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Improving Outcomes in Chronic Pain


Improving Outcomes in Chronic Pain

CME Certificate Fee: $25.00 (USD) per hr./credit
Up to 14.50 AMA PRA Category 1 Credit(s)TM
Estimated time to complete this activity: up to 14.50 hours
Author(s): Charles Chabal, MD; Bennet Davis, M.D.; Thomas Elliott, M.D.
DISCLOSURE STATEMENT: All author(s), contributor(s), editor(s), and CME Office Reviewer(s) state that they do not have any financial arrangements with commercial interests that could constitute a conflict of interest.
Further Author Information | Further CME Information
Meets Special CME Requirements in: California, Connecticut, Georgia, Iowa, Massachusetts, Nevada, New Mexico, Oregon, Rhode Island, Texas, Vermont, Virginia     Learn More >>

Course Learning Objectives:

  • Recognize how to diagnose common pain problems.
  • Assess and manage functional status in pain patients.
  • Manage long-term pain medications, particularly opioids.
  • Utilize referral and ancillary care providers in treating chronic pain.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by course or module). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine - Tucson
Credit Designation and Accreditation Statements >>
Current Approval Period: January 6, 2016 - January 5, 2018
Original Release Date: January 6, 2006
Most Recent Review by Author: January 6, 2016
Most Recent Review by CME Sponsor: January 6, 2016
Financial Support Received: Initial program development supported by a grant from the National Institute of Neurological Disorders and Stroke, #R43 NS045361
Improving Outcomes in Chronic Pain
Up to 14.50 AMA PRA Category 1 Credit(s)TM
Current Approval Period: January 6, 2016 - January 5, 2018
Financial Support Received: Initial program development supported by a grant from the National Institute of Neurological Disorders and Stroke, #R43 NS045361

ACCME/AMA PRA Accreditation Statement

The University of Arizona College of Medicine - Tucson is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Arizona College of Medicine - Tucson designates this enduring material for a maximum of 14.50 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


CME Office Contact Information and CME Disclosure

The University of Arizona College of Medicine - Tucson
Office of Continuing Medical Education
520-626-7832
uofacme@email.arizona.edu

The following University of Arizona College of Medicine - Tucson CME Reviewers, Activity Directors, or Planning Committee Members have no relevant financial relationships with commercial interests that could constitute a conflict of interest with the proposed activity:

Robert Amend, M.Ed.
Randa Kutob, MD

Improving Outcomes in Chronic Pain
Authors/Editor

Authors

Charles Chabal, M.D.
Director, Evergreen Pain Management Center
Chief Science Officer, Talaria, Inc.

Dr. Chabal directs the Evergreen Pain Management Center in Seattle, Washington. He has authored numerous articles and textbook chapters on pain medicine.

Dr. Chabal is certified in anesthesiology and pain management by the American Board of Anesthesiology. He is the founder and Chief Science Officer of Talaria Inc., a research company specializing in pain management medical device development, healthcare information dissemination, and medical informatics. He previously served as Director of Pain Services at the VA Puget Sound.

Disclosure: Dr. Chabal states that he does not have any financial arrangements that could constitute a conflict of interest.

Bennet Davis, M.D.
Assistant Professor
University of Arizona College of Pharmacy

Dr. Davis is President of the Integrative Pain Center of Arizona, a multidisciplinary pain clinic serving the southwestern United States. He is also Assistant Professor in the Department of Pharmacy Practice and Science at the University of Arizona College of Pharmacy.

Dr. Davis is certified in pain management by the American Board of Anesthesiology. He previously directed the fellowship program in Pain Medicine at the University of Arizona College of medicine.

Disclosure: Dr. Davis states that he does not have any financial arrangements that could constitute a conflict of interest.

Thomas Elliott, MD
Adjunct Professor
University of Minnesota, Duluth, School of Medicine

Until his recent retirement, Dr. Elliott was the Medical Director of the Pain Management Center and Chief of Education and Research at St. Mary's/Duluth Clinic Health System in Duluth, Minnesota. He is currently Adjunct Professor of Medicine at the University of Minnesota, Duluth School of Medicine.

Dr. Elliott is certified in Internal Medicine, Hematology/Medical Oncology, and Hospice and Palliative Medicine by the American Board of Internal Medicine. He is nationally known for his work in pain management education and his research in pain treatment, including his work as CEO of the Minnesota Cancer Pain Initiative. He has written extensively on the need for improved medical education in pain management.

Disclosure: Dr. Elliott states that he does not have any financial arrangements that could constitute a conflict of interest.

Editor

John Harris Jr., M.D., M.B.A.
Clinical Assistant Professor of Medicine
University of Arizona, College of Medicine

Dr. Harris is past Executive Director of the Office of CME at the University of Arizona College of Medicine. Dr. Harris has served as the Principal Investigator on multiple NIH-funded studies of online CME, and he is the author of a number of professional papers dealing with online CME.

