DIALOGUES IN PERSISTENT PAIN Release Date: December 2005 Expiration Date: December 31, 2007 NEEDS ASSESSMENT Because of their narcotic properties and adverse event profiles, there has been a movement away from opioid therapies for pain management. Complicating current treatment regimens is the recent announcement by the US Food and Drug Administration asking for the withdrawal of several of the cyclooxygenase (COX)-2 inhibitors (rofecoxib and valdecoxib) from the market due to the high risk of adverse cardiovascular events and the addition of a black box warning on other prescription nonsteroidal anti-inflammatory drugs (NSAIDs). These factors, and others, have created an increased need for education regarding safe, effective treatment of chronic pain. Hence, a program that addresses chronic, persistent pain states and that provides clinical data regarding new and evolving treatment strategies with nonopioid adjuvant analgesics will provide valuable information to clinicians. LEARNING OBJECTIVES Recognize and differentiate between chronic, persistent pain states Review current treatment modalities for these pain categories; review thresholds for treatment; and define safe, efficacious therapies Discuss evolving therapies, especially nonopioid adjuvant analgesics, for the treatment of chronic pain states Identify alternatives to opioids, COX-2 inhibitors, and NSAIDs TARGET AUDIENCE This activity has been developed for clinicians who specialize in pain management, including anesthesiologists, neurologists, physical medicine and rehabilitation specialists, and primary care physicians. PHYSICIAN ACCREDITATION This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Dannemiller Memorial Educational Foundation and SynerMed® Communications. The Dannemiller Memorial Educational Foundation is accredited by the ACCME to provide continuing medical education for physicians. DESIGNATION OF CREDIT The Dannemiller Memorial Educational Foundation designates this educational activity for a maximum of 1 Category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity. METHOD OF PARTICIPATION This CME activity should take approximately 1 hour to complete. This activity consists of a slide presentation with comprehensive annotations. To complete this activity the participant should, in order, read the CME information, view the slide presentation, go to the link provided at the end of the activity to take the posttest, complete the registration and evaluation, and print the CME certificate. The evaluation form provides each participant with the opportunity to comment on the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his or her views on future educational needs. To receive credit for this activity, follow the instructions provided on the posttest. If you have questions, you can contact Ed Dyer at edd@dannemiller.com. The activity expires on December 31, 2007, and no credit will be awarded after this date. FACULTY STEVEN SIMON, MD, RPh PROGRAM DIRECTOR JENNIFER S. KRIEGLER, MD JOSHUA PHILIP PRAGER, MD, MS Clinical Assistant Professor University of Kansas Department of Physical Medicine and Rehabilitation Overland Park, Kansas Clinical Assistant Professor Kansas City University of Medicine and Biosciences Department of Family Practice Kansas City, Missouri Associate Professor of Neurology (Clinical) Case Western Reserve University The Cleveland Clinic Foundation Department of Neurology Section of Headache Cleveland, Ohio Director Center for Rehabilitation of Pain Syndromes Director California Pain Medicine Centers at UCLA Los Angeles, California A portion of the content of this educational activity was developed during a Steering Committee held in Short Hills, New Jersey, in July 2005. Faculty at that Steering Committee included: Steven Simon, MD, RPh, Program Chair; Bernard M. Abrams, MD; Jennifer S. Kriegler, MD; John Claude Krusz, MD, PhD; Joshua Philip Prager, MD, MS; Howard L. Rosner, MD; Michael J. Schwartz, MD; and Todd P. Stitik, MD. DISCLOSURE In accordance with the Accreditation Council for Continuing Medical Education (ACCME), the Dannemiller Memorial Educational Foundation requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest. Accordingly; Dr. Abrams declares he has no financial interest or other relationship with any manufacturer of any commercial product. Dr. Kriegler is a speaker for Pfizer Inc, GlaxoSmithKline, Xcel Pharmaceuticals, Inc, Endo Pharmaceuticals, Ortho-McNeil Pharmaceutical, Inc, AstraZeneca, and Merck & Co. Inc. Dr. Krusz is a speaker for GlaxoSmithKline, Pfizer Inc, Sepracor Pharmaceuticals, Abbott Laboratories, and Ortho-McNeil Pharmaceutical, Inc. He is a consultant/advisor for Guilford Pharmaceuticals Inc. He has been an investigator and has received grant support from GlaxoSmithKline, Pfizer Inc, Abbott Laboratories, and Eiasi. He and his spouse/partner hold stock at AstraZeneca, Forest Laboratories, GlaxoSmithKline, ICOS, Pfizer Inc, Pozen, Inc, and Sepracor Pharmaceuticals. Dr. Prager is a speaker for Elan Corporation, Medtronic, Inc, Advanced Bionics Corporation, Endo Pharmaceuticals, Pfizer Inc, Janssen, and Ortho-McNeil Pharmaceutical, Inc. He is a consultant/advisor for Elan Corporation, Medtronic, Inc, and Advanced Bionics Corporation. He has been an investigator and has received grant support from Elan Corporation, Medtronic, Inc, Advanced Bionics Corporation, Endo Pharmaceuticals, and Celgene Corporation. He is on the speakers bureau for Cephalon, Inc, Eli Lilly and Company, and Alpharma Inc. Dr. Rosner is a speaker for Cephalon, Inc, Purdue Pharma, Pfizer Inc, and Endo Pharmaceuticals. Dr. Schwartz declares he has no financial interest or other relationship with any manufacturer of any commercial product. Dr. Simon is a speaker for Cephalon, Inc, Pfizer Inc, Alpharma Inc, Ortho-McNeil Pharmaceutical, Inc, Janssen, Purdue Pharma L.P, and Cornerstone BioPharma, Inc. He is a consultant/advisor for Cephalon, Inc. His spouse/partner has been an investigator and has received grant support from Cephalon, Inc, Pfizer Inc, Endo Pharmaceuticals, and Allergan, Inc. Dr. Stitik declares he has no financial interest or other relationship with any manufacturer of any commercial product. The Dannemiller staff and SynerMed® staff that was involved in the development of this activity have no financial relationships with any commercial interest that are relevant to this activity. To resolve identified conflicts of interest, the educational content was fully peer reviewed by a physician member of the Dannemiller Clinical Content Review Committee who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence-based and commercially balanced. OFF-LABEL/UNAPPROVED USE DISCLOSURE This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program. NOTICE: In accordance with ACCME Standards for Commercial Support, the audience is advised that this continuing medical education activity does contain references to unlabeled or unapproved uses of olanzapine, clozapine, amitriptyline, imipramine, fluoxetine, sertraline, duloxetine, carbamazepine, phenytoin, gabapentin, lamotrigine, pregabalin, oxcarbazepine, tizanidine, clonidine, pamidronate, lenalidomide, dextromethorphan, quetiapine, phenobarbital, primidone, ethosuximide, valproic acid, tiagabine, levetiracetam, zonisamide, and felbamate. DISCLAIMER The content and views presented in this educational program are those of the authors and do not necessarily reflect those of the Dannemiller Memorial Educational Foundation, Acorda® Therapeutics, or SynerMed® Communications. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information provided by the faculty. This educational activity is available on the Internet at: www.pain.com/persistent_pain and www.MedCME.org
	This activity is jointly sponsored by the Dannemiller Memorial Educational Foundation and SynerMed® Communications.
	Supported by an unrestricted educational grant from Acorda® Therapeutics