Painweek september 2 6 2014

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7/14/14 6:50 PM

OVeRVieW PARTICIPATING FACULTY ●● Heidi

Allespach, PhD Anderson, PA-C ●● Charles E. Argoff, MD, CPE ●● Jennifer Bolen, JD ●● John J. Burke ●● Jeanette S. Campos, MA ●● Gregory T. Carter, MD, MS ●● Martin D. Cheatle, PhD ●● Charles F. Cichon ●● Michael R. Clark, MD, MPH, MBA ●● Beth Darnall, PhD ●● Robert R. Edwards, PhD, MSPH ●● Erica Elfant, RN ●● Gilbert J. Fanciullo, PhD ●● Roger B Fillingim, PhD ●● Peter A. Foreman, DDS, DAAPM ●● Jeffrey Fudin, PharmD, FCCP ●● David M. Glick, DC, DAAPM, CPE, FASPE ●● Marc Gonzalez, PharmD ●● Errol M. Gould, PhD ●● Douglas L. Gourlay, MD, MSc, FRCPC, FASAM ●● Jeffrey A. Gudin, MD ●● Joshua Gunn, PhD ●● Jennifer Hah, MD ●● Marvel Hammer, RN ●● Hans Hansen, MD ●● R. Norman Harden, MD ●● Howard A. Heit, MD, FACP, FASAM ●● Christopher M. Herndon, PharmD, BCPS, CPE ●● Gary W. Jay, MD, DAAPM, FAAPM ●● Ted W. Jones, PhD, CPE ●● Jim

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NATIONAL CONFERENCE

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AINWeek is the largest US pain conference for frontline clinicians with an interest in pain management. Going into its 8th year, PAINWeek continues to diversify and expand and will welcome over 2,000 physicians, physician assistants, nurse practitioners, nurses, pharmacists, hospitalists, dentists, psychologists, and social workers this year.

Demographically, 59% of HCPs are prescribers, 69% of HCPs are PCPs, and 32% are specialists. Recent attendee surveys have uncovered compelling information: ●● 50% of attendees do not attend any other pain conference ●● 30% of attendees do not attend any other medical conference PAINWeek offers a diverse curriculum taught by a multidisciplinary faculty* in the following course concentrations: behavioral pain management, health coaching, interventional pain management, medical/legal, neurology, pain and chemical dependency, pharmacotherapy, and regional pain syndromes. Full-day programs will be presented by the American Academy of Pain Medicine, American Pain Society, the American Society of Interventional Pain Physicians, the American Society of Pain Educators, the National Association of Drug Diversion Investigators, and the Veterans Health Administration. There will be 120 hours of continuing medical education (CME/CE) courses and master classes, special interest sessions, and satellite symposia.

NEW for 2014 To enable attendees to experience even more of the conference agenda, PAINWeek will present a Bonus Day, Tuesday, September 2 offering approximately 5 hours of certified course activities. The highly popular Pain Educators Forum returns for its 9th consecutive year in an expanded 3 day format that includes “Neuropathica Glactica”, a new, limited attendance application and practice based activity.** Opioid and NSAID –focused courses will receive special attention during two days of the conference (Thursday and Friday respectively), as concern over these interventions for chronic pain continues to escalate. And the evolving role of cannabinoid-based therapies will be explored from both medical and legal perspectives.

PAINWeek 101 PAINWeek 101 is designed for first-timers and anyone else who would like more assistance with their course selection process and helps attendees to make the most of their PAINWeek experience. Selected faculty and staff will review session selections (and provide a recommended agenda), conference logistics, exhibits and special events, CME/CE credit request procedures, and more! This session will be presented on Tuesday evening at the conclusion of the conference Bonus Day. *Faculty and schedule of sessions subject to change **Separate registration fee of $150 applies to this activity. Precourse work will be made available prior to the program PAINWeek Conference Preview

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OVeRVieW PARTICIPATING FACULTY

PWE REGIONAL CONFERENCES

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he PAINWeekEnd Regional Conference Series brings a concentrated day of certified medical education to healthcare professionals in all disciplines with an interest in pain management. Created by the producers of PAINWeek—the national conference on pain for frontline practitioners—PAINWeekEnd conferences are scheduled in convenient locations across the country.

The 2014 fall conference series is currently scheduled for Denver, CO October 4

Irvine, CA October 25

New Orleans, LA November 8

●● Cynthia

Honolulu, HI December 6

Additional information will soon be available on www.painweekend.org.

PWJ—PAINWEEK JOURNAL

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AINWeek has evolved into more than an annual national conference. It is now a significant and branded communications platform comprised of national & regional conferences, a digital presence, and now print, with PWJ, our new quarterly journal.

PWJ, like our website, is meant to extend the energy and experience of the national conference through-out the entire year. Each issue presents articles developed by our PAINWeek faculty, adapted from their respective conference presentations.

Current and archived issues of PWJ may be read at www.painweek.org/painweek-journal.

LOCATION & VENUE

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AINWeek is convened annually the Wednesday to Saturday following Labor Day Weekend at The Cosmopolitan of Las Vegas. This year, we are excited to offer an additional bonus day, beginning on Tuesday.

The Cosmopolitan is a 2,995-room luxury resort located on the Las Vegas Strip next to Bellagio and City Center. With 150,000 square feet of state-of-theart convention and meeting space, it offers a multitude of benefits and features to PAINWeek attendees.

PLEASE NOTE: It is IMPORTANT that you book your accommodations during your registration process at www.painweek.org not directly with the hotel or via third party.

