin J Pain.2008;24(suppl 10):S3-S7.
- Soares LG, Chan VW. The rationale for a multimodal approach in the management of breakthrough cancer pain: a review. Am J Hosp Palliat Care. 2007;24(5):430-439.
- Jensen TS, et al. New perspectives on the management of diabetic peripheral neuropathic pain. Diab Vasc Dis Res. 2006;3(2):108-119.
- Fishbain DA. Pharmacotherapeutic management of breakthrough pain in patients with chronic persistent pain.Am J Manag Care. 2008:14(5 suppl 1):S123-S128.
- Portenoy RK. Appropriate use of opioids for persistent non-cancer pain. Lancet. 2004;364(9436):739-740.
- Walid MS, et al. The fifth vital sign—what does it mean? Pain Pract. 2008;8(6):417-422.
Faculty
