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Pain Treatment Challenge

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Price: $0

Chad Wright

Old Knee Injury

0.5 hr(s)CME/CE
Goal: To train providers in distinguishing between undertreated pain and opioid use disorder in patients on chronic opioid therapy and plan best medical management of the chronic pain condition.
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Activity Steps

Activity Content
Post-Assessments
Certificate

This activity is designed to change: Competence, Performance, Patient Outcomes. 0.50 hr(s)

Overview

Professional Practice Gaps

Educational Objectives:

After completing this activity participants will be able to:

  • Interview a patient to obtain a comprehensive history for chronic pain
  • Assess risk for substance use disorder in a patient on chronic opioid therapy
  • Recognize aberrant drug-related behaviors in patients
  • Modify treatment for patients with chronic pain who have aberrant drug-related behaviors

Training Activity References

Audience: Providers

Type Est. Time Released Expires
AMA PRA Category 1 Credit(s)™ 0.50 hrs 03/25/19 03/25/22

Accreditation Statement: Clinical Tools, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credit™ Designation Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

A letter of completion for 0.50 hour(s) is available for non-physicians.

A score of 70% on the post-test is required to complete the activity.

Participation Requirements

Funding
Initial development of this activity was supported by a grant from the National Institute on Drug Abuse (#1R44DA027245-01).

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.requires everyone who is in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest to the provider. The ACCME defines ‘relevant’ financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Any conflicts of interest are resolved prior to the delivery of the educational activity to the learner. CTI does not permit individuals with financial conflicts of interest to participate in any stage of activity development.

T Bradley Tanner, MD (President, Clinical Tools, Inc.)
Disclosure: Has disclosed no relevant financial relationships. Dr. Tanner is the owner of Clinical Tools.
Read Bio
T. Bradley Tanner, MD is president of Clinical Tools and responsible for the vision of the company. He has received funding via grants and contracts from NIDA, NIAAA, NIMH, NCI, AHRQ, CDC, the Dept of Defense, and NASA to develop medical and health education projects. Dr. Tanner served as principal investigator on 2 NIDA grants to develop the DATA-2000 qualifying buprenorphine training program and clinical practice tools on Bup.ClinicalEncounters.com. He also has a strong background in technology and oversees the development and delivery of all Clinical Tools websites. Dr. Tanner is also a board-certified psychiatrist with experience in inpatient, outpatient, and emergency health settings. He currently treats patients and educates medical students and residents via his role as a Clinical Associate Professor of Psychiatry at the University of North Carolina at Chapel Hill.
Karen Rossie, DDS, PhD (Research Scientist, Clinical Tools, Inc. )
Disclosure: Has disclosed no relevant financial relationships.
Read Bio
Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and the University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.

Reviewers

Steve Applegate, MEd, MEd (President, Applegate Consulting, )
Disclosure: Has disclosed no relevant financial relationships.
Read Bio
Mr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor’s Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology in our products. He helped guide the development of the curriculum plan and assessments in Phase I of the current project.

Most Recent Reviews

CTI Content Review: Friday, 03/08/2019
CTI Editorial Review: Monday, 03/18/2019

Funding Information Development of this website was funded by grant #1R44DA035042 from the National Institute of Drug Abuse. The website contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA. The site is maintained by Clinical Tools, Inc. No commercial support is received.
Clinical Tools is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you work through the case simulation and any associated content, complete the post-test with a 70% score, complete post-surveys, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: You will be required to spend a set amount of time in order to claim credit.

Technical Requirement: Our site requires the latest versions of Google Chrome, Safari, Firefox, or Microsoft Edge. The site is not optimized for Internet Explorer and certain functionality will not work with that browser. Please utilize a supported browser when accessing the site.

Professional Practice Gaps

The incidence of opioid overdose, diversion, and addiction has continued to rise (SAMHSA, 2018; Dowell, 2016), suggesting that physicians are not sufficiently following evidence-based guidelines for prescribing opioids to minimize these risks. The parallel rise of the rate of opioid addiction and the number of opioid prescriptions (SAMHSA, 2013a; SAMHSA, 2013b; ) suggests that physicians had not followed guidelines to limit opioid prescribing. Training physicians in the guidelines for safe opioid prescribing would decrease exposure of patients with chronic pain to unnecessary risks of opioids (Dowell, et al., 2016).