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F. Knorr-Mulder, MSN, BCNP, NP-C ●● Ernest A. Kopecky, PhD, MBA ●● Barbary L. Kornblau, JD, OTR/L, CPE, DASPE ●● Georgine Lamvu, MD ●● Scott Litin, MD ●● Sean Mackey, MD, PhD, CPE ●● Darren McCoy, FNP-BC, CPE ●● Lisa M. McElhaney ●● Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE ●● P. Michael Murphy ●● Srinivas Nalamachu, MD ●● Kimberly S. New, BSN, JD ●● Steven D. Passik, PhD ●● Joseph V. Pergolizzi, MD ●● Robert B. Raffa, PhD ●● James B. Ray, PharmD, CPE ●● Ilene R. Robeck, MD ●● Seddon R. Savage, MD ●● Michael E. Schatman, PhD, CPE, DASPE ●● Sanford M. Silverman, MD ●● Richard H. Smith, PhD ●● Brett B. Snodgrass, MSN, APRN, FNP-C ●● Natalie Strand, MD ●● Mark D. Sullivan, MD ●● Robert Taylor, Jr, PhD ●● Forest Tennant, MD, DrPH ●● Tanya Uritsky, PharmD, BCPS ●● Debra K. Weiner, MD ●● Anthony A. Whitney, MS, LHMC, BCB ●● Bernd Wollschlaeger, MD, FAAFP, FASAM ●● Kevin L. Zacharoff, MD ●● Stephen J. Ziegler, PhD, JD

OVeRVieW SESSIONS AT A GLANCE

PARTICIPATING ORGANIZATIONS ●● American

FRONTLiNE PRACTiTiONER FOCUS 8 Genetic Testing for Safer Prescribing 8 Cost Containment: When to Order a Study and When to Avoid It PARTiCiPATING ORGANiZATION TRACK AMERICAN PAIN SOCIETY

9 Vulvodynia: Clinical Profiles and Their Implications for Treatment 9 Chronic Pain after Breast Cancer Treatment AMERICAN ACADEMY OF PAIN MEDICINE

10 New Advances in Interventional Pain Management AMERICAN SOCIETY OF PAIN EDUCATORS

11 Using Social Media to Create Community Health Programs NATIONAL ASSOCIATION OF DRUG INVESTIGATION

15 A Bang or a Whimper? How Introverts and Extroverts Manage Pain COURSE TRACK HiGHLiGHTS MEDICAL MARIJUANA

16 The Changing Face of Cannabis in America 16 What Constitutes Best Medical Practice in Regards to Medical Marijuana?

16 What is the Appropriate Degree of Point-of-Care Testing?

STRESS

18 Evidence-Based Mind/Body Approaches to Pain Management NEUROLOGY

19 Small Fiber Neuropathies 19 A Tea Party in Hell: Unravelinxg the Mysteries of Celebrated Migraineurs

PAIN AND CHEMICAL DEPENDENCY

12 Hot Topics in Palliative Care 12 Sailing to Byzantium: Geriatric Management

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PHARMACOTHERAPY/MEDiCAL-LEGAL

SPECiAL iNTEREST SESSiONS

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11 Medical Marijuana— A Law Enforcement Perspective MASTER CLASSES

NSAID Pharmacotherapy: New Oral and Injectable Options Physician Office Laboratories: Myths and Realities

BEHAViORAL PAiN MANAGEMENT 15 Biopsychosocial Aspects of Catastrophizing About Pain

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Dealing with “Dread to Treat” Patients: Recognition, Diagnosis & Management of Addiction in the Office-Based Setting When Medication & Interventional Strategies Are Not Enough: Physician-Administered Cognitive Behavioral Pain Management

Controversies in Pain Medicine: Is Interventional Pain Management Over or Underutilized?

Psychology of Opioids NSAIDs: Not Just COX-1 and COX-2 The Scorpion and the Frog or Quid Pro Quo? A New Collaborative Approach

Academy of Pain Medicine ●● American Chronic Pain Association ●● American Headache Society ●● American Osteopathic Academy of Addiction Medicine ●● American Pain Society ●● American Society of Interventional Pain Physicians ●● American Society of Pain Educators ●● American Society for Pain Management Nursing ●● Eastern Pain Association ●● Foundation for Ethics in Pain Care ●● International Medical & Dental Hypnotherapy Association ●● Interstitial Cystitis Association ●● National Association of Drug Diversion Investigators ●● National Fibromyalgia & Chronic Pain Association ●● National Stroke Association ●● National Vulvodynia Association ●● Nevada Psychiatric Association ●● The North American Neuromodulation Society ●● Pain Society of Oregon ●● Power of Pain Foundation ●● Rheumatology Nurses Society ●● TNA The Facial Pain Association ●● US Pain Foundation ●● Western Pain Society

REGISTER ONLINE AT:

AGENDA 6:30 PM 7:00 PM 7:05 PM

8:00 PM 8:15 PM 8:30 PM

OLUTIONS DS AN

7:45 PM

ASED STRA TE E-B C GI N E DE

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7:25 PM

Registration and Dinner Introduction Jeffrey A. Gudin, MD (Chair) The Burden and Impact of Opioid-Induced Constipation (OIC): Proper Assessment and Management Strategies Michael J. Brennan, MD Insights into Newer, Targeted Pharmacotherapies for OIC Jeffrey A. Gudin, MD Interactive Case Presentation #1 Steven P. Stanos, DO Interactive Case Presentation #2 Bill H. McCarberg, MD Question-and-Answer Session Conclusion of Program

Best Practices for Effectively Managing Opioid-Induced Constipation (OIC) EV I

Scan this code to register

WWW.SYMPOSIAREG.COM/21418

FACULTY

Jeffrey A. Gudin, MD (Chair)

Director, Pain Management and Palliative Care Englewood Hospital and Medical Center Englewood, New Jersey

Michael J. Brennan, MD Associate Director, Chronic Pain and Recovery Program Silver Hill Hospital New Canaan, Connecticut

Bill H. McCarberg, MD

Adjunct Assistant Clinical Professor University of California, San Diego San Diego, California

Steven P. Stanos, DO

Associate Professor, Department of Physical Medicine and Rehabilitation Feinberg School of Medicine, Northwestern University Chicago, Illinois

Friday, September 5, 2014 Dinner and Registration: 6:30 PM – 7:00 Symposium: 7:00 PM – 8:30 PM

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The Cosmopolitan of Las Vegas Brera Ballroom, Level 3 3708 S Las Vegas Blvd.

Las Vegas, Nevada

ACCREDITATION AND CREDIT DESIGNATION STATEMENT Voxmedia LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Voxmedia LLC designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity has been planned and implemented in accordance with the Accreditation Standards for Continuing Pharmacy Education of the Accreditation Council for Pharmacy Education (ACPE), through the co-sponsorship of Northeast Ohio Medical University and Voxmedia LLC. Northeast Ohio Medical University is accredited by the ACPE to provide continuing education for pharmacists.

