ESP: Emerging Solutions in Pain

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Release Date: May 07, 2008
Expiration Date: May 07, 2011

Program Overview

Chronic pain and comorbid diseases and syndromes often induce or exacerbate sleep disorders; in turn, sleep disorders may exacerbate chronic pain. Furthermore, research has strongly indicated that chronic opioid therapy can impact sleep quality and quantity, independent of the underlying chronic pain condition. Sleep disorders in a chronic pain patient are more than simple sleeplessness, and the ramifications of untreated, or undertreated sleep disorders in a chronic pain patient can be both numerous and complex, ranging from lack of progression toward personal goals, to severe injury, and even death. While much media attention has recently been focused on the role of chronic opioid therapy and sleep apnea, other, subtler negative consequences of sleep disorders in this patient population may be even more prevalent. Primary among these hidden negative consequences is the issue of sleep apnea-related drowsy driving and related accidents, which result in a significant annual loss in both deaths and lost income. It is, therefore, critical that health care professionals who treat chronic pain patients understand the importance of independent assessment and proactive treatment for sleep disorders, especially in those patients prescribed chronic opioid therapy.

Treating chronic pain patients is a complex challenge under the best of circumstances, and when the need to proactively assess and treat sleep disorders in these patients is included, patient management becomes significantly more complex. Such patients are excellent candidates for a multidisciplinary approach to pain management, which combines the skills and knowledge of clinicians from diverse specialties to positively impact patient care, and therefore, outcomes.

Target Audience

This activity is designed for physicians, pharmacists, physician assistants, and nurses who have an interest in enhancing their knowledge and understanding of pain management.

Learning Objectives

Persons reading this monograph should be able to:

1. Describe the relationship between chronic pain and sleep disorders, focusing on how chronic opioid therapy can impact sleep.
2. Identify the possible negative consequences associated with sleep apnea-related drowsy driving, and outline strategies for assessing chronic pain patients treated with opioids for driving functionality.
3. Describe a multidisciplinary approach to the management of chronic pain, and the role of the sleep specialist in assessing and treating chronic pain patients.
4. Outline possible pharmacologic strategies to address sleep disorders in chronic pain patients.

General Information

This activity is eligible for credit through May 7, 2011. After this date, this activity will expire and no further credit will be awarded.

Expected time to complete this activity as designed: 60 minutes

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

Faculty Biography

Dr. Bradley J. Schnierow received his medical degree from the University of Kansas, and completed a general psychiatry residency at the University of New Mexico. His first exposure to sleep disorders was an NIH research grant awarded during his last year of residency to study melatonin levels in elderly suffering from insomnia. Following his residency, Dr. Schnierow was a staff physician at University of New Mexico Sleep Disorders Center, until heading to San Diego for a two-year research fellowship in the Department of Psychiatry at the University of California, San Diego. He is currently an assistant clinical professor, School of Medicine, UC San Diego, where he has been the director of the required sleep disorders curriculum since 1998. In addition, Dr. Schnierow is the founder and medical director of San Diego Sleep Medicine, Inc., a private sleep center in La Jolla, California.

Dr. Joseph Shurman received his medical degree from Temple University Medical School in Philadelphia. He then had a rotating internship at Chestnut Hill Hospital in Philadelphia, followed by an anesthesia residency with Harvard Medical School, Massachusetts General Hospital, which included a three-month pediatric anesthesia and intensive care rotation at Philadelphia Children's Hospital. Dr. Shurman is currently an anesthesiologist and a pain consultant, as well as chairman of pain management at Scripps Memorial Hospital, La Jolla, California. In addition, he is a clinical assistant professor at the University of California, San Diego.

Accreditation

CME CREDIT
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 MediCom Worldwide, Inc. and Medical Learning Solutions. MediCom Worldwide, Inc. is accredited by the ACCME to provide continuing medical education for physicians.
Designation Statement: MediCom Worldwide, Inc. 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.

CPE CREDIT
MediCom Worldwide, Inc. is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is acceptable for 1.0 contact hour of Continuing Education Credit. Universal Activity Number: 0827-9999-08-106-H01-P Knowledge-based CPE activity.

NURSING CREDIT
Accreditation Statement: This activity has been planned and implemented through the joint sponsorship of MediCom Worldwide, Inc. and Medical Learning Solutions. 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 1.0 contact hour. Program Number: 08-206-202

Disclosure

It is the policy of MediCom Worldwide, Inc. to plan and implement educational activities in accordance with the ACCME, ACPE and California Board of Nursing. As a provider, it is the policy of MediCom Worldwide, Inc. to ensure balance, independence, objectivity, and scientific rigor in all its sponsored educational activities.

All program planners, faculty, and providers 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. 

Faculty Financial Disclosure

The presenting faculty reported the following: Dr. Bradley J. Schnierow has disclosed that he has no significant relationships with the grantor Cephalon, Inc. or any other commercial company whose products and services may be related to his presentation.

Dr. Joseph Shurman has received honoraria related to speakers' bureau activities from Alpharma Inc.; Ameritox, Ltd.; Cephalon, Inc.; Empi; Endo Pharmaceuticals; King Pharmaceuticals, Inc.; Pfizer Inc.; and Reckitt Benckiser Group plc. He has received honoraria as a consultant from Ameritox; Bay Recovery Centers Inc.; Cephalon; Empi; and Purdue Pharma L.P. Dr. Shurman is also an ABC News on-call pain management consultant, and is on the editorial advisory board of Practical Pain Management journal.

Planner and Provider Financial Disclosure

The individuals listed below reported the following for this activity:
MediCom Worldwide, Inc. – Joan Meyer, executive director; Ruth Widmer, medical editor and Alan Vogenberg, RPh, FASCP, clinical reviewer have nothing to disclose.

Medical Learning Solutions – Sheri Gavinski, president and Bronwyn Boyes, director have nothing to disclose.

Jeffrey Gudin, MD, was the clinical reviewer for this activity and disclosed that he has received honoraria related to speakers’ bureau activities from Cephalon, Inc.; Endo Pharmaceuticals; King Pharmaceuticals, Inc. and Pfizer Inc. He has received grant support related to research activities from Cephalon; Neuromed Pharmaceuticals Ltd.; and Pfizer.

Conflict of Interest Resolution

To identify and resolve conflicts of interest, the educational content was fully peer reviewed by a member of the MediCom Worldwide, Inc. Clinical Content Review Committee. The resulting activity was found to provide educational content that is current, evidence based, and commercially balanced.

Off-Label/Investigational Disclosures

In accordance with MediCom Worldwide, Inc. policy, the audience is advised of the following disclosures regarding unlabeled or unapproved uses of drugs or devices: At the time of printing, Dr. Schnierow indicated that his presentation would include the discussion of unlabeled/investigational uses of sodium oxybate that are not approved by the FDA for certain uses in the United States.

At the time of printing, Dr. Shurman indicated that his presentation would not include the discussion of unlabeled uses of commercial products or investigational products not yet approved by the FDA for any use in the United States.

Hardware/Software Requirements

MediCom Worldwide, Inc. requires Internet Explorer® version 7.0 or higher, or Firefox 3.0 or higher, a computer running Windows® XP, Windows® Vista, 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 be Adobe® Flash® Player, Adobe® Acrobat®, Windows Media® Player or Microsoft®Silverlight™.

This activity is supported by an independent educational grant from

©2008 MediCom Worldwide, Inc., 101 Washington St., Morrisville, PA 19067.

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