CARE Series - Pain Management and Substance Use Disorders

Monday, July 15, 2024, 12:00 PM - Thursday, July 15, 2027, 1:00 PM

AMA PRA Category 1 Credits™ (1.00 hours), ANCC Nursing Contact Hours (1.00 hours), CME-Designated Participation Credit (1.00 hours)

Overview of:

• Historical and societal context of pain & substance use
• Interrelationships between pain & substance use
• Principles of pain treatment in opioid & other substance use disorders
• Practical considerations in acute, chronic and terminal pain in patient on MOUD

Presenter

Seddon R. Savage, MD, MS
Clinical Associate Professor of Anesthesiology
Geisel School of Medicine at Dartmouth College

1. Describe one pervasive historical attitude towards use of opioids to treat pain.
2. Identify two functional problems typically experienced when pain and addiction co-occur.
3. Explain one principle for treatment of pain for people with a substance use disorder.

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours.

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

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Bibliographic Sources

• Barry DT, Cutter CJ, Beitel M, Kerns RD, Liong C, Schottenfeld RS. Psychiatric Disorders Among Patients Seeking Treatment for Co-Occurring Chronic Pain and Opioid Use Disorder. J Clin Psychiatry. 2016 Oct;77(10):1413-1419. 
  
  
• Booth, Martin. Opium a history, St Martin’s Press, 1998 New York. 
  
  
• Bernard SA et al. Management of Pain in the United States-A Brief History and Implications for the Opioid Epidemic. Health Serv Insights. 2018 Dec 26 
  
  
• Case Ann, Deaton 
  
  
• Cole W. Foreword. In: Schiffrin MJ, ed. The Management of Pain in Cancer. Chicago, IL: Year Book; 1956:7-8. 20. Jacox A. Pain: A Source Book for Nursing 
  
  
• CDC Wonder in NIDA Drug Overdose deaths, https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates 
  
  
• Corder G, Castro DC, Bruchas MR, Scherrer G. Endogenous and Exogenous Opioids in Pain. Annu Rev Neurosci. 2018 Jul 8;41:453-473 
  
  
• Dasgupta N, Beletsky L, Ciccarone D. Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. Am J Public Health. 2018 Feb;108(2):182-186 
  
  
• Dayer LE et al. A recent history of opioid use in the US: Three decades of change. Subst Use Misuse. 2019;54(2):331-339 
  
  
• Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95 
  
  
• Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. J Pain. 2016 Sep;17(9 Suppl):T70-92. 
  
  
• Elman I, Borsook D. Common Brain Mechanisms of Chronic Pain and Addiction. Neuron. 2016 Jan 6;89(1):11-36. 
  
  
• Florence C, Luo F, Rice K. The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017. Drug Alcohol Depend. 2021 Jan 1;218:108350 
  
  
• Galaj E, Xi ZX. Progress in opioid reward research: From a canonical two-neuron hypothesis to two neural circuits. Pharmacol Biochem Behav. 2021 Jan 
  
  
• Garland EL, et al. Mindfulness-Oriented Recovery Enhancement reduces opioid craving among individuals with opioid use disorder and chronic pain in medication assisted treatment Drug Alcohol Depend. 2019 Oct 1;203:61-65. 
  
  
• Manhapra A, Becker WC. Pain and Addiction: An Integrative Therapeutic Approach. Med Clin North Am. 2018 Jul;102(4):745-763. 
  
  
• Meldrum ML. Opioids' Long Shadow. AMA J Ethics. 2020 Aug 1;22(1):E729-734 
  
  
• Meldrum ML. A Capsule History of Pain Management. JAMA. 2003;290(18):2470–2475 
  
  
• Mercadante S, Arcuri E, Santoni A. Opioid-Induced Tolerance and Hyperalgesia. CNS Drugs. 2019 Oct;33(10):943-955 
  
  
• National Survey on Drug Use and Health, 2021 https://www.samhsa.gov/data/sites/default/files/reports/rpt39441/NSDUHDetailedTabs2021/NSDUHDetailedTabs2021/NSDUHDetTabsSect5pe2021.htm
  
  
• Racine M. Chronic pain and suicide risk: A comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry. 2018 Dec 20;87(Pt B):269-280 
  
  
• Savage SR, Kirsh KL, Passik SD. Challenges in using opioids to treat pain in persons with substance use disorders. Addict Sci Clin Pract. 2008 Jun;4(2):42 
  
  
• Scarborough BM, Smith CB. Optimal pain management for patients with cancer in the modern era. CA Cancer J Clin. 2018 May;68(3):182-196 
  
  
• Serafini RA, Pryce KD, Zachariou V. The Mesolimbic Dopamine System in Chronic Pain and Associated Affective Comorbidities. Biol Psychiatry. 2020;87(1):64-73. doi:10.1016/j.biopsych.2019.10.018 
  
  
• U.S. Pain Management Interagency Task Force Report: Pain Management Best Practice. US Depatment of Health & Human Services, 2019 https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf 
  
  
• Volkow ND, Jones EB, Einstein EB, Wargo EM. Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry. 2019 Feb 1;76(2):208-216 
  
  
• Volkow ND, Blanco C. The changing opioid crisis: development, challenges and opportunities. Mol Psychiatry. 2021 Jan;26(1):218-233 
  
  
• Volkow N, Benveniste H, McLellan AT. Use and Misuse of Opioids in Chronic Pain. Annu Rev Med. 2018 Jan 29;69:451-465
  
  

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
CE Office
Dartmouth Health
[email protected]

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Mitigation of Relevant Financial Relationships

Dartmouth Health adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  Any individuals in a position to control the content of a CE activity, including planners, faculty, authors, or others are required to disclose all financial relationships with ineligible companies^.  All relevant financial relationships have been mitigated prior to the commencement of the activity.

^Ineligible Company is any entity whose primary business purpose is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.