This application-based activity has been assigned Universal Activity Number (UAN) 0479-9999-14-153-L01-P and will award 1.5 contact hours (0.15 CEUs) of continuing pharmacy education.

OhioMHAS Continuing Education Committee is an approved provider of Continuing Education for RNs for the Ohio Board of Nursing and awards 1.5 CE contact hours per OBN003 92-1819CO. A program evaluation form must be completed in order to obtain credit.

PAINWeek Conference Preview.v15.indd 1

This activity is co-sponsored by Voxmedia LLC, Northeast Ohio Medical University, and Ohio Department of Mental Health and Addiction Services.

This activity is supported by an educational grant from AstraZeneca Pharmaceuticals LP. This satellite symposium is neither sponsored by nor endorsed by PAINWeek®.

6/25/14 9:59 PM

FRONTLiNE PRACTiTiONER FOCUS Genetic Testing for Safer Prescribing Brett B. Snodgrass, MSN, APRN, FNP-C

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here continues to be great interest in the study of genetic defects of patients with chronic pain who have difficulty metabolizing opioids. This is especially true as more and more pain patients are requiring high opioid dosages and/or an unusual treatment regimen.

Research shows that one-third of the Caucasian population in the United States has a genetic defect in the cytochrome P450 (CYP450) enzyme system. Thus, the pain practitioner must suspect that a high percentage of patients will have a genetic defect in opioid metabolism. These patients will, therefore, require high doses of opioids and/or an “odd” regimen of drugs, which will inevitably include an opioid combined with at least one

other drug class, such as benzodiazepines, stimulants, or antidepressants.

WHO should attend? All healthcare providers and prescribers.

WHY should they attend? To learn about the newest genetic tests available for patients with chronic pain.

WHAT will they learn? Genomics testing can be a way to help navigate “difficult-to-treat” patients, allowing providers to know what medications patients may or may not be able to metabolize.

For example, if a patient continually presents complaining of breakthrough pain, despite appropriate doses being used, genetic testing should be employed to determine if the patient is an ultra-rapid drug metabolizer, which would negate treatment effects. A genetic test would help determine the patient’s potential drug reaction based on the presence of a specific genetic marker.

Cost Containment: When to Order a Study and When to Avoid It Darren McCoy, FNP-BC, CPE

WHO should attend? All healthcare providers involved in ordering imaging studies, drug tests, or prescribing medications or other treatments for patients with pain issues.

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WHY should they attend? The “order vs do not order” point in healthcare delivery is the point at which money is spent or saved.

Every healthcare provider has a role to play in improving efficiency and curbing costs.

WHAT will they learn? The burden of healthcare costs today can be partly attributed to unnecessary overutilization of tests and studies, as well as many medical costs hidden from both patient and provider. Attendees will gain a clearer understanding of the enormity of costs associated with healthcare in the United States and learn of new technologies to guide decision-making, including online guidelines for radiology study appropriateness.

I THINK WHY PAiNWEEK IS SO EFFECTiVE iS BECAUSE NOT ONLY DOES iT TOUCH ON ALL DiFFERENT TYPES OF PAiN PATiENTS iN ALL DiFFERENT SPECiALTiES, BUT YOU HAVE REAL TANGiBLE TREATMENT OPTiONS WHEN YOU LEAVE HERE. COLLEEN M. FITZGERALD, MD, MS

PAINWeek Conference Preview

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he costs of diagnostic imaging, drug screens, and pharmacogenetic testing are at times not considered carefully with enough depth prior to clinical decision-making. New technologies and online comparison tools that guide decision-making can reduce the overutilization of tests and studies and, subsequently, healthcare costs.

PARTiCiPATING ORGANiZATION TRACK

AMERICAN PAIN SOCIETY FEATURED PRESENTATION

Vulvodynia: Clinical Profiles and Their Implications for Treatment Georgine Lamvu, MD

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ulvodynia is a chronic, complex vaginal pain problem that is under-reported by women with chronic pain syndromes and thus not usually evaluated in pain assessment. The challenge: vaginal pain cannot be separated from intimate psychosocial issues such as sexual behavior.

Patients with vulvodynia may present with pain and skin changes consistent with inflammation, have pain-mediated musculoskeletal problems, or have psychosocial and environmental issues.

While providers might feel “overwhelmed” when faced with initiating conversations with patients about their sexual relationships, this is crucial to a successful outcome. For that reason, simple pointers on how best to

engage patients in a discussion will be provided, with the understanding that several office visits may be needed to address the source of vulvodynia so that appropriate treatment can be initiated.

WHO should attend? All healthcare providers who treat women.

WHY should they attend? “I want to make sure people understand vulvodynia is like other pain disorders and providers should not be afraid of it,” said Dr. Lamvu.

WHAT will they learn? Attendees will learn to identify at least three subtypes of clinical vulvodynia, describe symptoms of each, and understand what treatments are primarily used for each subtype. Also provided will be appropriate therapies. “It is really important for providers to learn about multimodal treatments in vaginal pain,” she said. Templates delineating important parameters for each of the three subtypes will be provided.

FEATURED PRESENTATION

Chronic Pain after Breast Cancer Treatment Robert R. Edwards, PhD, MSPH

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early 250,000 new cases of breast cancer were diagnosed in 2013, and the 10-year survival rate is now close to 85%. Pain following the surgical treatment of breast cancer is extremely common (40% to 50% of women in most studies) and is generally unrelated to surgical factors. These pain syndromes can persist over time, and strongly affect quality of life. It is important to identify risk factors for chronic pain after breast cancer treatment, and the biopsychosocial model of pain suggests that numerous multidimensional influences are likely to shape individuals’ experience of pain. Factors such as sleep disruption, physical fitness, psychological states, and variability in pain sensitivity and pain modulation appear to play crucial roles in conferring risk for or protection from persistent pain after breast cancer treatment regimens.

WHO should attend? Any healthcare provider involved in the care of patients with breast cancer.

WHY should they attend? To gain an understanding about the all-too-common sequelae of breast cancer treatment and determine who might be at risk.

