Overview

Well-documented abuse and overdose risks associated with high-dose opioid therapy require clinicians to consider alternative modalities when severe, chronic pain is refractory to conventional management strategies. This program examines the potential benefits and risks of delivering analgesics intrathecally, including recommendations on appropriate candidates, intrathecal medication options, and longitudinal patient monitoring.

Learning Objectives

  • Discuss neurobiologic mechanisms that contribute to severe chronic pain, and support the therapeutic value of various intrathecal analgesics
  • Identify patients with severe chronic pain who should be referred to interventional pain specialists as potential candidates for intrathecal therapy
  • Describe the clinical profiles of analgesic medications approved by US Food and Drug Administration (FDA) for intrathecal delivery
  • Monitor patients being treated with intrathecally delivered analgesics to document ongoing pain relief, functional outcomes, and treatment-emergent

Faculty Disclosures

Timothy R. Deer, MD, DABPM, FIPP

Advisory Board: Axonics Modulation Technologies, Inc., Bioness Inc., Flowonix Medical Inc., Jazz Pharmaceuticals, Medtronic, Nevro Corp., St. Jude Medical, Inc.

Consultant/Independent Contractor: Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Flowonix Medical Inc., Medtronic, Nevro Corp., Saluda Medical Pty Ltd., SpineThera, Inc., St. Jude Medical, Inc., Vertos

Medical Inc.; Grant/Research Support: Bioness Inc., Jazz Pharmaceuticals, Medtronic, St. Jude Medical, Inc.

Speakers Bureau: Jazz Pharmaceuticals; 

Stock Options: Axonics Modulation Technologies, Inc., Bioness Inc., Ethos Pharmaceuticals, Inc., Saluda Medical Pty Ltd., SpineThera, Inc., Vertos Medical Inc.

Charles E. Argoff, MD, FABPM

Advisory Board: Depomed, Inc., Grünenthal GmbH, Pfizer Inc., Quest Diagnostics, SCILEX Pharmaceuticals, Inc., Teva Pharmaceutical Industries Ltd.

Grant/Research Support: Endo Pharmaceuticals Inc., Forest Laboratories, Grünenthal GmbH

Speakers Bureau: Allergan USA, Inc., Avanir Pharmaceuticals, Inc., Depomed, Inc., Endo Pharmaceuticals Inc., Pernix Therapeutics Holdings, Inc., Teva Pharmaceutical Industries Ltd., XenoPort, Inc.

Stock Shareholder: Depomed, Inc., Pfizer Inc.

Salim Hayek, MD, PhD

Nothing to disclose.

Disclosures

Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose.

CME Information

CME

AMA PRA Category 1 Credits

Accreditation Statement

pmiCME is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.


Designation Statement

pmiCME designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME

AANP

Accreditation Statement

pmiCME is approved as a provider of nurse practitioner continuing education by the American Association of Nurse Practitioners. AANP Provider number 040308. This activity was planned in accordance with AANP Accreditation Standards and Policies.


Designation Statement

This program has been approved for 0.50 contact hour of continuing education, which includes 0.00 hour of pharmacology.

Instructions for Obtaining Credit

Once you have completed the activity, please click the "next" button to advance to the post-activity assessment. To complete this activity and claim credit, you must answer 2 out of the 3 questions correctly. If you are not successful after your first attempt, you will be given an opportunity to reflect upon the answer rationales and have the opportunity to review the educational content before proceeding. Once you have selected your answers, click the "submit" button to complete the evaluation questions and proceed to the claim credit screen.

Commercial Supporter

Jazz Pharmaceuticals, Inc.

Education Partner

Integritas Communications, LLC


Fine Print

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The opinions, ideas, and recommendations expressed in this educational activity are those of the faculty only and are not necessarily endorsed by, nor do they necessarily reflect, those of their affiliated institutions, pmiCME, pmiCME Advisory Boards and Consultants, DBC Pri-Med, LLC.

Clinical judgment must guide each clinician in weighing the possible risks, benefits, or contraindications of any diagnostics, interventions or treatments discussed. Clinicians should review manufacturers’ product information and consider these with the recommendations of other authorities when applying the assessment and/or clinical management strategies discussed in this activity to the care of their patients.

pmiCME educational activities are developed and conducted in accordance with the ACCME's Essential Areas and Policies. It is the mission of pmiCME to develop and present educational activities that are timely, fair-balanced, scientifically rigorous, and that serve to improve patient outcomes. To that end, we welcome your comments about how to better serve your needs.

pmiCME Accredited Provider
Pri-Med programs are owned and operated by DBC Pri-Med, LLC, a division of Diversified Communications, Inc. pmiCME, the accredited division of Pri-Med, is accredited with commendation by the ACCME and approved as a provider of continuing education by the AANP. pmiCME is the accredited provider for this activity.

Disclosures and Conflict of Interest
pmiCME requires all individuals in a position to influence educational content for pmiCME-certified CME activities to disclose relevant personal financial relationships with commercial interests prior to contributing to its educational activities. pmiCME assesses disclosed relationships and follows a defined process to resolve real or implied conflicts to ensure, to the best of its ability, that all educational content is free of commercial bias. Financial disclosures are listed in the activity syllabus and will also be printed on the slides and announced at the start of each presentation.

Discussion of Off-Label Uses and Investigational Products
During the course of their presentations, the faculty may mention uses of products that have not been approved in the United States for the indication(s) being discussed. All presenters are instructed to notify participants when they are discussing unapproved uses or investigational agents. In addition, specific slides will include notation of the off-label use or investigational agent being discussed. Views presented related to unapproved uses of products are solely those of the presenter(s) and are not endorsed by pmiCME or DBC Pri-Med, LLC.

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