Disclosure: Dr. Harris states that he does not have any financial arrangements that could constitute a conflict of interest.

Improving Outcomes in Chronic Pain
Ratings (2712 responses)
How would you rate this program overall?
Average Rating: 4.43/5.00
How well were the learning objectives of this program met?
Average Rating: 4.47/5.00
How relevant was the information in this program to your clinical practice?
Average Rating: 4.11/5.00
Likelihood you will make a change in practice behavior based on your participation in this activity.
Average Rating: 4.00/5.00
User Comments
by Hidden | May 15, 2017
One of the best uses of video in a physical examination format that I have run across.
by Steven Kozmary | May 13, 2017
10. Lumbar facet injections This selection is incorrect! There is no evidence supporting any benefit from therapeutic vertebral facet joint injection of local anesthetic and/or steroids. Joint denervation techniques have supplanted joint injections for facet joint pain ( Slipman et al., 2003). Joint denervation techniques can not be done prior to doing facet joint injections, typically injecting local anesthetic around the medial branch nerves to the facet joints. Morphine is an opiate or a substance derived directly from opium. An immunoassay screening test is very responsive for morphine, codeine, and heroin (natural opiates), but non-responsive for semisynthetic and synthetic opioids (all opioids, except morphine, codeine, heroin). Cross-reactivity on immunoassay testing may occur when ephedrine or pseudoephedrine are present, resulting in a positive test for amphetamine/methamphetamine. We don’t do screening tests for urine. Medicare does not pay for any screening tests. Urine drug testing is a better and more accurate term. Immunoassay has incorrect, either false positives or false negatives in approximately 15% of the tests done necessitating confirmation testing with liquid chromatography and mass spectrometry. 6.  Continue all current drugs unchanged. This selection is incorrect! In view of her current outcomes, the opioid, antidepressant, and acetaminophen doses and schedules shouldn’t be changed at this visit. However, the Senna dose should be increased to better manage her constipation. Since the constipation is almost certainly opiate induced constipation, Senna will be ineffective despite an increased dosage. A better choice would be one of the newer medications for opiate induced constipation e.g. movantik, or relistor.
by Ayne Iafolla | May 1, 2017
I am a neonatologist. I do not manage chronic pain. It would be nice to have something pediatric or neonatal.
by Francisca Lytle, M.D. | Feb 25, 2017
The initial visit should have included a detailed (and of necessity usually lengthy) discussion on Regional Pain syndrome as a well informed patient can help avoid the full blown syndrome. I find I rarely need to resort to medication such as gabapentin, and certainly not narcotics, if patient is treated aggressively immediately! This includes full weight bearing immediately and NSAIDs only if needed for pain. It takes time to explain the condition to patients but if you do, especially if patient understands what a full blown condition will be like, you will almost always be able to prevent it! When in doubt early referral to orthopaedic is therefore to be recommended. I disagree with the course taken in this patient!
by Francisca Lytle, M.D. | Feb 25, 2017
If this were my patient I would complete the medical work up, I routinely schedule one hour for patients with chronic back pain. It is not appropriate to diagnose fibromyalgia after a limited visit. I am doing this course because of need for CME re pain management. This is not how I treat my chronic pain patients!
by Amy Wecker | Feb 15, 2017
was concise, but thorough, very good!
Improving Outcomes in Chronic Pain
This course meets general AMA PRA Category 1 CME Credit(s)TM requirements in states that have a CME requirement.

Based on information from state licensing authorities, this program meets special CME requirements in these states:

California Pain Management CME
Connecticut Behavioral Health CME
Georgia Pain Management CME / Palliative Medicine
Iowa Chronic Pain Management CME
Massachusetts Opiod Education/Pain Management CME
May be counted as risk management credits.
Nevada Ethics CME
New Mexico Pain Management CME
Oregon Pain Management CME / Terminally Ill / End-of-life
Rhode Island Opioid pain management / Chronic pain management CME
Texas Pain Management CME (pain clinics only)
These courses meet the pain management CME requirement for pain management clinics.
Vermont Hospice / Palliative Care / Pain Management CME
Virginia Pain Management and the Proper Prescribing of Controlled Substances CME

View other courses meeting Special State Requirements
Improving Outcomes in Chronic Pain
Technical Requirements

This web-based activity is offered online and requires an always-on connection to the Internet (the activity cannot be downloaded). The activity works on PC or Mac computers and most tablet computers. The activity should work with the newer versions of major Internet browsers, including Internet Explorer, Firefox, Google Chrome, and Safari. JavaScript should be enabled in all browsers, and Popups and first party cookies need to be accepted from www.VLH.com. You should also have the latest, free Adobe Reader installed for reading documents.

For additional information, read the Technical Assistance FAQ.

This program also requires that you have the latest free Flash Player.

IMPORTANT for iPad Users: Please download and use the Free Puffin Browser from the app store if you want to complete this course on an iPad.

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