WHAT will they learn? Information on risk factors for chronic pain after treatment for breast cancer and nonpharmacologic therapies that might prevent or reduce the impact of such pain syndromes will be presented. For example, cognitive behavioral therapy (CBT) may be useful in helping patients reduce catastrophizing, a set of negative cognitions, emotions, attitudes, and beliefs related to pain that includes magnification, rumination, and helplessness. Use of CBT may also improve sleep and facilitate exercise.

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PARTiCiPATiNG ORGANiZATiON TRACK

AMERICAN ACADEMY OF PAIN MEDICINE

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he American Academy of Pain Medicine educational track, “Essential Tools for Treating Patients in Pain,” aims to provide healthcare providers with an overview of the fundamentals of pain medicine in addition to practical approaches to the treatment of common pain disorders. An expert panel of physicians and pain educators will discuss assessment, diagnosis, and integrated approaches to the management of

headache, myofascial pain syndromes, and neuropathic pain.

Attendees will learn how the brain responds to acute and chronic pain and how it influences changes based upon that input in the body. Described will be the neuroplastic processes that occur in people with persistent pain, as well as the brain-body link in perpetuating and resolving pain.

AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS FEATURED PRESENTATION

New Advances in Interventional Pain Management Sanford Silverman, MD; Hans Hansen, MD

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cute pain can become chronic and chronic pain sometimes involves acute episodes, raising complex painmanagement challenges. Interventional procedures can minimize opioid load and improve patients’ function and quality of life. New and emerging interventional approaches are expanding pain management’s armamentarium.

WHO should attend? Healthcare providers who manage acute and chronic pain conditions.

WHY should they attend? Practitioners should know the limitations of pharmacologic therapy and when to consult a pain physician that offers Interventional Pain Medicine (IPM) as an option. Understanding when to implement these techniques is crucial to achieving the goal of successful management of a patient whose complaint is pain. Most pain complaints are multidimensional, and interventional pain techniques often tease apart the complexity of the many comorbidities accompanying those in pain.

Many times patients with pain have been to multiple practitioners, and a fresh perspective is sometimes offered by the interventionalist.

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WHAT will they learn? Attendees will review the anatomy of the peripheral and central nervous system, particularly the spine, and its role in pain modulation. Central neuraxial spinal blocks will be detailed, including evidence-based literature reviews.

Neuromodulation and advanced technologies will be described, as well as promising emerging therapies such as mesenchymal stem cell therapy and plasma rich protein therapy. A multidimensional approach to dealing with those in pain will be emphasized.

Adjunctive pathways and therapies are utilized to enhance outcome, and knowing when to apply principles of physical rehabilitation, and psychological therapy is often enhanced with interventional procedures. This will be discussed in a cost-effective, patient-centered and compassionate-care arena in the patient’s best interest.

This will be a comprehensive didactic course on IPM and its role in the treatment of chronic pain. Those who attend will understand the indications, and best understand the concept of a “multimodality” approach to treating those that suffer from pain. Pain is both a subjective and objective complaint, and the value of both the diagnostic and therapeutic approach to treating those in pain will broaden the attendees perspective.

AMERICAN SOCIETY OF PAIN EDUCATORS FEATURED PRESENTATION

Using Social Media to Create Community Health Programs Jeanette S. Campos, MA

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ocial media tools allow improved outreach and education of patients and better communication of priorities, values and information to broader communities. Updates can be automatically sent to a network of followers, who can in turn share those updates with thousands of others, extending the reach of particular messages or information.

As social networking platforms proliferate, building a social media strategy to coherently and efficiently utilize those tools will be the key to successful engagement with patients.

WHO should attend? Any practitioner who is trying to engage with patients and communicate more broadly in new and different ways.

WHY should they attend? Anyone interested in improving outreach to their patient population and possibly improving efficiencies in their communication methods should attend.

WHAT will they learn? Attendees will gain a better awareness of new social networking tools and will think differently about how they provide communications and outreach to their patients, using different social media platforms.

NATIONAL ASSOCIATION OF DRUG INVESTIGATION FEATURED PRESENTATION

Medical Marijuana – A Law Enforcement Perspective John J. Burke

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moked medical marijuana is a scam.” That’s the underlying message of this presentation by John Burke, President of the National Association of Drug Diversion Investigators (NADDI), who will focus on the law enforcement perspective when marijuana is prescribed.

Using statistics compiled by the Rocky Mountain High Intensity Drug Trafficking Area (HIDTA), which is tracking the impact of marijuana legalization in the State of Colorado, Burke will present the collateral damage of smoked marijuana. For example, from 2006 to 2011, the most recent data available, traffic fatalities decreased in Colorado 16%, but fatalities involving drivers testing positive for marijuana increased 114%.

WHO should attend? Any practitioner considering using smoked marijuana as a medicine for patients with pain or is involved in a practice that is prescribing smoked marijuana as a viable pain treatment.

WHY should they attend? To learn about the unique realities of the effects of medical marijuana in an era of increasing push for more widespread legalization. The well-documented dangers and unique challenges that law enforcement has observed when people smoke marijuana will be reviewed.

WHAT will they learn? Statistics will be presented from the Rocky Mountain HIDTA, a federal grant program administered by the White House Office of National Drug Control Policy.

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MASTER CLASSES Hot Topics in Palliative Care Mary Lynn McPherson, PharmD, BCPS, CPE, FASPE

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nd-of-life pain and symptom management presents important clinical challenges and conundrums.

“Pharmacomistakes,” like the inappropriate use of benzodiazepines to treat delirium, are frequent in the care of patients with terminal illnesses and can worsen the delirium and family and patients’ quality of life.

WHO should attend? Healthcare providers caring for patients with life-limiting illness.

WHY should they attend? Attendees will walk away knowing how to address often-thorny pharmacologic issues, and how to be a myth buster!

WHAT will they learn? Among other topics, the lecture will cover concerns about the use of antipsychotics to treat delirium in dementia patients, opioid tolerance, the appropriate management of nausea and vomiting, identifying who is a good candidate for transdermal fentanyl, and end-of-life glycemic control goals and anticoagulation therapy.

