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Primary Care Management of Neuropathic Pain: Approaches for Accurate Assessment and Appropriate Treatment

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Premiere Date: Tuesday, December 4, 2012

This activity offers CE credit for:

1. Physicians (CME)
2. Pharmacists (ACPE)
3. Other

All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™

Credit Expiration Date:
Thursday, December 4, 2014
Note: Credit Is No Longer Available

Faculty

W. Vaughn McCall, MD, MS (Moderator) Case Distinguished University Chair Department of Psychiatry and Health Behavior Executive Vice Dean Medical College of Georgia Augusta University Augusta, GA

Daniel Clauw, MD  Professor of Anesthesiology, Medicine, and Psychiatry Director, Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor, MI

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Statement of Need

Neuropathic pain is a challenge to health care providers because it is often underdiagnosed and undertreated. It may be associated with variable levels of pain, problems with the activities of daily living, impaired quality of life, and functional disabilities.(1)

The impact of neuropathic pain is well known to those who have experienced it themselves and to the clinicians who specialize in the care of these patients. Neuropathic pain causes immense suffering that is accompanied, all too often, by a pervasive sense of alienation as the individual moves from doctor to doctor in search of an answer, if not a cure.(1)

It has only recently become clear that there is little to match the pain that arises from neuropathic causes. In a landmark study, Melzack and colleagues demonstrated that neuropathic pain exceeded every other cause of pain in the intensity of its effects. Thus possibly more than any other area of medicine, neuropathic pain demands that a thorough scientific knowledge of pain be partnered with the utmost in professional qualities.(2) Neuropathic pain has been a particularly difficult challenge to the research and clinical communities in the overall management because the severity of pain and resistance to treatment.(3)

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1. Fields HL. Neuropathic pain: a conceptual history. In: Dworkin RH, ed. Neuropathic Pain: Mechanisms, Diagnosis and Treatment. New York, NY: Oxford University Press; 2012: pp. 1-13.
2. Melzack R, Coderre TJ, Katz J, Vaccarino AL. Central neuroplasticity and pathological pain. Ann N Y Acad Sci. 2001;933:157-174. PMID: 12000018.
3. Treede RD. Peripheral and central mechanism of pain. In: Dworkin RH, ed. Neuropathic Pain: Mechanisms, Diagnosis and Treatment. New York, NY: Oxford University Press; 2012: pp. 14-24.

Activity Goal

To present current diagnostic presentations of, and treatment approaches to, neuropathic pain.

Learning Objectives

At the end of this CE activity, participants should be able to:

• Increase recognition and diagnosis of neuropathic pain. According to the AMA’s 2012 Physician Quality Reporting System, a thorough assessment that includes the use of a self-report questionnaire and documentation of pain is a critical step to take before initiating treatment and follow-up.(1)
• Implement appropriate pharmacological approaches in the management of neuropathic pain.
• Recommend non-pharmacological, adjunctive approaches such as exercise and cognitive-behavioral therapy to patients with neuropathic pain.(1)

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American Medical Association. 2012 PQRS quality measures, #131. 2012. http://www.ama-assn.org/apps/listserv/x-check/qmeasure.cgi?submit=PQRS2012.

Financial Support

This activity is supported by an educational grant from Endo Pharmaceuticals.

Target Audience

Physicians, pharmacists, and health care professionals whose scope of practice involves pain management.

Credit Information

CME Credit (Physicians):
USF Health is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of .5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. .5 contact hours (0.05 CEUs)
Universal Activity Number: 0376-0000-12-030-H01-P (recorded programs)
Activity Type: knowledge-based

Post-tests, credit request forms, and activity evaluations must be completed online at www.cmeoutfitters.com/TST729 (requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit www.neurosciencecme.com/technical.asp.

Disclosure of Relevant Financial Relationships with Commercial Interests

USF Health and CME Outfitters, LLC, adhere to the ACCME Standards, as well as those of the ACPE, APA, and ANCC, regarding commercial support of continuing medical education. It is the policy of USF Health and CME Outfitters, LLC, that the faculty and planning committee disclose real or apparent conflicts of interest relating to the topics of this educational activity, that relevant conflict(s) of interest are resolved, and also that speakers will disclose any unlabeled/unapproved use of drug(s) or device(s) during their presentation.

A conflict of interest is created when individuals in a position to control the content of CME have a relevant financial relationship with a commercial interest which therefore may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks or other financial benefits.

USF Health and CME Outfitters will identify, review, and resolve all conflicts of interest that speakers, authors or planners disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist between the following individuals and commercial interests:

Dr. McCall has nothing to disclose.

Dr. Clauw has disclosed that he receives grants/research support from Forest Laboratories, Inc.; and Pfizer Inc. He serves as a consultant to Cypress Biosciences, Inc.; Eli Lilly and Company; Forest Laboratories, Inc.; Jazz Pharmaceuticals, Inc.; Merck & Co., Inc.; Pfizer Inc.; Pierre Fabre Pharmaceuticals USA; and UCB, Inc.

Disclosures were obtained from the planning committee members and are on file in the USF Health Office of Continuing Professional Development (OCPD) for review. Disclosures were obtained from the USF Health OCPD staff: Nothing to Disclose.

Tony Graham, MD (content/peer reviewer) has nothing to disclose.

Robert Kennedy, MA (planning committee) has nothing to disclose.

Sharon Tordoff, CCMEP (planning committee) has nothing to disclose.

Joy Bartnett Leffler, MLA, NASW, CSE (planning committee) has nothing to disclose.

Sandra Haas Binford, MAEd (planning committee) has nothing to disclose.

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

USF Health, CME Outfitters, LLC, the faculty, and Endo Pharmaceuticals do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

Equal Opportunity Statement: Events, activities, programs and facilities of the University of South Florida are available to all without regard to race, color, marital status, gender, sexual orientation, religion, national origin, disability, age, Vietnam or disabled veteran status as provided by law and in accordance with the university's respect for personal dignity.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).