NH AIM/ERASE Maternal Mortality Webinar Series - Standardizing Peripartum Pain Management for Patients With Opioid Use Disorder

Wednesday, April 1, 2026, 12:00 PM - Sunday, April 1, 2029, 1:00 PM

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

This session will provide an overview of the spectrum of factors to consider in planning patient-centered peripartum pain management as well as strategies for creating standardized guidelines for pain management for patients with Substance Use Disorder (SUD) and Opioid Use Disorder (OUD). Our AIM implementation team and the NHPQC will briefly share administrative updates and relevant data from New Hampshire's implementation of the SUD-focused AIM Patient Safety Bundle. We will then hear from Johanna Cobb, MD, Assistant Professor of Anesthesiology at the Geisel School of Medicine at Dartmouth. Johanna will present considerations for standardizing both pharmacologic and non-pharmacologic pain management across the intrapartum, postpartum, and discharge phases of care. We will end the hour with a Q&A session.

Presenter

Johanna Cobb, MD
Assistant Professor Anesthesiology at the Geisel School of Medicine at Dartmouth

1. Discuss the wide spectrum of factors to consider in pain management planning for patients with opioid use disorder.
2. Describe practical examples of standardized pain management policies and procedures that can be applied to clinical practice.

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.

Association of Social Work Boards (ASWB)
As a Jointly Accredited Organization, Dartmouth Health is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 1.00 general continuing education credits.

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Bibliographic Material

• ACOG. Committee Opinion 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol 2017; 130:e81-e94.

• Babazade, Rovnat, et al. "Acute postcesarean pain is associated with in-hospital exclusive breastfeeding, length of stay and post-partum depression." Journal of Clinical Anesthesia 62 (2020): 109697.

• Cobb, Johanna, et al. "A retrospective study of acute postoperative pain after cesarean delivery in patients with opioid use disorder treated with opioid agonist pharmacotherapy." Journal of addiction medicine 16.5 (2022): 549-556.

• Cobb, J., et al. "Low-dose ketamine infusion for post-cesarean delivery analgesia in patients with opioid use disorder." International Journal of Obstetric Anesthesia 47 (2021).

• Cook, Meghan I., et al. "Analgesic outcomes in opioid use disorder patients receiving spinal anesthesia with or without intrathecal clonidine for cesarean delivery: a retrospective investigation." Journal of Pain Research (2022): 1191-1201.

• Duzyj, Christina M., et al. "281: transcutaneous electrical nerve stimulation to reduce pain and opioid use after cesarean: a pilot study." American Journal of Obstetrics & Gynecology 222.1 (2020): S190.

• Ellis, Jennifer D., et al. "Correlates of treatment retention and opioid misuse among postpartum women in methadone treatment." Journal of addiction medicine 13.2 (2019): 153-158.

• Gabrielson, S. M. B., et al. "Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009 2018." Public Health 181 (2020): 171-179.

• Hallet, Taylor N., et al. Association of Receipt of Opioid Prescription for Acute Post-Delivery Pain Management with Buprenorphine Discontinuation among Postpartum People with Opioid Use Disorder. Pharmacoepidemiology 3.2 (2024): 198-207.

• Holland, Erica, et al. "A comparison of postpartum opioid consumption and opioid discharge prescriptions among opioid-naive patients and those with opioid use disorder." American Journal of Obstetrics & Gynecology MFM 5.8 (2023): 101025.

• Hoyt, M. R., et al. "Use of epidural clonidine for the management of analgesia in the opioid addicted parturient on buprenorphine maintenance therapy: an observational study." International journal of obstetric anesthesia 34 (2018): 67-72.

• Jin, Daozhong, et al. "mGluR5 from primary sensory neurons promotes opioid-induced hyperalgesia and tolerance by interacting with and potentiating synaptic NMDA receptors." Journal of Neuroscience 43.31 (2023): 5593-5607.

• Karlstr m, Annika, et al. "Postoperative pain after cesarean birth affects breastfeeding and infant care." Journal of Obstetric, Gynecologic & Neonatal Nursing 36.5 (2007): 430-440.

• Landau, R. "Post-cesarean delivery pain. Management of the opioid-dependent patient before, during and after cesarean delivery." International journal of obstetric anesthesia 39 (2019): 105-116.

• Lim, Grace, et al. "A systematic scoping review of peridelivery pain management for pregnant people with opioid use disorder: from the society for obstetric anesthesia and perinatology and society for maternal fetal medicine." Anesthesia & Analgesia 135.5 (2022): 912-925.

• Lim, Grace, et al. "Associations between postpartum pain type, pain intensity and opioid use in patients with and without opioid use disorder: a cross-sectional study." British Journal of Anaesthesia 130.1 (2023): 94-102.

• Cook, Meghan I., et al. "Analgesic outcomes in opioid use disorder patients receiving spinal anesthesia with or without intrathecal clonidine for cesarean delivery: a retrospective investigation." Journal of Pain Research (2022): 1191-1201.

• Ludlow, Joanne P., Sharon F. Evans, and Gary Hulse. "Obstetric and perinatal outcomes in pregnancies associated with illicit substance abuse." Australian and New Zealand Journal of Obstetrics and Gynaecology 44.4 (2004): 302-306.

• Margerison, C., et al. Pregnancy-Associated Deaths Due to Drugs, Suicide, and Homicide in the United States, 2010-2019. Obstetrics and Gynecology 139.2 (2022): 172 - 180.

• Martin, Caitlin E., et al. "Postpartum and addiction recovery of women in opioid use disorder treatment: A qualitative study." Substance abuse 43.1 (2022): 389-396.

• Meyer, Marjorie, et al. "Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy." European journal of pain 14.9 (2010): 939-943.

• Meyer, Marjorie, et al. "Intrapartum and postpartum analgesia for women maintained on methadone during pregnancy." Obstetrics & Gynecology 110.2 Part 1 (2007): 261-266.

• Nonacs, Ruta. Increasing Rates of Maternal Mortality: How Do Overdose Deaths Contribute? MGH Center for Women s Mental Health. http://womensmentalhealth.org/posts/increasing-rates-of-maternal-mortality-how-do-overdose-deaths-contribute/. Accessed 24 October 2024.

• Nowakowski, Emma, et al. "Obstetric pain management for pregnant women with opioid use disorder: A qualitative and quantitative comparison of patient and provider perspectives (QUEST study)." Addiction 118.6 (2023): 1093-1104.

• Reno, Joseph L., et al. "Post-cesarean delivery analgesic outcomes in patients maintained on methadone and buprenorphine: a retrospective investigation." Journal of Pain Research (2020): 3513-3524.

• Suppa, E., Valente, A., Catarci, S., Zanfini, B. A., & Draisci, G. (2012). A study of low-dose S-ketamine infusion as" preventive" pain treatment for cesarean section with spinal anesthesia: benefits and side effects. Minerva anestesiologica, 78(7), 774.

• Vilkins, Annmarie L., et al. "Comparison of post-cesarean section opioid analgesic requirements in women with opioid use disorder treated with methadone or buprenorphine." Journal of addiction medicine 11.5 (2017): 397-401.

• Wang, Jianwei, et al. "Impact of ketamine on pain management in cesarean section: a systematic review and meta-analysis." Pain Physician 23.2 (2020): 135.

• Wendling, Adam L., et al. "Pain outcomes among patients after cesarean consuming buprenorphine or methadone and opioid-naive patients." Journal of Clinical Anesthesia 65 (2020): 109905-109905.

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

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

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.