For example, glycemic control goals should be liberalized at the end of life – perhaps even as liberal as a blood glucose of 140-250 mg/dL (provided the patient is not symptomatic). Trying to achieve “normal” glycemic control puts undue stress on the patient and family and can increase the risk of hypoglycemia. Improving quality of life without sacrificing symptom management is essential when caring for this vulnerable population.

Sailing to Byzantium: Geriatric Management Debra Kaye Weiner, MD

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WHY should they attend? To learn how to better take care of geriatric patients with chronic pain. Older patients tend to be more psychologically robust so psychological interventions tend to be needed less frequently; but knowledge of drug-drug and drug-disease interactions is important in older adults.

Adequate pain treatment can help with agitated behaviors in nursing home residents.

Clinicians face clinical challenges with older adults, such as determining whether or not pain should really be the primary management issue, or if dementia should instead be the focus of evaluation and management.

WHAT will they learn? Attendees will learn an approach to comprehensive assessment of the older adult with chronic low-back pain, a stepped-care approach to treatment, and issues to consider when evaluating and treating the older adult with dementia. The lecture will convey practical tools for taking care of patients. Evidence will be cited but the focus will be clinical care.

WHO should attend? All healthcare providers and attendees who take care of older adults.

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PAiNWEEK iS AN AMAZiNG FUSiON OF THE SCiENTiFiC AND THE CLiNiCAL AND THE DiFFERENT PEOPLE WHO ARE ALL iNVOLVED AS A COMMUNiTY TO TAKE CARE OF PEOPLE WiTH PAiN. STEVEN D. PASSIK, PhD

PAINWeek Conference Preview

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lder adults are an ever-growing segment of our population. They are not simply a chronologically older version of younger patients with chronic pain, however. Understanding the differences can lead to not only improved care but potentially significant cost savings for the individual and for society.

myCME Simplifies Your CME Search Relevant courses automatically displayed based on your profession, specialties and topics of interest

Personal dashboard of bookmarked, in progress and completed activities

Resources and Trending features keep you updated with personalized medical news and information, along with rankings of the most popular CME/CE activities

Extensive array of accredited CME/CE activities in dozens of therapeutic areas

Your personalized myCME homepage will make it easier to ďŹ nd relevant CME/CE activities.

Simplify Your CME Search.

Visit myCME.com Today Š2014 Haymarket Media, Inc.

PHARMACOTHERAPY/MEDiCAL-LEGAL NSAID Pharmacotherapy: New Oral and Injectable Options Jeffrey Fudin, PharmD, DAAPM, FCCP

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he development and clinical uses of antiinflammatory therapies have seen big changes over recent years, including the “rise and fall” of popular treatments and the development of innovative new oral, injectable and intra-articular, pharmaceutically-engineered non-steroidal antiinflammatory (NSAID) agents. Nano-scale agents have been formulated with radically-reduced particle size to increase surface areas, hastening dissolution.

WHO should attend? All healthcare providers.

WHY should they attend? This lecture will give an exciting glimpse of future technologies that have just been released or are just over the horizon, and others of which are predicted to be available in the very near future. Among other things, this is a chance for attendees to learn about a practical example of how nanotechnology and the pharmaceutical industry will shape the future of drug development.

WHAT will they learn? Attendees will learn about nitric oxide (hydrogen sulfide-donating drugs), new injectable NSAIDs for perioperative and inpatient use, novel intra-articular extendedrelease NSAIDs combined with intra-articular hyaluronic acid, and nanotech submicron NSAID pharmaceuticals that will deliver lesser doses without compromising efficacy.

Other developing technologies to be discussed are products that mitigate gastrointestinal toxicity with certain oral NSAIDs while incorporating unique pharmaceutical maneuvers to enhance safety and efficacy, some of which include vasodilating adjuvants.

Examples include naproxcinod, a cyclooxygenase-inhibiting nitric oxide donor; hydrogen sulfide-releasing compounds; glycoscience technologies; and nano-formulated SoluMatrix submicron technologies.

Some of these new formulations that are still under development hold promises to mitigate gastrointestinal and cardiovascular difficulties inherent to current NSAID-class therapies.

Physician Office Laboratories: Myths and Realities Jennifer Bolen, JD

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he Therapeutic Drug Monitoring (TDM) laboratory space is under intense scrutiny stemming from a parade of fact patterns demonstrating significant fraud and abuse tied to clinical laboratory test utilization and inappropriate relationships between physicians and third parties. The potential consequences for inappropriate relationships and claims for reimbrusement are significant.

Solid compliance programs can minimize the potential of getting caught up in fraud schemes and inappropriate billing and claims for reimbursement. Drug testing policies can help the physician demonstrate medical necessity for TDM and related clinical laboratory testing.

WHO should attend? Physicians who own laboratories, or have invested in a physician-partnered independent clinical laboratory.

Also, high-level management and compliance representatives from

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independent clinical laboratories and laboratory instrumentation and supply companies.

WHY should they attend? Change is coming and it’s important to stay current to minimize the potential of significant financial consequences.

WHAT will they learn? Attendees will learn of the changes coming to the Clinical Laboratory Fee Schedule and CPT/HCPCS coding for 2015, as well as updates to coverage indications and limitations through newly adopted Medicare Local Coverage Determinations and Commercial Medical Policies governing TDM. Also presented will be how Stark law and state and federal anti-kickback laws impact relationships in the clinical laboratory space.

The lecture will describe what auditors look for, what’s true and not true with regard to coverage and reimbursement of clinical laboratory services, how to do a basic self-audit, and what types of relationships to avoid or postpone until proper due-diligence is performed to ensure arms-length transactions with laboratory vendors and reference laboratories.

BEHAViORAL PAiN MANAGEMENT Biopsychosocial Aspects of Catastrophizing About Pain Robert R. Edwards, PhD, MSPH

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ariability in pain is the rule rather than the exception, and the biopsychosocial model of pain suggests that numerous multidimensional influences are likely to shape individuals’ experience of pain.

Psychological processes have long been recognized as important determinants of pain responses. Pain-related catastrophizing has emerged, as one of the most powerful contributors to individual variability in the pain experience.

Catastrophizing is a set of negative cognitive and emotional processes that involves feelings of helplessness with a focus on the threat value of pain.

WHO should attend? Any healthcare provider or attendee involved in the care of patients with chronic pain.

