6th Annual Kaua'i Pain Conference

Mar 6, 2020 ‐ Mar 7, 2020


Hawai’i’s Leading Conference on Pain Management


About

Learn the most relevant data and treatment options in a forum for designed for engagement.

Discuss evidence-based medicine and best practices with foremost experts in order to improve access to and quality of care for patients. There will be ample opportunity to network with colleagues and experts, and to attend educational sessions. Our world-class Program Committee and unrivaled faculty create an environment for collaboration, problem solving, and skill-based learning.

Audience

You don't have to be a pain specialist to benefit from Kaua'i Pain Conference (KPC). KPC is where all types of clinical providers and professionals come to improve their understanding of the etiology, assessment, and treatment of pain. This unique conference is designed for non-specialists to learn the best, most accessible, most clinically relevant pain therapies for patients with chronic pain. 

Including:

  • clinicians (physicians, advanced practice providers, nurses)
  • scientists
  • pharmacists
  • industry employees
  • regulators

There were over 200 in-person attendees in 2020.



Sessions

6th Annual Kaua'i Pain Conference Live Program

Mar 6, 2020 8:00am ‐ Mar 7, 2020 5:00pm

Credits: None available.

Learn the most relevant data and treatment options in a forum for designed for engagement.

Discuss evidence-based medicine and best practices with foremost experts in order to improve access to and quality of care for patients. There will be ample opportunity to network with colleagues and experts, and to attend educational sessions. Our world-class Program Committee and unrivaled faculty create an environment for collaboration, problem solving, and skill-based learning.

Speaker(s):

What Really Matters in the Treatment of Chronic Pain

Mar 6, 2020 9:30am ‐ Mar 6, 2020 10:30am
Expiration Date: Mar 5, 2023

Credits: None available.


What Really Matters in the Treatment of Chronic Pain: 

Significant Signals Revealed through the CHOIR Registry of Real World Patients


Overview

Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don't know which half is which.
- Charles Sidney Burwell, MD; Dean of Harvard Medical School, 1935-1949

The Learning Health Systems framework [IOM] applies advanced analytics to real-world data. The patterns uncovered through by this approach identify novel interventions and demonstrate the efficacy of interventions amongst a homogenous patient population.  For the more than 25 million Americans living with daily chronic pain [SAMHSA, 2017], these insights can't come soon enough. 

The economic cost of chronic pain to the United States exceeds $635,000,000 per year. That’s more than the impacts of heart disease, stroke, cancer and diabetes combined [IOM, 2014]. Every clinician needs to utilize what truly works when treating chronic pain, and how to leverage data-driven insights to provide the best patient care.


Accreditation & Designation

Release date: This activity was released 3/6/2020.

Termination date: The content of this activity remains eligible for CME Credit until 3/5/2023, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Recognize factors associated with prescription opioid misuse amongst persons with chronic, non-cancer pain
  • Interpolate assessments of fatigue for persons with non-cancer, chronic pain with the impact upon sleep, pain intensity, and depression
  • Deconstruct the causal interactions between pain intensity, anger, depression, physical function, and social interaction
  • Modify prognoses based upon patient-specific lifestyle factors
  • Integrate broad-based, real-world outcomes data into the development of treatment plans and algorithms

Desirable Physician Attributes

  • Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
  • Provide Patient-centered Care [IOM] Identify, respect, and care about patients’ differences, values, preferences and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
  • Systems-based practice [ACGME] Awareness and responsiveness to larger context and system of health care, use of system resources
  • Professionalism [ACGME/ABMS] As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
  • Utilize informatics [IOM] Communicate, manage knowledge, mitigate error, and support decision making using information technology

