Breakthrough Pain Challenge: An Expert Led Debate

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Release Date: July 01, 2009
Expiration Date: July 01, 2010

Program Overview

Breakthrough pain (BTP) is a common, disabling feature of malignant and non-malignant illnesses.
Unfortunately, BTP is underdiagnosed and undertreated causing unnecessary negative impacts of patient suffering, quality of life, and the associated economic burden. Efforts focused on elucidating health care professionals’ approach to BTP management are required to improve patient outcomes.
This program will explore through debate, data, and case studies, the complexities surrounding breakthrough pain management of chronic noncancer pain. It will serve to:

  • Identify the issues and controversies surrounding BTP
  • Collect information about the participants’ common questions, beliefs, and attitudes toward BTP
  • Incorporate a dynamic video case vignette into the point-counterpoint debate to comprehensively discuss the challenges of BTP

Target Audience

This activity is designed for physicians, pharmacists, nurses and other allied health care professionals who have an interest in enhancing their clinical knowledge in the management and assessment of chronic pain patients.

Learning Objectives

At the conclusion of this educational activity, participants should be able to:

  • Identify controversies and issues associated with current understanding of breakthrough pain
  • Describe assessment strategies for identifying breakthrough pain in chronic pain patients
  • Summarize the role of proactive and ongoing assessment in the development of a comprehensive treatment strategy in chronic pain patients


Challenges of Managing Breakthrough Pain in Chronic Pain Patients
Case Vignette with Point-Counterpoint Discussion of Managing Breakthrough Pain – Characteristics, Assessment and Treatment Implications – Steven D. Passik, PhD – Moderator; John D. Markman, MD; and Michael J. Brennan, MD

General Information

This activity is eligible for credit through July 1, 2010. After this date, this activity will expire and no further credit will be awarded.

Expected time to complete this activity as designed: 90 minutes

There are no fees for participating in this activity. All participants must complete the Pre- and Post-Activity Evaluation Forms. Participants must receive a minimum score of 70% on the self-assessment post-activity to qualify for CE credit. Certificates will be saved to your CE Records and may be printed immediately after successfully completing the online self-assessment post-activity and evaluation.

Faculty Biographies

Steven D. Passik, PhD - Moderator
Associate Professor of Psychology
Weill Medical College of Cornell University
Associate Attending Psychologist
Memorial Sloan-Kettering Cancer Center
New York, New York

Dr. Steven Passik received his doctorate degree in clinical psychology from the New School for Social Research in New York City, and was chief fellow in the psychiatry service at Memorial Sloan-Kettering Cancer Center. He is currently an associate attending psychologist at Memorial Sloan-Kettering Cancer Center, and a clinical psychologist at the Rockefeller University Hospital, as well as an associate professor of psychology at Weill Medical College of Cornell University, all of which are located in New York City.

Dr. Passik was a faculty scholar for the SOROS Foundation’s Project on Death in America. He has served on the editorial board of the Journal of Pain and Symptom Management, and has been a reviewer for the Journal of Pharmaceutical Care in Pain and Symptom Control, Journal of Pain and Symptom Management, Psycho-Oncology, Agency for Health Care Policy and Research Cancer Pain Guidelines, Cancer Investigation, and Oncology. Dr. Passik has served as the president of the Indiana Cancer and AIDS Pain Initiative, and as editor in chief of the National Cancer Institute’s PDQ Supportive Care Editorial Board. He is the author of numerous journal articles, book chapters, and abstracts.

Dr. Passik was recently named a Fellow of DIV 28 of APA (Psychopharmacology & Substance Abuse), awarded a MayDay Fund Pain & Society Fellowship, given the Academy of Psychosomatic Medicine 2007 Visiting Professor Award, the 2007 American Psycho-Oncology Excellence in Clinical Care Award, and received the Elizabeth Narcessian Award for Outstanding Educational Achievements.

Michael J. Brennan, MD
The Pain Center of Fairfield
Fairfield, Connecticut
Senior Attending Physician
Department of Medicine
Bridgeport Hospital
Bridgeport, 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.

Dr. Brennan has special interests of the management of pain as well as disability in patients suffering from the acute and long-term effects of musculoskeletal diseases, neurological disorders, and cancer and various cancer treatments. He has published over 30 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.

John D. Markman, MD
Assistant Professor of Neurosurgery and Neurology
Director, Neuromedicine Pain Management Center and Translational Pain Research
University of Rochester Medical Center
Rochester, New York

Dr. John Markman earned his medical degree at the University of Rochester School of Medicine & Dentistry where he was awarded the Rudolph Angell prize and the Robert J. Joynt Prize for Excellence in Clinical Neurology. He continued his training in with a residency in neurology at Massachusetts General Hospital and Brigham and Women’s Hospital, and a pain management fellowship in the Department of Anesthesiology at Harvard's Beth Israel Deaconess Medical Center. Dr. Markman directs the Department of Neurosurgery’s Translational Pain Research Program at the University of Rochester Medical Center, and the Neuromedicine Pain Management Center, a multi-specialty pain practice with a focus on patients with chronic pain associated with nerve injury. He also holds appointments in the Departments of Neurosurgery and Neurology.