WHY should they attend? To gain an understanding of how catastrophizing presents, its impact on endogenous pain-modulatory processes, and what treatment options are available.

WHAT will they learn? One way to capture individual differences in experiencing pain is by implementing the 13-item Pain Catastrophizing Scale, which measure a patient’s thoughts and feelings by capturing the degree of response to the question “When I’m in pain….” This is followed by 13 statements, including “I worry all the time about whether the pain will end,” “I feel I can’t stand the pain anymore,” and “I wonder whether something serious may happen.” Overall, the questions capture magnification, rumination, and helplessness. Cognitive behavioral therapy has been shown to reduce catastrophizing and improve the quality-of-life of patients with pain.

A Bang or a Whimper? How Introverts and Extroverts Manage Pain

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nderstanding why some patients can be more “difficult” than others involves an awareness of personality differences. There are different personality traits, one set of which is introversion/extraversion; some people are more outgoing, more dramatic, more emotionexpressing, and others are introverted, shy and reserved.

Understanding a patient’s personality can ease clinical interactions and improve patient compliance.

WHO should attend? All healthcare providers and attendees who treat patients with pain syndromes.

WHY should they attend? This presentation will give attendees a more comprehensive understanding of their patients’ personalities

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and what the strengths and weaknesses are of those personality traits. This knowledge will enable participants to better think of specific strategies for dealing with difficult patients, understanding that it is due to personality traits they possess.

WHAT will they learn? The role of personality in management of patients with chronic pain. Discussed will be the major personality dimensions, how people conceptualize personality traits and profiles right now, and how these are relevant in pain management.

Rather than reducing patients to a stereotype, cases should be individualized based on personalities.

It is also important to consider the clinician’s own personality and the interaction of personalities in a relationship. If we are not careful and self-aware as clinicians, our own vulnerabilities can be provoked and reduce our effectiveness as healthcare providers.

PAiNWEEK ENCOURAGES THE FRONTLiNE PROFESSiONALS TO RECOGNiZE THE CHALLENGES THAT ARE OUT THERE, AND THEN PROViDES THE TOOLS TO DEAL WITH THEM. JENNIFER BOLEN, JD

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Michael R. Clark, MD, MPH, MBA

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COURSE TRACK HiGHLiGHTS

MEDICAL MARIJUANA The Changing Face of Cannabis in America Michael E. Schatman, PhD, CPE, DASPE

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n the current “war on opioids” era, many physicians who treat pain feel that they are without options.

Through this symposium, physicians will learn how they can treat their patients with cannabinoids like cannabidiol.

WHO should attend? Any clinician interested in alternatives to standard pain treatment that are progressively gaining a stronger evidence base.

WHY should they attend? As the evidence-basis of medical cannabinoids grows, providers of pain management services will want to be able to understand their options for treating challenging patients more adeptly.

WHAT will they learn? Attendees will learn about legal, ethical, and clinical issues associated with medical cannabinoids from thought leaders in the field. Importantly, they will learn about the in-depth research that is finally being conducted on specific cannabinoids in the treatment of pain – with an emphasis on cannabidiol.

What Constitutes Best Medical Practice in Regards to Medical Marijuana?

Gilbert J. Fanciullo, MD, MS

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re some patients better candidates than others for medical marijuana? What is the addiction potential for marijuana compared with, for example, nicotine, alcohol, and/or opioids? Due to its ubiquity with respect to receptors and its pleiotropic effects, marijuana may be useful for a number of conditions such as pain, posttraumatic stress disorder, anxiety, and irritable bowel syndrome.

WHO should attend? All healthcare providers.

WHY should they attend? To determine which patients may benefit from the use of medical marijuana.

WHAT will they learn? How to select patients most likely to benefit and at least risk of harm. For example, due to marijuana’s potential for 72-hour residual effects, caution may be advised in prescribing to patients with various employment requirements.

What is the Appropriate Degree of Point-of-Care Testing?

Gilbert J. Fanciullo, MD, MS

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law enforcement official stops a driver and administers a point-of-care (POC) test to determine alcohol and marijuana use. Employers with mandated random drug screens test an employee’s urine for illegal substances, including marijuana. In both cases, the test for marijuana is positive. And, in both cases, the marijuana has been recommended for medical purposes. These two scenarios raise a number of questions regarding the role and implications of POC testing.

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WHO should attend? All healthcare providers.

WHY should they attend? To understand what POC tests are measuring and gain a broader perspective on the potential legal liabilities of authorizing the use of medical marijuana.

WHAT will they learn? Statistics will be presented from the Rocky Mountain HIDTA, a What hair, urine, and saliva tests are available for POC testing for marijuana and how to place results in a clinical context.

COURSE TRACK HiGHLiGHTS

STRESS Evidence-Based Mind/Body Approaches to Pain Management Seddon R. Savage, MD

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urgeoning evidence is shedding new light on the neurobiological mechanisms underscoring the powerful effects of mind/body approaches to pain management. An evidence base is expanding that documents that these approaches can work to improve patients’ quality of life, to augment other treatment modalities, and to reduce their reliance on medications.

Mind/body approaches can crucially reduce stress, improve pain management, and empower patients by facilitating active involvement in their own pain management.

WHO should attend? Healthcare providers, therapists with an interest in improving outcomes of pain treatment by engaging people with pain in a vibrant role of self-care.

WHY should they attend? To learn how to help patients with pain to utilize self-awareness and self-management skills to better manage their pain in the context of other, more specific medical treatments they may receive.

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WHAT will they learn? The session will explore the current scientific understanding of the experience of pain and the role of mind/body interventions in empowering people with pain to improve their quality of life. Dr. Savage will discuss the neuropsychobiology of pain and the influences of co-occurring physical and psychological conditions on the experience of pain. Explained will be the rationale for and efficacy of engaging patients in self-management of pain that include mind/body interventions such as meditation, cognitive behavioral therapy, exercise/movement and group processing. We are learning, for example, that meditation can reduce pain not only through reduction of stress reactivity and muscular tension, which has long been 5:11 PM recognized, but by actually changing the way the brain processes incoming pain signals.

In addition to exploring the science of mind/body approaches to pain management, this session will provide practical strategies to engage persons with pain in active self-care.

