This product is an ASHP Learning Center activity.
Accreditation
The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.
Target Audience
These self-guided activities are designed for pharmacists to increase the knowledge and skills necessary to provide care to patients with pain. In addition, pharmacists will learn to apply opioid risk reduction and mitigation strategies in their practices and establish an opioid stewardship program.
Overview
The Pain Management Certificate is designed for pharmacists to increase the knowledge and skills necessary to provide care to patients with pain. The curriculum addresses basic principles associated with pain pathogenesis and assessment, effective pharmacologic and non-pharmacologic treatment options, and appropriate therapeutic regimens. The course further concentrates on acquiring advanced knowledge about managing pain associated with specific disease states most often encountered in practice. A significant portion of the curriculum is dedicated to establishing an opioid stewardship program. Strategies for effective use of opioids and mitigating their risks are covered in detail. Upon completion of all the modules, participants should be proficient in assessing pain and identifying pharmacologic and non-pharmacologic treatment options based on disease states and other patient-related factors.
Professional Certificate Requirement
Once a learner has completed the educational curriculum, they will have the opportunity to complete an online comprehensive final exam. Once the learner completes the final exam (minimum 80% passing rate; unlimited attempts permitted), they will earn the professional certificate.
Educational Activities
The Pathogenesis and Assessment of Pain
ACPE: 0204-0000-24-731-H08-P
1.25 contact hours
Learning Objectives:
- Identify where the five phases of nociception take place within the peripheral and central nervous systems.
- Differentiate between hyperalgesia and allodynia.
- Contrast nociceptive, neuropathic, and nociplastic pain.
- Distinguish between acute and chronic pain.
- Differentiate between a unidimensional and multidimensional pain assessment.
- Identify the eight elements of symptom analysis and provide examples of how to obtain this information when evaluating a complaint of pain.
The Role of Analgesics in Managing Pain
ACPE: 0204-0000-24-732-H08-P
3 contact hours
Learning Objectives:
- Describe the pharmacodynamic and pharmacokinetic properties of acetaminophen and the nonsteroidal anti-inflammatory drugs (NSAIDs).
- Describe the role of non-opioid analgesics in the management of acute and chronic pain and recommend specific dosing regimens.
- Describe the role of adjuvant analgesics in the management of acute and chronic pain.
- Propose specific adjuvant analgesic dosing regimens for patients suffering from acute and chronic pain.
- List recommendations for first, second, third and fourth-line treatment options for neuropathic pain from national and international guidelines.
- Describe the role of opioid analgesics in the management of acute and chronic pain.
- Propose specific opioid analgesic dosing regimens for patients suffering from acute and chronic pain.
- Explain how patient- and agent-related variables influence the selection of an opioid for a specific patient.
- Describe the steps in the drug therapy decision-making process.
- Recommend an analgesic regimen with appropriate patient monitoring and regimen adjustment to meet therapeutic goals in a patient with a complaint of pain.
Acute Postoperative Pain
ACPE: 0204-0000-24-733-H08-P
2 contact hours
Learning Objectives:
- Explain the pathophysiology of acute pain.
- Discuss parameters that should be reviewed as part of a pre-operative pain assessment.
- Describe the role of acetaminophen, NSAIDs, gabapentin, lidocaine, and ketamine in the treatment of peri-operative pain.
- Contrast neuraxial and regional analgesia.
- Recognize possible adverse effects with analgesic pharmacotherapy.
- Select an appropriate opioid for a given patient.
- Discuss dosing and adjustment of patient-controlled analgesia in a given patient.
- Develop a plan to assess pain and function.
- 9.Recognize potential adverse effects associated with pain medication regimen.
Neuropathic and Functional Pain Syndromes
ACPE: 0204-0000-24-734-H08-P
1.75 contact hours
Learning Objectives:
- Describe the presentation of peripheral neuropathic pain.
- Apply currently available evidence-based guidelines for the treatment of peripheral neuropathic pain.
- Choose an appropriate analgesic based on co-morbidities for a given patient.
- Compare the efficacy and safety of agents used for neuropathic pain.
- Describe the presentation of different central pain syndromes.
