How2Torial™ - Screening Scales, Pain Questionnaires, and Multidimensional Tools: Facilitating the Assessment and Treatment of Chronic Pain
- Credit Type
- CME
- Credit Amount
- 0.5
- Release Date
- 05/04/2011
- Expiration Date
- 05/04/2012
- Activity Type
- Videocast
This CME activity is jointly sponsored by the University of Michigan Medical School and
Asante Communications, LLC.
Supported by an educational grant from Lilly USA, LLC.
Intended Audiences
This activity is intended for primary care physicians and other health professionals who treat patients with chronic pain.
Learning Objectives
At the completion of this activity, participants should be better prepared to:
- Determine the self-reported intensity of pain
- Characterize the adverse effects of pain on patient function, affect, workplace productivity, and interpersonal relations
- Establish realistic expectations and treatment goals based in part on validated metrics
- Measure the response to behavioral and pharmacologic treatment modalities
Statement of Need and Learner’s Gap
An estimated 1 in 3 (38%) patients presenting to primary care physicians (PCPs) have chronic pain.(Smith, Elliott et al. 2004) The experience is unpleasant both emotionally and physically and can have profound effects on affect, mood, and physical functioning.(Gatchel, Peng et al. 2007; Ossipov, Dussor et al. 2010) Moreover, the sensory component of chronic pain is heterogeneous, each carrying different implications for treatment strategies. Woolf describes four different pain classes: nociceptive, evoked by potentially damaging stimuli; inflammatory, evoked by activation of the inflammatory response by tissue injury or infection; neuropathic, pain associated with a neural lesion; and dysfunctional (also called noninflammatory, non-neuropathic), pain resulting from abnormal functioning of the nervous system in the absence of a lesion.(Woolf 2010) The coexistence of different pain classes within the same patient (mixed pain states) adds an additional level of complexity.(Baron and Binder 2004) Thus, to fully characterize the multiple dimensions involved, a comprehensive assessment of the patient who presents with chronic pain is necessary, including a detailed physical exam and history and a discussion with the patient of related functional impairment, along with laboratory, neurologic, or imaging tests, as needed. A number of unidimensional and multidimensional pain assessment tools are available, but their practical application is guided less by robust evidence than by clinical experience.(Bennett, Attal et al. 2007; Krebs, Lorenz et al. 2009) PCPs are also increasingly faced with the daunting challenge of balancing overloaded schedules with the time required to fully manage disorders as heterogeneous and difficult to quantify as chronic pain. Accordingly, a best practices discussion that summarizes practical strategies for tightly focused, effective assessment of patients with chronic pain (one that leaves both stakeholders satisfied) would be a valuable resource for this clinician audience.
References
- Baron, R. and A. Binder (2004). "[How neuropathic is sciatica? The mixed pain concept]." Orthopade 33(5): 568-75.
- Bennett, M. I., N. Attal, et al. (2007). "Using screening tools to identify neuropathic pain." Pain 127(3): 199-203.
- Breuer, B., R. Cruciani, et al. (2010). "Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: a national survey." South Med J 103(8): 738-47.
- Gatchel, R. J., Y. B. Peng, et al. (2007). "The biopsychosocial approach to chronic pain: scientific advances and future directions." Psychol Bull 133(4): 581-624.
- Krebs, E. E., K. A. Lorenz, et al. (2009). "Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference." J Gen Intern Med 24(6): 733-8.
- Matthias, M. S., M. J. Bair, et al. (2010). "Self-management support and communication from nurse care managers compared with primary care physicians: a focus group study of patients with chronic musculoskeletal pain." Pain Manag Nurs 11(1): 26-34.
- Ossipov, M. H., G. O. Dussor, et al. (2010). "Central modulation of pain." J Clin Invest 120(11): 3779-87.
- Smith, B. H., A. M. Elliott, et al. (2004). "Is chronic pain a distinct diagnosis in primary care? Evidence arising from the Royal College of General Practitioners' Oral Contraception study." Fam Pract 21(1): 66-74.
- Upshur, C. C., G. Bacigalupe, et al. (2010). ""They don't want anything to do with you": patient views of primary care management of chronic pain." Pain Med 11(12): 1791-8.
- Woolf, C. J. (2010). "What is this thing called pain?" J Clin Invest 120(11): 3742-4.
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 the University of Michigan Medical School and Asante Communications, LLC. The University of Michigan is accredited by the ACCME to provide continuing medical education to physicians.
Credit Designation
The University of Michigan Medical School designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Method of Participation
There are no prerequisites for this educational activity. To receive credit for this activity, you must read the CME information (including learning objectives and disclosures) and view the videos. You must complete the pre- and post- questionnaires and evaluation form, and receive at least 70% on the posttest. You will be permitted one retake of the exam. After successful completion of the posttest, you will be asked to fill out a program evaluation form and prompted to print your CME certificate. Please be ready to print your certificate at this time.
Conflict of Interest Statement
The University of Michigan Office of CME (UM OCME) requires instructors, planners, managers, and other individuals who are in a position to control the content of CME activities to disclose any conflict of interest. All relevant conflicts of interest that are identified are thoroughly vetted by UM OCME for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. UM OCME is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty/Planning Committee Disclosures
Paul P. Doghramji, MD
AstraZeneca US (consultant, speaker’s bureau); Cephalon, Inc (consultant, speaker’s bureau); MAP Pharmaceuticals, Inc (advisory board); Pfizer Inc (advisory board, consultant, speaker’s bureau); Sanofi-Aventis U.S. LLC (advisory board); URL Pharma, Inc (advisory board).
Douglas C. Schottenstein, MD
Endo Pharmaceuticals (speaker’s bureau); Pfizer Inc (speaker’s bureau); Takeda Pharmaceuticals North America, Inc. (speaker’s bureau).
Daniel Clauw, MD
Cypress Bioscience, Inc. (consultant); Forest Laboratories Inc, (consultant); Jazz Pharmaceuticals, Inc. (consultant); Laboratories Pierre Fabre SA, (consultant); Lilly USA (consultant, grant/research support); Merck & Co., Inc. (consultant); Pfizer Inc (consultant, grant/research support); UCB SA (consultant).
Disclaimer
The opinions, ideas, recommendations, and perspectives expressed in this program and accompanying materials are those of the program authors and presenting faculty only and should not be construed as including all proper methods of care or excluding other acceptable methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific clinical procedure or treatment must be made by the physician in light of the circumstances presented by the patient. The opinions, ideas, recommendations, and perspectives of the authors and faculty do not necessarily reflect those of their affiliated institutions, University of Michigan Medical School, Asante Communications, or the program's commercial supporters.
Copyright Information
Copyright © 2011 University of Michigan Medical School and Asante Communications, LLC. All rights reserved.
No part of this activity may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations.
Faculty