COURSE TRACK HiGHLiGHTS

NEUROLOGY Small Fiber Neuropathies Charles E. Argoff, MD, CPE

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mall fiber neuropathy is a painful disorder that frequently is manifested by chronic widespread pain.

Symptoms of small fiber neuropathy—burning and shooting pain, allodynia, and hyperesthesia—may result from myriad diseases, including diabetes, thyroid dysfunction, sarcoidosis, vitamin B12 deficiency, HIV, and neurotoxic medications, among others; however, often no specific cause is determined. Data about treatment for small fiber neuropathy remain sparse. Recent guidelines propose using antidepressants, anticonvulsants, opioids, topical therapies, and nonpharmacologic treatments.

WHO should attend? All clinicians who treat patients with neuropathy.

WHY should they attend? Approximately 40 million people in the United States suffer from peripheral neuropathy and a growing subset of those appears to suffer from small fiber neuropathy.

WHAT will they learn? This presentation will review the causes and symptoms of small fiber neuropathy. History and physical examination are primarily used to diagnose this condition.

Functional neurophysiologic testing and intraepidermal nerve fiber density evaluation using skin biopsy should also be used to confirm the diagnosis, For up to 50% of patients, the diagnosis may, however, remain “idiopathic.” Emphasis will be placed on determining the underlying etiology so that treatment can be tailored as much as possible, including management of associated neuropathic pain.

A Tea Party in Hell: Unraveling the Mysteries of Celebrated Migraineurs Gary W. Jay, MD, DAAPM, FAAPM

WHO should attend? Any healthcare providers who treat migraine with or without aura, and particularly migraine with visual aura.

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WHAT will they learn? Attendees will learn what happens during migraine with aura: the pathophysiology and treatment of migraine with aura, as well as a brief history of what we used to do to treat them, what we do now, and interesting facts about how visual auras can affect people and what they’ve done.

PAiNWEEK’S GOT A LiTTLE BiT OF SOMETHiNG FOR EVERYBODY: THE THERAPEUTiCS OF PAiN MANAGEMENT, RiSK MANAGEMENT STRATEGiES, AND CERTAiNLY CUTTiNG EDGE RESEARCH. MARY LYNN MCPHERSON, PHARMD, BCPS, FASPE, CPE

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estimated 18% of the US population suffers migraines; 20% of these patients experience visual and neurologically-complex perceptual disturbances known as auras, which are believed to have inspired Lewis Carroll’s Alice in Wonderland and the paintings of Vincent van Gogh and Georges-Pierre Seurat.

WHY should they attend? This will be a lighter-side, historic lecture but it will definitely have scientific value, describing the pathophysiology and treatment of migraine aura.

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COURSE TRACK HiGHLiGHTS

PAIN AND CHEMICAL DEPENDENCY Dealing with “Dread to Treat” Patients: Recognition, Diagnosis & Management of Addiction in the Office-Based Setting Heidi Allespach, PhD, and Bernd Wollschlaeger MD, FAAFP, FASAM

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get very little, if any, training in how to work effectively with this extremely difficult patient population.

ne of the most difficult “dread to treat” populations is patients with substance use disorders. If providers cannot learn to see the person who exists under his or her illness—and addiction is a primary, chronic illness—they will not be able to provide effective care.

WHAT will they learn? Dr. Allespach and Dr. Wollschlaeger, both of whom specialize in treating patients with substance use disorders, will help clinicians differentiate between patients who present with “real” pain versus addiction or drug-seeking behavior. For example, patients may experience both emotional as well as physical pain because of their addiction.

WHO should attend? All healthcare providers, especially those with patients with chronic nonterminal pain.

This can be a very draining population, and clinicians may feel inadequate, frustrated, hopeless, and angry. Providers will learn how to care for themselves when dealing with these often problematic patients, including learning how and when to set appropriate boundaries. One example: enforcing medication agreements while not doing anything one is uncomfortable doing in terms of prescribing and/or patient care.

WHY should they attend? Unless the clinician can develop an understanding of what addiction is and how best to interact with patients who have this disease, they will find these relationships very troublesome. Unfortunately, in pain management, addictive behaviors and drug seeking are very common, yet, most clinicians

When Medication & Interventional Strategies Are Not Enough: Physician-Administered Cognitive Behavioral Pain Management Heidi Allespach, PhD

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ven if a patient with chronic pain is doing well with medication and interventional strategies, clinicians need to have additional, effective nonpharmacologic tools to add to their armamentaria.

Dr. Allespach has taken four of the most powerful cognitive behavioral pain management interventions and incorporated them into a three-visit model. Currently, she teaches these evidence-based techniques to primary care physicians as well as specialists.

WHO should attend? Anyone who works at the front line of patient care in decreasing distress and pain and who wants to learn how to administer these brief cognitive behavioral interventions.

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WHY should they attend? To learn how to weave into their practices nonpharmacologic pain management strategies that are brief, easy to learn, and extremely effective.

WHAT will they learn? “I will be teaching participants four different techniques that they can immediately begin utilizing with their patients,” Dr. Allespach said. These techniques are cognitive restructuring, mindfulness exercises, diaphragmatic breathing, and a 6-minute relaxation/imagery exercise. All can be done in a regular office visit and all four can be covered over the course of three visits.

Attendees will also be encouraged to start using the techniques themselves, to “feel happier and to experience a greater sense of perceived control.” In addition, she added, these techniques also “help patients feel empowered and in control, which is critically important for the patient in pain who feels so out of control so much of the time.”

SPECiAL iNTEREST SESSiONS Controversies in Pain Medicine: Is Interventional Pain Management Over or Underutilized?

Charles E. Argoff, MD, CPE; Jeffrey A. Gudin, MD

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illions of dollars a year are spent on medically unnecessary initial interventional pain procedures and repeated procedures despite the failure of significant and persistent pain relief from the first series of injections administered.

According to a recent report by the US Department of Health & Human Services Office of the Inspector General (OIG), 34% of transforaminal epidermal injection services allowed by Medicare in 2007 did not meet federal requirements, resulting in approximately $45 million in improper payments. The most common errors cited in the report were related to documentation of medical necessity.

WHO should attend? Primary care physicians, pain specialists, neurologists, nurse practitioners, physician assistants.