Practice Gap References

CDC. “Understanding the Epidemic | Drug Overdose | CDC Injury Center,” December 19, 2018. https://www.cdc.gov/drugoverdose/epidemic/index.html Accessed 02/13/2019.

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016; ePub: March 2016: DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1er. Available at: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm Accessed 02/13/2019.

SAMHSA. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration. 2013a. Available at: http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf Accessed 02/13/2019.

SAMHSA. National Estimates of Drug-Related Emergency Department Visits. Drug Abuse Warning Network, 2011. 2013b. Available at: http://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf Accessed 02/13/2019.

SAMHSA. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration., September 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/NSDUHFFR2017.pdf Accessed 02/13/2019.

Training Activity References

American Academy of Orthopedic Surgeons. Treatment of Osteoarthritis of the Knee 2nd edition. 2011; Available at: https://www.ncbi.nlm.nih.gov/pubmed/23996988 Accessed 02/14/2019.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC, American Psychiatric Association. 2013 page 541.

PCSS-MAT/APA. Opioid use disorder diagnostic criteria. Reprinted from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013) American Psychiatric Association. Available at: https://pcssnow.org/resource/opioid-use-disorder-opioid-addiction/ Accessed 02/14/2019.

Babor TF, de la Fluente JF, Saunders J, Grant M. AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Generva, Switzerland: World Health Organization. 1992.

Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review. 1988; 8(1):77-100.

Belgrade M, Schamber CD, Lindgren BR. The DIRE score. Predicting outcomes of opioid prescribing for chronic pain. The Journal of Pain. 2006; 7(9): 671-81. Available at: http://www.jpain.org/article/S1526-5900(06)00626-2/abstract. Accessed 02/14/2019.

Briley M, Moret C. Treatment of comorbid pain with serotonin norepinephrine reuptake inhibitors. CNS Spectr. 2008; 13(7): 22-26.

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016; ePub: March 2016: DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1er. Available at: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. Accessed 02/14/2019.

FDA. Drug Safety and Availability – FDA Drug Safety Communication: FDA recommends against the continued use of propoxyphene. https://www.fda.gov/Drugs/DrugSafety/ucm234338.htm. Accessed 02/14/2019.

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann. Rheum. Dis. 2000;16 (4): 494-502. Available at https://www.ncbi.nlm.nih.gov/pubmed/13498604. Accessed 02/14/2019.

Krebs EE, Lorenz KA, Bair MJ. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009; 24(6): 733-738. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686775/ Accessed 02/14/2019.

Kumar L, Barker C, Emmanuel A. Opioid-induced constipation: Pathophysiology, clinicial consequences, and management. Gastroenterology Research and Practice. 2014; 2014. Available at: https://www.hindawi.com/journals/grp/2014/141737/ Accessed 02/14/2019.

Marshall, PS. Physical Functional Ability Questionnaire (FAQ5). In: Assessment and Management of Chronic Pain, 5th edition. Institute for Clinical Systems Improvement. 2011; 14: Appendix C:99. Available at: http://www.generationsprimarycare.com/assets/pain-contract.pdf Accessed 02/14/2019.

Merrill JO, Von Korff M, Banta-Green CJ, et al. Prescribed opioid difficulties, depression and opioid dose among chronic opioid therapy patients. General Hospital Psychiatry. 2012; 34: 581-587. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22959422 Accessed 02/14/2019.

Pani PP, Vacca R, Troqu E, Amato L, Davoli M. Pharmacological treatment for depression during opioid agonist treatment for opioid dependence. Cochrane Database of Systematic Reviews. 2010; 8(9): CD008373. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008373.pub2/abstract Accessed 02/14/2019.

Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning and monitoring compliance. Pain Med. 2008; 9: S145-S166.

Webster LR. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Medicine. 2005;6(6):432-442. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16336480 Accessed 02/14/2019.