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COMMUNITY PHARMACISTS: ISSUES AND CHALLENGES IN PAIN MANAGEMENT

OVERVIEW
Pain is one of the most common reasons patients seek medical attention. Often pain has no cure, and left untreated, it may affect many areas of life. The condition is difficult to diagnose and manage because an individual’s perception of his or her pain is subjective, and the cause varies from patient to patient. Chronic pain, in particular, can lead to desperation, addiction, and diversion. There is a need for effective pain relief while minimizing the potential for abuse and diversion. Several novel therapeutic strategies have been developed and provide additional opportunities to effectively manage both acute and chronic pain. Pharmacists can optimize treatment strategies, as well as provide physicians and staff with important information regarding the administration, side effects, drug interaction potential, and efficacy of pharmacologic agents used to address pain. They are readily available to patients and fellow colleagues for questions regarding pain management and are often the most accessible, approachable, and trusted members of the healthcare team. In order to continue to provide this type of care, pharmacists need a detailed understanding of all aspects of pain management. The following interactive case module examines the side effects and complications associated with several drugs that treat pain and provides information to help the community pharmacist identify methods for safely using these drugs to improve patient outcomes.

GOAL
This interactive case module is designed to improve community pharmacists’ quality of care by enhancing their understanding of the issues surrounding pain management in various clinical settings, raising awareness of quality measures, and how to incorporate that learning into their daily practices to improve patient outcomes.

TARGET AUDIENCE
This activity is designed for community pharmacists. No prerequisites required.

LEARNING OBJECTIVES
The University of Tennessee College of Pharmacy takes responsibility for the content, quality, and scientific integrity of this CPE activity. At the conclusion of this activity, the participant should be able to:

  • HAVE increased knowledge regarding:
    • Factors that influence response to drugs that require metabolic activation to produce analgesia (eg, codeine)
    • The risk of gastric bleeding and cardiovascular complications with nonsteroidal anti-inflammatory drugs (NSAIDs), and how this risk is influenced by other commonly used medications
    • The risk of excessive acetaminophen doses in patients with pain
    • The risk that NSAIDs may reduce the cardioprotective effects of low-dose aspirin
    • The unique pharmacologic characteristics of methadone, including its effects on the QTc interval and the risk of cardiac arrhythmias
  • HAVE increased confidence in their ability to:
    • Recognize patients who may not be responding adequately to codeine and related analgesics
    • Identify treatment regimens that increase the risk of NSAID-induced gastric bleeding or cardiovascular complications
    • Provide acetaminophen-containing products and professional advice in a manner that reduces the risk of toxicity
    • Recognize NSAIDs that may reduce the cardioprotective effects of daily low-dose aspirin
    • Recognize methadone-treated patients who require more intensive follow-up evaluation
  • INCREASE their planned frequency of use (as compared with their current frequency of use) of the following:
    • For patients using NSAIDs, review coprescribed agents to identify those that increase the risk of gastric bleeding or cardiovascular disease
    • Counsel patients about the risk of excessive acetaminophen doses, and help patients to identify potential acetaminophen-containing products
    • For patients using low-dose aspirin for the prevention of cardiovascular disease, recommend NSAIDs that are unlikely to interfere with the beneficial effects of aspirin
    • Counsel patients about the safe and effective use of methadone for the management of chronic pain
  • SELF-REPORT increased frequency of use of the same clinical practice strategies as shown in the above objective and self-report observations of positive patient outcomes based on their new/increased use of these pain management strategies.

ACCREDITATION STATEMENT
The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education to provide continuing education for pharmacists.

CREDIT DESIGNATION STATEMENT
acpe logoThe University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this application-based educational activity will provide a statement for 1.0 contact hour credit (0.1 CEUs) and will be available for download following successful completion of the activity. Successful completion includes taking the pre-test, participating in the activity, completing a self-assessment instrument with a score of at least 70%, and completing an evaluation instrument. If you score less than 70% on the self-assessment instrument, you will be allowed to complete the examination one more time. ACPE Program #0064-0000-10-216-H01-P.

This continuing pharmacy education activity was produced under the supervision of Glen E. Farr, PharmD, Associate Dean for Continuing Pharmacy Education, University of Tennessee College of Pharmacy.

The estimated time to complete this educational activity: 1 hour.

Release date: November 30, 2010; Expiration date: November 30, 2012.

FULL DISCLOSURE POLICY AFFECTING CPE ACTIVITIES
As an accredited provider by the Accreditation Council for Pharmacy Education (ACPE), it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Course Director reported the following:

J. Richard Brown, PharmD, FASHP
Professor, Department of Clinical Pharmacy
Colleges of Pharmacy and Medicine
University of Tennessee
Memphis, Tennessee
Dr Brown reports having no significant financial or advisory relationships with corporate organizations related to this activity.

OFF-LABEL PRODUCT DISCUSSION
In accordance with ACPE Criteria for Quality, the audience is advised that authors in this CPE activity may include reference(s) to unlabeled, unapproved, or investigational uses of therapeutic agents or biomedical devices. The authors will inform the reader of when they discuss or reference an unapproved, unlabeled, or investigational use of therapeutic agent or biomedical device.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of The University of Tennessee College of Pharmacy name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

GRIEVANCE POLICY
A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an educational activity sponsored or cosponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level review.

FEE INFORMATION
There is no fee for this educational activity.

INSTRUCTIONS
The following is an interactive educational activity designed to help you gauge your basic knowledge of the topic and direct you to areas you may need to focus on. It consists of 3 sections: a pre-test, 2 interactive case activities, and a CPE post-test with an evaluation. All 3 sections must be completed to receive CPE credit. A Statement of Credit will be available online immediately following successful completion of the module.

Pre-Test

Case 1. A 76-Year-Old Asian American Man with Acute Pain

Case 2. A 68-Year-Old Man with Back Pain

Post-Test

This activity is supported by an educational grant from PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil-Janssen Scientific Affairs, LLC.

procced to pretest
University of Tennessee Advanced Studies in Pharmacy (ISSN-1558-0350), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2015 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.