References

  • Pizzo, P. A., Clark, N. M., & Carter-Pokras, O. (2011). Relieving Pain in America: A blueprint for transforming prevention, care, education, and research. IOM (Institute of Medicine).
  • Mackey, S. (2014). National pain strategy task force: the strategic plan for the IOM pain report. Pain Medicine, 15(7), 1070-1071.
  • Dzau, V. J., & Pizzo, P. A. (2014). Relieving pain in America: insights from an Institute of Medicine committee. JAMA, 312(15), 1507-1508.
  • Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., ... & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. Morbidity and Mortality Weekly Report, 67(36), 1001.
  • Von Korff, M., Scher, A. I., Helmick, C., Carter-Pokras, O., Dodick, D. W., Goulet, J., ... & Terman, G. (2016). United States national pain strategy for population research: concepts, definitions, and pilot data. The Journal of Pain, 17(10), 1068-1080.
  • Worley, S. L. (2016). New directions in the treatment of chronic pain: national pain strategy will guide prevention, management, and research. Pharmacy and Therapeutics, 41(2), 107.
  • Rogers, W. H., Wittink, H. M., Ashburn, M. A., Cynn, D., & Carr, D. B. (2000). Using the “TOPS,” an outcomes instrument for multidisciplinary outpatient pain treatment. Pain Medicine, 1(1), 55-67.
  • IOM (Institute of Medicine). 2008. Evidence-based medicine and the changing nature of health care: 2007 IOM annual meeting summary. Washington, DC: The National Academies Press.
  • IOM (Institute of Medicine). 2010. Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches: Workshop Summary. Washington, DC: The National Academies Press.
  • Institute of Medicine (US); Grossmann C, Powers B, McGinnis JM, editors. Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary. Washington (DC): National Academies Press (US); 2011.
  • Sharifzadeh, Y., Kao, M. C., Sturgeon, J. A., Rico, T. J., Mackey, S., & Darnall, B. D. (2017). Pain catastrophizing moderates relationships between pain intensity and opioid prescription nonlinear sex differences revealed using a learning health system. Anesthesiology: The Journal of the American Society of Anesthesiologists, 127(1), 136-146.
  • Sturgeon, J. A., Dixon, E. A., Darnall, B. D., & Mackey, S. C. (2015). Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study. Pain, 156(12), 2627.
  • Sturgeon, J. A., Darnall, B. D., Kao, M. C. J., & Mackey, S. C. (2015). Physical and psychological correlates of fatigue and physical function: a Collaborative Health Outcomes Information Registry (CHOIR) study. The Journal of Pain, 16(3), 291-298.
  • Karayannis, N. V., Sturgeon, J. A., Chih-Kao, M., Cooley, C., & Mackey, S. C. (2017). Pain interference and physical function demonstrate poor longitudinal association in people living with pain: a PROMIS investigation. Pain, 158(6), 1063.
  • Khan, J. S., Hah, J. M., & Mackey, S. C. (2019). Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain, 160(10), 2374-2379.
  • Barad, M., Sturgeon, J. A., Fish, S., Dexter, F., Mackey, S., & Flood, P. D. (2019). Response to Botulinum toxin A in a migraine cohort with multiple comorbidities and widespread pain. Regional Anesthesia & Pain Medicine, 44(6), 660-668.
  • Hah, J. M., Sturgeon, J. A., Zocca, J., Sharifzadeh, Y., & Mackey, S. C. (2017). Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain. Journal of Pain Research, 10, 979.

Disclosures of Financial Relationships

Neither the speaker, peer reviewers nor any other person with control of, or responsibility for, the development, management, presentation or evaluation of the CME activity has, or has had within the past 12 months, any relevant financial relationships to disclose. This includes any relationships of an involved person's spouse/partner.


Learning Objectives:
  • Recognize factors associated with prescription opioid misuse amongst persons with chronic, non-cancer pain
  • Interpolate assessments of fatigue for persons with non-cancer, chronic pain with the impact upon sleep, pain intensity, and depression
  • Deconstruct the causal interactions between pain intensity, anger, depression, physical function, and social interaction
  • Modify prognoses based upon patient-specific lifestyle factors
  • Integrate broad-based, real-world outcomes data into the development of treatment plans and algorithms
Speaker(s):
  • Dr. Sean Mackey, MD, PhD, Redlich Professor, Professor of Anesthesiology, Perioperative, and Pain Medicine and, by courtesy, of Neurology, Stanford University Medical Center
Disclosures
  • Sean Mackey, MD, PhD : I do not have any financial relationships to disclose.
Category: General Session
Standard: $59.95

Avoiding Iatrogenic Harms of Forced Opioid Tapering

Mar 6, 2020 11:15am ‐ Mar 6, 2020 12:00pm
Expiration Date: Mar 5, 2023

Credits: None available.

Avoiding Iatrogenic Harms of Forced Opioid Tapering


Overview

Because pain often produces psychological and cognitive effects – anxiety, depression, and anger among them – interdisciplinary, biopsychosocial approaches are the most promising for treating patients with persistent pain. – IOM, 2011


Outcomes

Learners completing this activity report improved abilities in:

  • Opioid prescribing practices 
  • Treating patients on long-term opioid therapy
  • Determining when, and when not to taper specific patients
  • Working with patients to reduce their doses, in a safe, effective manner

Accreditation & Designation

Release date: This activity was released 3/6/2020.

Termination date: The content of this activity remains eligible for CME Credit until 3/5/2023, unless reviewed or amended prior to this date.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this Enduring Material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.



Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Determine when tapering a patient's opioid prescription may cause iatrogenic harm.
  • Identify persons receiving long-term opioid therapy for whom tapering is both:
    • appropriate, and
    • necessary.
  • Account for the neurobiological adaptations experienced by persons receiving long-term opioid therapy.
  • Develop opioid tapering plans that include mitigation strategies addressing long-term psychological effects and threats to patient well-being, individualized to the needs of the patient.
  • Provide leadership, professionally and as a member of my community, in addressing the opioid crisis.
  • Communicate the goals and methods of an opioid tapering plan in a manner more likely to engender patient adherence.