- Distinguish the different types of pain that occur within each type of central pain syndrome.
- Identify the symptoms of central pain syndromes in a given patient.
- Propose appropriate analgesic(s) and/or non-pharmacologic therapies given a patient with central pain.
- Distinguish patients with central sensitization.
- Design a pharmacologic plan for a patient with fibromyalgia.
- Develop a nonpharmacologic plan for a patient with fibromyalgia.
Musculoskeletal Pain
ACPE: 0204-0000-24-735-H08-P
1 contact hour
Learning Objectives:
- Create a nonpharmacologic plan for a patient with osteoarthritis.
- Develop a pharmacologic plan for a patient with osteoarthritis.
- Recommend when to initiate gout prophylaxis.
- Create a treatment plan to treat an acute gout flare and prevent future attacks.
- Develop a monitoring plan for medications initiated to treat gout.
- Develop a nonpharmacologic treatment plan for a patient with acute or chronic low back pain.
- Create a pharmacologic treatment plan for a patient with acute or chronic low back pain.
Autoimmune, Cancer, Headache, and Sickle Cell Disease Pain
ACPE: 0204-0000-24-736-H08-P
4 contact hours
Learning Objectives:
- Review the epidemiology of arthralgia, myalgia, and visceral pain associated with common autoimmune / rheumatologic conditions.
- Describe the pathogenesis of painful manifestations of common autoimmune / rheumatologic conditions.
- Identify common autoimmune / rheumatologic conditions based on signs, symptoms, laboratory values, and test results.
- Select pharmacologic and non-pharmacologic therapies for the prevention or treatment of pain for the real or simulated patient with autoimmune / rheumatologic disease.
- Identify the different mechanisms of pain in cancer patients.
- Evaluate pharmacologic options for cancer-related pain.
- Describe the epidemiology and pathogenesis of primary headaches and facial pain syndromes.
- Classify commonly encountered primary headache and facial pain syndromes.
- Choose pharmacologic and non-pharmacologic treatment modalities for primary headaches and facial pain syndromes using evidence-based guidelines as available.
- Recognize the epidemiology and pathogenesis of Sickle Cell Disease (SCD).
- Describe the painful manifestations of SCD during and between vaso-occlusive crisis (VOC).
- Identify validated methods for assessing pain in the pediatric patient population.
- Discuss the risks for disparities in care for at-risk patient populations.
- Select pharmacologic and non-pharmacologic therapies for the prevention or treatment of pain for the real or simulated patient with SCD using recent SCD practice guidelines.
Special Considerations in Pain Management
ACPE: 0204-0000-24-737-H08-P
3 contact hours
Learning Objectives:
- Describe the common co-occurring psychiatric conditions frequently experienced by those with chronic pain.
- Recognize effects of untreated co-morbid psychiatric conditions on pain management outcomes.
- Identify common myths of treating pain in those with previous or current substance use disorders.
- Determine and apply appropriate dosage adjustments for commonly used analgesics, including opioids, based on the specific type and severity of organ dysfunction
- Adjust the pain management plan for patients with organ dysfunction based on response to the therapy.
- Compare and contrast analgesics based on effective and safe use in the perinatal and postpartum settings.
- Propose a pharmacotherapeutic care plan for a woman with acute or chronic pain in the perinatal or postpartum setting.
- Identify nonpharmacologic treatment plans for patients with chronic pain.
- Recommend nonpharmacologic treatment options for chronic pain.
- Apply methodology of an emergency department opioid stewardship program to an organization.
Safe Prescribing and Pain Management Practices for Patients Receiving Opioids - Part 1
ACPE: 0204-0000-24-738-H08-P
3.25 contact hours
Learning Objectives:
- Distinguish between abuse, addiction, dependence, and tolerance.
- Propose a strategy to maximize opioid safety specific to a patient with an indication for opioid analgesics.
- Recognize potential aberrant drug taking behaviors of a real or simulated patient based on prescription drug monitoring review, drug screen, interpretation, and validated risk tools.
- Identify the three FDA approved naloxone delivery methods for opioid overdose reversal.
