CME Program

Pain Management

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Course Description

Managing patient pain can be a tremendous challenge. A variety of factors contribute to the pressures experienced by providers who deal with pain management every day. Trying to “stay on top” of what continues to evolve in the clinical pain management literature is difficult. Other factors include the multiple regulatory bodies that impose constraints on prescribing certain types of medications, the exponential growth of clinical practice guidelines for managing pain, and the drug abuse and drug diversion programs simultaneously occurring across the country. Noteworthy under-treatment and over-treatment malpractice claims and criminal prosecutions for illegal prescribing practices have increased both providers’ and the public’s awareness of pain management challenges.

To get a sense of the pressures facing healthcare providers, it is important to consider a number of different pain management practice factors. Factors fall within three general domains:

• External influences or pressures (e.g., laws, regulations, clinical guidelines, nationwide increases in pain medication prescribing and public awareness of prescription pain medication abuse)
• Patient factors (e.g., the growth of the chronic pain patient population, growing pain health literacy regarding pain medication, and complicating comorbidities)
• Practitioners concerns (e.g., the subjective nature of pain, the difficulties of keeping up with the pain management literature, fear of patient addiction, fear of prosecution for prescribing practices, and pressures from health plans to keep the patients satisfied)

This course uses NORCAL closed claims, appellate court decisions, medical board disciplinary filing and Drug Enforcement Administration (DEA) criminal cases to address these factors through risk management strategies designed to help providers successfully navigate pain management challenges.

While reading this course, course participants are encouraged to take advantage of the information contained in the appendices:

Appendix 1: Glossary of Pain Management Terms
Appendix 2: Resources
Appendix 3: Sample Tools and Forms
Appendix 4: Model Policy for the Use of Controlled Substances for the Treatment of Pain
Appendix 5: Selected Pain Management Laws and Regulations

Target Audience

This course is intended for all healthcare providers who manage pain patients.

Educational Objectives

By implementing the risk management recommendations herein, participants will be able to:

• Identify and address barriers/obstacles to successful pain management in their practices.
• Select and implement an appropriate pain assessment tool.
• Implement appropriate informed consent practices related to the treatment of pain, utilizing communication strategies that facilitate comprehension and compliance.
• Properly utilize therapeutic agreements for opioid use.
• Recognize and abide by laws regulating the prescription and dispensing of controlled substances.

Disclosure Policy

As an ACCME accredited provider, NORCAL Mutual Insurance Company requires planners, reviewers or authors who influence or control content of a CME activity to disclose financial relationships (of any amount) they have with commercial interests associated with the CME activity during the past 12 months. Any identified conflicts of interest are resolved prior to the commencement the activity.

Disclosure

Individuals involved in the planning, reviewing or execution of this activity have indicated they have no relevant financial relationship to disclose.

Content Advisors/Planners

Stephen M. Farber
Vice President, Risk Management and Continuing Medical Education

Dustin Shaver
Manager, Risk Management and Continuing Medical Education

Paula Snyder, RN CPHRM
Manager, Risk Management

Marlene Nazerey, RN, MSN
Manager, Risk Management

Josh Hyatt, MHL, CPHRM
Risk Management Specialist

Sonia Rutherford
Risk Management/CME Program Services Coordinator

Mary-Lynn Ryan
Consulting Risk Management Specialist

Jo Townson
Risk Management Specialist/Continuing Medical Education

Expert Reviewers

Bernard Wilcosky, MD
Anesthesiology/Pain Management
Redwood City, CA

Accreditation Statement
NORCAL Mutual Insurance Company is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement
NORCAL Mutual Insurance Company designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Original release date: September 2009
Expiration date: September 30, 2012