Recognizing and Treating Breakthrough Pain: Aligning Our Treatment Approach

Please Log In or Register to continue.

Release Date: July 16, 2015
Expiration Date: July 16, 2016

Expected time to complete this activity as designed: 90 minutes
There are no fees for participating in or receiving credit for this online activity.

Program Overview

Approximately 70% of patients with advanced cancer will indicate pain as their primary issue related to quality of life at some point in their illness. Pain in patients with cancer is a symptom that can be well managed, and yet it is a consistently undertreated problem.

Cancer patients may experience several types of pain ranging from sudden onset of pain, chronic pain, and breakthrough pain. The prevalence of breakthrough pain in cancer patients suffering from chronic pain ranges from 65%-85%. Its root causes vary, and experts agree that breakthrough pain is still not routinely recognized, evaluated, and treated.

Because pain is so heterogeneous, the key to the best management of an individual’s pain, including breakthrough pain, requires a thorough assessment to individualize treatment strategies, and a personalized approach is vital. Finding the proper agent or combination of agents is important to overall care and improvement in quality of life for the patient.

This activity will take a closer look at the fundamentals of breakthrough pain including the need for proper assessment, ongoing monitoring, and a thorough knowledge of therapeutic options available to treat and manage breakthrough pain episodes in this patient population.

Target Audience

This activity is designed for oncology nurses and allied health professionals who have an interest in enhancing their clinical skills in the management of breakthrough pain.

Learning Objectives

Upon completion of this educational activity, participants should be able to:

  • Define the elements of breakthrough pain associated with the cancer pain experience including prevalence, symptoms of presentation, and subtypes
  • Summarize QOL issues and impact of breakthrough pain in the cancer management setting
  • Identify available treatment strategies modeling best practice in aligning patient symptomatology and needs to pharmacologic treatment options, keeping in mind safety, efficacy, and REMS requirements


Part 1
The Art and Science of Assessing and Diagnosing Breakthrough Pain – April Hazard Vallerand, PhD, RN, FAAN

Treatment Options Available to Manage Breakthrough Pain Episodes: Aligning Pharmacologic Treatment Options to Symptomatology and Pain Type – Michael J. Brennan, MD

Part 2
Case Challenge: Patient-Centered Approach in Assessing and Treating Breakthrough Pain – Michael J. Brennan, MD, and April Hazard Vallerand, PhD, RN, FAAN

Instructions for Participation and Credit

This activity is eligible for credit through July 16, 2016. After this date, this activity will expire and no further credit will be awarded.
1. Read the target audience, learning objectives, and faculty disclosures.
2. You may be asked to complete a short pre-test before accessing the educational content. This must be completed in order to move forward in the activity.
3. Complete the educational content as designed.
4. Complete the post-test. To receive a certificate, you must receive a passing score of 70%.
5. Complete the activity evaluation survey to provide feedback and information useful for future programming.
6. Certificates for CNE may be printed immediately after successfully completing the post-test and activity evaluation.

Faculty Biographies

Michael J. Brennan, MD
Medical Director
The Pain Center of Fairfield
Fairfield, Connecticut
Associate Director, Chronic Pain and Recovery Center
Silver Hill Hospital
New Canaan, Connecticut

Dr. Michael J. Brennan received his medical degree at the State University of New York Downstate Medical Center, and completed a residency in physical medicine and rehabilitation at the New York Hospital-Cornell University Medical Center, where he served as chief resident. While at New York Hospital, Dr. Brennan also served as chief resident at the International Center for the Disabled in New York City. Dr. Brennan is a board certified physiatrist in private practice in Fairfield, Connecticut.

After completing his residency, Dr. Brennan was appointed to the faculty of New York Hospital and Cornell Medical College in the Department of Physical Medicine and Rehabilitation. He served as acting chief of the rehabilitation service in the Department of Neurology at Memorial Sloan-Kettering Cancer Center. After leaving Sloan-Kettering, Dr. Brennan became the medical director of the Rehabilitation Center of Fairfield County and Ahlbin Centers for Rehabilitation Medicine and chief of the section of physical medicine at Bridgeport Hospital in Bridgeport, Connecticut. He is currently a senior attending physician in the Department of Medicine at Bridgeport Hospital and consulting physician at St. Vincent’s Hospital in Bridgeport, Connecticut. He is associate director of the interdisciplinary chronic pain and addiction program at Silver Hill Hospital in New Canaan, Connecticut, which is designed to address the complex needs of patients suffering with chronic pain and substance misuse, addiction and behavioral disorders.