Dr. Markman is board certified in neurology and has received subspecialty certification in pain management. His clinical research on chronic pain and low back pain have recently appeared in Journal of Pain, Pain, Rheumatology, Neurology, Anesthesiology Clinics of North America, Medical Clinics of North America, and Geriatric Clinics of North America in addition to numerous book chapters. He is a councilor to the Pain Section of the American Academy of Neurology, the guest editor of its upcoming Continuum Edition on Neuropathic Pain, a reviewer and editorial board member of several peer-reviewed journals, and an examiner for the American Board of Psychiatry and Neurology. He lectures internationally and nationally on lumbar stenosis, chronic low back pain, opioid therapy, and neuropathic pain.


MediCom Worldwide, Inc.CME CREDIT
Accreditation Statement: MediCom Worldwide, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation Statement: MediCom Worldwide, Inc. designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


MediCom Worldwide, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is acceptable for 1.5 contact hour(s) of Continuing Education Credit. Universal Activity Number: 827-0000-09-231-H01-P Knowledge-based CPE activity.

MediCom Worldwide, Inc.NURSING CREDIT
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: 09-231-225


In accordance with the Accreditation Council for Continuing Medical Education (ACCME), ACPE and California Board of Nursing, MediCom Worldwide, Inc. requires that all program planners, faculty, and providers who are in a position to control the content of a CE activity are required to disclose any relevant financial relationships they may have or have had within the last 12 months with the commercial supporter or the manufacturer(s) of any commercial device(s) discussed in this educational activity. Accordingly, the following disclosures were made.

Faculty Disclosures

The presenting faculty reported the following:

Dr. Steven Passik has received honoraria related to speakers' bureau activities and as a consultant from Cephalon, Inc.; Ligand Pharmaceuticals Incorporated; Eli Lilly and Company; PRICARA®, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.; and King Pharmaceuticals, Inc. He has received grant support related to research activities from Cephalon and Ligand.

Dr. Michael Brennan has received honoraria related to speakers' bureau activities from Cephalon, Inc., Eli Lilly and Company, Endo Pharmaceuticals, Forest Laboratories, Inc., Merck & Co., Inc., Pfizer Inc., King Pharmaceuticals, Inc., and Purdue Pharma L.P., as well as formal advisory activities from Cephalon, Endo, Johnson & Johnson, Wyeth, King, and Purdue. He has received consultant fees from Cephalon, Endo, J & J, King, and Purdue.

Dr. John Markman has received grant support related to research activities from Endo Pharmaceuticals and Pfizer Inc.

Planner and Provider Disclosures

The individuals listed below from MediCom Worldwide, Inc. staff reported the following for this activity: Joan Meyer, executive director, Bronwyn Boyes, director, Ruth Widmer, medical writer, Alan Vogenberg, RPh, FASCP, clinical advisor have nothing to disclose.

The clinical advisors for the planning of this activity reported the following:

Jeffrey A. Gudin, MD, clinical reviewer and advisor, has received honoraria related to speakers’ bureau activities from Cephalon, Inc., Endo Pharmaceuticals, King Pharmaceuticals, Inc., and Pfizer Inc.

David M. Simpson, MD, clinical advisor, has received honoraria as a consultant from Alpharma Inc., Cephalon, Inc., Eli Lilly and Company, Endo Pharmaceuticals, Meda Pharmaceuticals, and Pfizer Inc. He has received honoraria related to speakers’ bureau activities from Eli Lilly.

Steven Stanos, DO, clinical advisor, has received honoraria related to formal advisory activities from Abbott Laboratories, Alpharma Inc., Cephalon, Inc., and Endo Pharmaceuticals, as well as honoraria related to speakers’ bureau activities from Endo, Pfizer Inc., and Ortho-McNeil, Inc. He has received grant support related to research activities from Abbott.

Lynn R. Webster, MD, clinical advisor, has received honoraria as a consultant from Advanced Bionics Corporation; Cephalon, Inc.; Covidien AG; Elan Pharmaceuticals, Inc.; Elite Pharmaceuticals, Inc.; Medtronic, Inc.; MEDACorp; and ZARS Pharma. He has received grant support related to research activities from Abbott Laboratories; Advanced Bionics; Alpharma Inc.; Ameritox, Ltd.; Array BioPharma Inc.; AstraZeneca PLC; Boehringer Ingelheim Pharmaceuticals, Inc.; Cervelo Pharmaceuticals Inc.; CoMentis, Inc.; DURECT Corporation; Elan; Elite; Forest Laboratories, Inc.; GlaxoSmithKline; Jazz Pharmaceuticals, Inc.; King Pharmaceuticals, Inc.; Medtronic; Merck & Co., Inc.; Nektar Therapeutics; NeurogesX; Pain Therapeutics, Inc.; Purdue Pharma L.P.; QRxPharma Ltd.; Respironics, Inc.; Takeda Pharmaceuticals North America, Inc.; TorreyPines Therapeutics; Wyeth; and ZARS. In addition he has received honoraria related to formal advisory activities from Alpharma; Ameritox; Cortex Pharmaceuticals, Inc.; King; Nektar; Nervo; Neuromed Pharmaceuticals Inc.; Purdue; and QRxPharma.

Off-Label/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.

Drs. Passik, Brennan, and Markman indicated that their presentations would include the discussion of unlabeled uses of commercial products or investigational products not yet approved by the FDA for use in the United States.

Conflict of Interest Resolution

To resolve identified conflicts of interest, the educational content was fully peer reviewed by members of the MediCom Content Review Committee. The resulting certified activity was found to provide educational content that is current, evidence-based, and commercially balanced.

Hardware/Software Requirements

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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 independent educational grant from Cephalon, Inc.
Cephalon, Inc.

©2009 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.

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