WHY should they attend? The number of interventional pain procedures performed annually has increased dramatically over

the past decade, but these interventions do not appear to have reduced disability and impairment due to chronic pain in the United States.

Attendees will learn more about the proper administration of commonly-performed interventional pain medicine procedures, such as epidural steroid injections for radicular pain from lumbar spine disorders, and the proper documentation of medical necessity.

WHAT will they learn? Presented will be a rational approach to the proper use of these procedures and documentation of indications and findings, such as the patient’s initial lack of response to exercise, oral medications like NSAIDs and muscle relaxants, and other oral medications.

In a point/counterpoint panel lecture, competing arguments will be presented: first, that these are expensive, marginally effective procedures that should be limited; and second, that all treatments available for these challenging patients are expensive and marginally effective, and that interventional procedures are at least as good as available alternative treatments. Audience interaction is recommended.

Psychology of Opioids Beth Darnall, PhD; Sean Mackey, MD, PhD, CPE; and Mark D. Sullivan, MD

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pioids have been overprescribed in recent years, with increasing concern about overreliance and downstream consequences, including opioid use for non-medical purposes, negative side effects, and addiction and abuse.

During this session, Dr. Mackey will discuss the predictors for opioid prescription, including what psychological factors are related to dose and response to long-term opioid use. Included will be epidemiological “big picture” trends.

Dr. Sullivan will focus on opioid discontinuation; specifically, the Pilot Trial of Opioid Taper Support (POTS), and

the national Veterans Affairs study on psychological response predictors to opioid discontinuation. Dr. Darnall will focus on empowering patients to use mind-body techniques and other skills in lieu of opioids to exert better control over the cognitive, behavioral, and emotional factors affecting pain.

WHO should attend? Everyone, especially prescribers of opioids and those who treat chronic pain.

WHY should they attend? Free resources to steer patients in the right direction will be provided.

WHAT will they learn? Surprising findings that fly in the face of what most people would expect and what most people fear from discontinuation of opioids will be presented, including data that suggest long-term use of opioids is not necessarily helpful.

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SPECiAL iNTEREST SESSiONS NSAIDs: Not Just COX-1 and COX-2 Joseph V. Pergolizzi, MD; Robert B. Raffa, PhD

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SAIDs have been used for so long and so commonly that it is possible to become complacent about them, using them out of habit or assuming that all there is to know is whether they are COX-1 or COX-2 “selective” (with the assumption that this is welldefined). This presentation provides both a refresher on the sites and mechanism of action of NSAIDs as well as new thoughts and developments about pharmacokinetics and pharmacodynamics.

WHO should attend? Any practitioner involved in the selection or use of NSAIDs in their clinical practice and is interested in updated

ideas about the use of NSAIDs beyond the too-simplistic COX-1 vs COX-2 designation (eg, target site, appropriate dose, and dosing schedule), in new formulations, and in ideas regarding the design of novel NSAIDs. WHY should they attend? NSAIDs are widely, and increasingly, used in clinical practice. While effective, they also have well-known adverse effects. The key is to maximize the difference.

WHAT will they learn? Attendees will learn that the simple differentiation as COX-1 vs COX-2 is surprisingly imprecise and undervalues the role of other, practical pharmacokinetic and pharmacodynamic factors that can aid in both the understanding and the clinical issues involved in the use of NSAID as analgesics.

The Scorpion and the Frog or Quid Pro Quo? A New Collaborative Approach Stephen J. Ziegler, PhD, JD; Marc Gonzalez, PharmD

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WHO should attend? Any healthcare provider involved in prescribing and pain treatment, as well as those who are interested in reforming the way prescribers are regulated.

WHY should they attend? To understand the critical balancing act that exists between regulators and the regulated, the need for reform, and ways they can participate in reform.

WHAT will they learn? Attendees will learn about the various regulators and regulatory approaches to reducing harm and abuse while ensuring access to appropriate controlled pharmaceuticals.

Attendees will be able to evaluate and discuss a new interactive approach that encourages regulators and prescribers to collaborate on a continual basis to help improve patient care and reduce the harm associated with the improper use of opioids.

THE PRESENTATiONS AT PAiNWEEK ARE SO iMPORTANT, BUT WHAT HAPPENS iN BETWEEN PRESENTATiONS iS EQUALLY iMPORTANT. WE GET A CHANCE TO TALK WiTH ONE ANOTHER, SHARE iDEAS, AND SHARE iNNOVATiONS. ILENE R. ROBECK, MD

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mong the various laws, policies, and approaches that have been created to reduce prescription drug abuse, the law enforcement model dominates.

While law enforcement efforts have helped reduce the harms associated with drug abuse, those same efforts have also negatively impacted prescribing behavior and the treatment of pain. In an effort to reduce these unintended side effects, stakeholders from the law enforcement and pain communities have tried to create policies that ensure legitimate access to opioids while at the same time prevent their abuse. However, many of these balanced policy efforts have failed. Consequently, a new collaborative approach between drug regulators and prescribers is needed.

WHERE OTHERS SEE COMPLEX PROBLEMS, MALLINCKRODT SEES UNIQUE SOLUTIONS Today’s Mallinckrodt Pharmaceuticals combines more than 146 years of expertise with the determined focus needed to solve the complex specialty pharmaceutical challenges of today. Whether it’s the production of medicines for pain or ADHD, the development of drugs that treat CNS conditions, or providing patients with hospital-based analgesia treatment options, we are working to make complex products simpler, safer and better for patients.

Learn more at www.mallinckrodt.com

Mallinckrodt, the “M” brand mark and the Mallinckrodt Pharmaceuticals logo are trademarks of a Mallinckrodt company. © 2014 Mallinckrodt.

JOB NUMBER: 13-MAL-1054

SAFETY AREA: .5” all sides

FILENAME: 13-MAL-1054_Ad_8.x10.875.indd

COLOR SPACE: CMYK (no embedded profile)

JOURNAL:

PAINWeek Pre Conference Preview

ARTIST:

TRIM SIZE:

8” x 10.875”

REVISION: Final

BLEED SIZE:

8.25” x 11.125” (.125” bleeds)

DATE: 2014-07-16

Mike 518-693-6960 x1305