Dr. Brennan has special interests in the emerging role of pharmacogenomics, particularly as to the role of variability and vulnerability to opioid and adjuvant analgesics in individuals suffering with pain. He has recently published articles on opioids and pharmacogenomics opioid metabolism as well as articles concerning deleterious effects of opioids on the endocrine system. Dr. Brennan has a long-held interest in the management of pain as well as disability in patients suffering from the acute and long-term effects of musculoskeletal diseases, neurological disorders, cancer, and various cancer treatments. He has published over 40 scholarly articles, abstracts, and textbook chapters on the treatment of cancer and noncancer related disabilities including lymphedema and pain. He is a reviewer for several medical journals and has served as guest editor for the Journal of Musculoskeletal Rehabilitation and as online editor for Recently, Dr. Brennan was awarded the Dr. Elizabeth Narcessian Memorial Award from Kessler Institute, recognizing his commitment to the treatment of patients suffering from chronic pain.

April Hazard Vallerand, PhD, RN, FAAN
College of Nursing Alumni Endowed Professor
Interim Associate Dean for Research
College of Nursing
Wayne State University
Detroit, Michigan

Dr. April Hazard Vallerand received her bachelor’s degree in nursing from Mount St. Mary’s College and her master of science in nursing from California State University in Los Angeles. She received her PhD in nursing from the University of Pennsylvania and completed a three-year postdoctoral fellowship in psychosocial oncology at the University of Pennsylvania School of Nursing. Dr. Vallerand is currently the College of Nursing Alumni Endowed Professor in the College of Nursing at Wayne State University, Detroit. She is also the interim associate dean for research and the interim director of the PhD program.

Dr. Vallerand is a fellow in the American Academy of Nursing. She lectures nationally on the management of pain, and has published numerous articles on pain and pain control. She has also authored five books on pharmacology for nurses and other health care professionals, including Davis’s Drug Guide for Nurses. Dr. Vallerand’s research interests are focused on the improvement and maintenance of functional status in patients with chronic pain, and the identification and reduction of pain-related disparities. She is the Principal Investigator on a study, Improving Functional Status in African Americans with Cancer Pain, funded by the NCI.


Accreditation Statement: MediCom Worldwide, Inc., 101 Washington Street, Morrisville, PA 19067 is approved by the California Board of Registered Nursing, Provider Number CEP11380. MediCom designates this CNE activity for 1.5 contact hours. Program Number: 15-041-011


As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Pharmacy Education (ACPE) and California State Board of Registered Nursing, MediCom Worldwide, Inc. requires everyone who is a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Accordingly, the following disclosures were made.

Faculty Disclosures

Dr. Michael Brennan has received honoraria related to formal advisory activities, the development of educational materials, speakers’ bureau activities, and consultant fees from Insys Therapeutics, Inc., Kaleo, Inc., Purdue Pharma L.P., and Teva Pharmaceuticals, as well as speakers’ bureau activities from Depomed, Inc. and Johnson & Johnson Services, Inc. He has received grant support related to research activities from Millennium Laboratories, LLC.

Dr. April Vallerand has received honoraria related to speakers’ bureau activities AstraZeneca, and as a consultant from TEVA Pharmaceutical LTD and Mallinckrodt Pharmaceuticals.

Planning Committee Disclosures

The individuals listed below from MediCom Worldwide, Inc. reported the following for this activity: Joan Meyer, RN, MHA, executive director, has no relevant financial relationships.

Peer Reviewer Disclosure

In accordance with MediCom Worldwide, Inc. policy, all content is independently peer reviewed for balance, objectivity and commercial bias. The peer reviewers have no relevant financial relationships to disclose.

Off-Label Disclosures/Investigational Disclosures

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Dr. Brennan and Dr. Vallerand have indicated that they do not intend to discuss off-label uses of drugs, mechanical devices, biologics or diagnostics approved by the US Food and Drug Administration (FDA) for use in the US.

Dr. Brennan and Dr. Vallerand have indicated that they do not intend to discuss investigational drugs, mechanical devices, biologics or diagnostics not approved by the FDA for use in the US.

Hardware/Software/Internet Requirements

MediCom Worldwide, Inc. requires Internet Explorer® version 9.0 or higher, the latest version of Google Chrome, or the latest version of Safari, a computer running Windows® Vista, Windows® 7, or Mac OS X, 512MB of RAM or greater, 1.5 GHZ or faster processor, and a screen resolution of 1024x768 or higher. Certain educational activities may require additional software to view. These activities will be marked with the information and/or links to the required software. That software may include Adobe® Flashreg; Player, Adobe® Acrobat®, Windows Media® Player and/or Microsoft® Silverlight.

If you have any questions or concerns regarding this activity, please contact MediCom Worldwide, Inc. at 1-800-408-4242 or email us at

Provided by MediCom Worldwide, Inc.

This activity is supported by an unrestricted educational grant from Teva Pharmaceuticals.

©2015 MediCom Worldwide, Inc., 101 Washington St., Morrisville, PA 19067, 800-408-4242.
No portion of this material may be copied or duplicated without the expressed permission of MediCom Worldwide, Inc.

Please Log In or Register to continue.