Desirable Physician Attributes

  • Patient Care [ACGME/ABMS] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
  • Provide Patient-centered Care [IOM] Identify, respect, and care about patients’ differences, values, preferences and expressed needs; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health
  • Professionalism [ACGME/ABMS] As manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

References

  • CDC Guideline for Prescribing Opiates for Chronic Pain, March 18, 2016.
  • Jones, C. M., Einstein, E. B., & Compton, W. M. (2018). Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA, 319(17), 1819-1821.
  • IOM (Institute of Medicine). 2011. Patients charting the course: Citizen engagement and the learning health system: Workshop summary. Washington, DC: The National Academies Press
  • Fenton, J. J., Agnoli, A. L., Xing, G., Hang, L., Altan, A. E., Tancredi, D. J., ... & Magnan, E. (2019). Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017. JAMA Network Open, 2(11), e1916271-e1916271.
  • Bootzin, R. R., & Bailey, E. T. (2005). Understanding placebo, nocebo, and iatrogenic treatment effects. Journal of Clinical Psychology, 61(7), 871-880.
  • Villemure, C., & Bushnell, C. M. (2002). Cognitive modulation of pain: how do attention and emotion influence pain processing?. Pain, 95(3), 195-199.
  • IOM (Institute of Medicine). 2014. Partnering with patients to drive shared decisions, better value, and care improvement: Workshop proceedings. Washington, DC: The National Academies Press.
  • Fenton, J. J., Agnoli, A. L., Xing, G., Hang, L., Altan, A. E., Tancredi, D. J., ... & Magnan, E. (2019). Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017. JAMA Network Open, 2(11), e1916271-e1916271.
  • Darnall, B. D., Ziadni, M. S., Stieg, R. L., Mackey, I. G., Kao, M. C., & Flood, P. (2018). Patient-centered prescription opioid tapering in community outpatients with chronic pain. JAMA Internal Medicine, 178(5), 707-708.
  • Bingel, U., Wanigasekera, V., Wiech, K., Mhuircheartaigh, R. N., Lee, M. C., Ploner, M., & Tracey, I. (2011). The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil. Science Translational Medicine, 3(70), 70ra14-70ra14.
  • Oliva, E. M., Bowe, T., Manhapra, A., Kertesz, S., Hah, J. M., Henderson, P., ... & Trafton, J. A. (2020). Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. BMJ, 368.
  • Murphy, J. L., Clark, M. E., & Banou, E. (2013). Opioid cessation and multidimensional outcomes after interdisciplinary chronic pain treatment. The Clinical Journal of Pain, 29(2), 109-117.
  • Perez, H. R., Buonora, M., Cunningham, C. O., Heo, M., & Starrels, J. L. (2020). Opioid taper is associated with subsequent termination of care: A retrospective cohort study. Journal of General Internal Medicine, 35(1), 36-42.
  • Glanz, J. M., Binswanger, I. A., Shetterly, S. M., Narwaney, K. J., & Xu, S. (2019). Association between opioid dose variability and opioid overdose among adults prescribed long-term opioid therapy. JAMA Network Open, 2(4), e192613-e192613.
  • Darnall, B. D., & Colloca, L. (2018). Optimizing placebo and minimizing nocebo to reduce pain, catastrophizing, and opioid use: a review of the science and an evidence-informed clinical toolkit. In International Review of Neurobiology (Vol. 139, pp. 129-157). Academic Press.
  • Demidenko, M. I., Dobscha, S. K., Morasco, B. J., Meath, T. H., Ilgen, M. A., & Lovejoy, T. I. (2017). Suicidal ideation and suicidal self-directed violence following clinician-initiated prescription opioid discontinuation among long-term opioid users. General Hospital Psychiatry, 47, 29-35.
  • US Department of Health and Human Services. (2019). HHS guide for clinicians on the appropriate dosage reduction or discontinuation of long-term opioid analgesics. 2019.
  • Darnall, B. D., Mackey, S. C., Lorig, K., Kao, M. C., Mardian, A., Stieg, R., ... & Okvat, H. (2020). Comparative effectiveness of cognitive behavioral therapy for chronic pain and chronic pain self-management within the context of voluntary patient-centered prescription opioid tapering: The EMPOWER study protocol. Pain Medicine, 21(8), 1523-1531.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

[Speaker] Beth Darnall discloses the following financial relationships: Consulting: Applied VR, Axial Healthcare

Neither the peer reviewers nor any other person with control of, or responsibility for, the development, management, presentation or evaluation of the CME activity has, or has had within the past 12 months, any financial relationships to disclose. This includes any relationships of an involved person's spouse/partner.

Materials were peer-reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).


Speaker(s):
  • Beth Darnall, PhD, Director, Stanford Pain Relief Innovations Lab
Disclosures
  • Beth Darnall, PhD : Consulting: Applied VR, Axial Healthcare These relationships were assessed in the context of the content and were deemed not to create a conflict of interest. 
Standard: $44.95