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Clinical Issues in Chronic Pain: <em>Consensus and Controversies for Responsible Opioid Prescribing</em>

Clinical Issues in Chronic Pain: Consensus and Controversies for Responsible Opioid Prescribing



Time to Complete

1 hour


January 11, 2016


January 11, 2017
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Maximum Credits

1.00 / AMA PRA Category 1 Credit(s)TM
1.00 / CE for Nurse Practitioners (0.50 pharmacology credit)
1.00 / CE for Pharmacists (0.10 CEUs)

Accredited Provider

This activity is jointly provided by Global Education Group and Integritas Communications.

Commercial Supporter

This activity is supported by an educational grant from Teva CNS

Program Description

Affecting an estimated 100 million adults in the United States, chronic pain is among the most common reasons that patients seek medical treatment.1 Prescription opioids are an established treatment option for functionally limiting chronic pain severe enough to require around-the-clock therapy.2-4 Indeed, opioids are the cornerstone of cancer pain treatment,2,3 and have gained acceptance—though not unqualified—for select patients with noncancer chronic pain.4 Unfortunately, increased opioid prescribing for patients in pain has been mirrored by higher rates of opioid abuse and overdose.4 For example, in recent years, prescription opioids have been linked to approximately three quarters of pharmaceutical overdose deaths in the United States.4,5 To ensure patient safety and meet regulatory requirements, clinicians must adopt responsible prescribing strategies, including assessing all patients for risks related to opioid pharmacology and potential aberrant drug use.4 Initial risk-stratification efforts must be accompanied by appropriate follow-up monitoring and meticulous documentation of clinical decision making. Even among pain management experts, recommendations for the individualization of opioid-based regimens, incorporation of urine drug testing, and potential roles of abuse-deterrent opioid formulations continue to evolve.6-8 During this Clinical IssuesTM program, an expert faculty panel will discuss and debate guideline recommendations and newly published data on long-term opioid therapy, while providing practical advice on the growing evidence pool, risk-mitigation strategies, and regulatory requirements.


1. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011.
2. Swarm RA, Abernethy AP, Anghelescu DL, et al. National Comprehensive Cancer Network: Adult Cancer Pain. J Natl Compr Canc Netw. 2013;11(8):992-1022.
3. Portenoy RK. Treatment of cancer pain. Lancet. 2011;377(9784):2236-2247.
4. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
5. Warner M, Hedegaard H, Chen L-H. Trends in Drug-poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 1999-2012. NCHS Health E-Stat. Atlanta, GA: Centers for Disease Control and Prevention/National Center for Health Statistics; 2014.
6. Peppin JF, Passik SD, Couto JE, et al. Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain. Pain Med. 2012;13(7):886-896.
7. Butler SF, Cassidy TA, Chilcoat H, et al. Abuse rates and routes of administration of reformulated extended-release oxycodone: initial findings from a sentinel surveillance sample of individuals assessed for substance abuse treatment. J Pain. 2013;14(4):351-358.
8. Simon K, Worthy SL, Barnes MC, Tarbell B. Abuse-deterrent formulations: transitioning the pharmaceutical market to improve public health and safety. Ther Adv Drug Saf. 2015;6(2):67-79.

Intended Audience

The educational design of this activity addresses the needs of pain specialists, primary care providers, and other clinicians involved in opioid-based management of chronic pain.

Educational Objectives

After completing this activity, the participant should be better able to:

  • Assess candidates for chronic opioid therapy via comprehensive clinical interviews, reviews of the medical history, physical exam, and stratification of risks for drug misuse and abuse
  • Discuss the clinical profiles of current and emerging prescription opioid analgesics, including abuse-deterrent formulations
  • Initiate opioid trials for patients with functionally impairing chronic pain severe enough to require around-the-clock, long-term therapy
  • Tailor opioid-based regimens founded on evaluations of analgesia, functional goals, side effects, and risk evaluation and mitigation strategy (REMS)–compliant principles for patient monitoring and documentation
  • Engage in open dialogues with patients with chronic pain about actively participating in a care plan, adhering to the treatment regimen, and safely using prescription opioid analgesics

Conflict Of Interest Disclosure Policy

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.


Charles E. Argoff, MD
Professor of Neurology
Albany Medical College
Director, Comprehensive Pain Center
Albany Medical Center
Albany, New York

Dr. Argoff discloses:
Consultant/Independent Contractor: AstraZeneca, Depomed, Endo, Janssen, Nektar, Pfizer, Purdue, Teva, Xenoport, Zogenix
Grant/Research Support: Dong Therapeutics, Endo, Forest Labs, Lilly
Speakers Bureau: Allergan, AstraZeneca, Depomed, Janssen, Xenoport
Stock Shareholder: Depomed, Pfizer
Other/Royalty: Elsevier

Jeffrey A. Gudin, MD
Pain Management and Wellness Center
Englewood Hospital and Medical Center
Englewood, New Jersey

Dr. Gudin discloses:
Consultant/Independent Contractor: AstraZeneca, Scilex
Speakers Bureau: AstraZeneca, Scilex

Steven P. Stanos, DO
Medical Director, Swedish Pain Services
Medical Director, Occupational Medicine Services
Swedish Health Services and Swedish Medical Group
Seattle, Washington

Dr. Stanos discloses:
Consultant/Independent Contractor: Analgesic Solutions, AstraZeneca, myMatrixx, Pfizer, Purdue

Planners' and Managers' Disclosures

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME/CE activity:

Kristen Delisi has nothing to disclose.
Amanda Glazar, PhD, has nothing to disclose.
Andrea Funk has nothing to disclose.
Laura Gilsdorf has nothing to disclose
Jim Kappler, PhD, has nothing to disclose.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas. Global is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

Global Education Group designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.




CE for Nurse Practitioners

Accreditation Statement

Global Education Group is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners: AANP Provider Number 110121. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Standard.

Designation Statement

This program has been approved for 1.00 contact hour of continuing education (which includes 0.50 hours of pharmacology).




CE for Pharmacists

Accreditation Statement

Global Education Group is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Designation Statement

Global Education Group designates this continuing education activity for 1.00 contact hour (0.10 CEUs) of the Accreditation Council for Pharmacy Education.

(Universal Activity Number - 0530-9999-15-209-H04-P)

This is a knowledge-based activity.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Fee and Refund / Cancellation Policy

There is no fee for this educational activity.


In order to receive credit for this activity, the participant must complete the pre-activity questionnaire, post-test, and program evaluation. Participants must also score at least 70% on the post-test. Certificates will be distributed online at the conclusion of the activity. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

For information about the accreditation of this program, please contact Global at 303-395-1782 or

If you have any other questions relating to your certificate or other issues with the activity, please contact

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