- Identify different formulations and strengths of transdermal fentanyl delivery systems on the market.
- List three contraindications and three precautions associated with the use of transdermal fentanyl.
- Calculate the appropriate equianalgesic dose of transdermal fentanyl with a given patient.
- Recommend a starting dose, and equivalent dose of transdermal buprenorphine and transmucosal buprenorphine.
- Describe the pharmacodynamic and pharmacokinetic properties of methadone.
- List five drugs that inhibit and five drugs that induce the metabolism of methadone.
- List characteristics of appropriate and inappropriate candidates for methadone therapy.
- Recommend a starting dose of methadone for specific patients.
- Describe cardiac safety monitoring recommendations for methadone patients.
- Explain five reasons why a clinician would need to switch a patient from one opioid regimen to another.
- Define potency, equipotency, and bioavailability.
- List the five-step process in opioid conversion calculations.
- Calculate a conversion to a new opioid regimen, taking into consideration patient-specific variables including level of pain control.
- Describe the history of opioid medication use.
- Select appropriate dosing for a patient with opioid tolerance.
- Identify methods to treat opioid use disorder while concurrently treating pain.
- Explain opioid overdose management strategies and methods for naloxone rescue advocacy.
Safe Prescribing and Pain Management Practices for Patients Receiving Opioids - Part 2
ACPE: 0204-0000-24-739-H08-P
2 contact hours
Learning Objectives:
- Analyze pain management strategies across practice settings that emphasize opioid reduction and risk mitigation.
- Apply processes to recognize patients at high risk for adverse outcomes related to opioid therapy.
- Create an individualized, evidence-based pain management plan that includes measurable pain management goals.
- Identify opioid-related adverse drug events (ORADEs) and appropriate management.
- Recommend best practice opioid-associated care coordination and communication across service lines and treatment providers.
- Differentiate patients appropriate for referral to pain management specialty care.
- Apply methods to screen and engage patients with opioid use disorder in harm reduction and addiction treatment services.
- Recommend population health management programs for patients with high-risk opioid therapy.
Opioid Stewardship - Introduction and Goals
ACPE: 0204-0000-24-740-H08-P
1.25 contact hours
Learning Objectives:
- Describe the current state of the opioid crisis.
- Analyze factors and influencers of the opioid crisis.
- Summarize the rationale and purpose of opioid stewardship.
- Identify the current gaps and priorities for implementing or expanding opioid stewardship initiatives.
- Assess how patient engagement and shared-decision making can improve opioid safety and stewardship efforts.
Opioid Stewardship Leadership
ACPE: 0204-0000-24-741-H08-P
2 contact hours
Learning Objectives:
- Develop an approach to engaging leadership support.
- Apply a model to create an opioid stewardship program that integrates into the organizational leadership structure.
- Identify an accountability structure for opioid stewardship.
- Describe how to establish a leadership committee charter.
- Identify regulatory requirements for controlled substances that impact provider practice requirements, patient outcomes, and community safety.
- Explain education interventional strategies that improve opioid risk mitigation through team based interprofessional care delivery models.
- Design a business case to support electronic health record decision support that enhances safe prescribing practice measures aligned with a high reliability organization model.
- Analyze opioid stewardship team representation, strengths, weaknesses, goals, and communication to identify opportunities for improvement.
Opioid Stewardship Program Development and Implementation
ACPE: 0204-0000-24-742-H08-P
2 contact hours
Learning Objectives:
- Design a comprehensive plan for a chartered, multi-disciplinary pain management and opioid stewardship committee and program.
- Outline an implementation process that incorporates dynamic and routine data monitoring for assessing changes and action plan mapping for sustainability.
- Choose strategies that establish bi-directional communication with a loop-closing plan that ensures feedback.
- Evaluate key organizational opioid stewardship gaps and opportunities through data review.
- Calculate opioid stewardship financial implications, business case, and return on investment.
- Apply stakeholder analysis to manage, garner support from, and communicate with key stakeholders in an opioid stewardship program.
- Evaluate the current state of an established opioid stewardship program to identify areas for continued development and innovation.
Opioid Stewardship Program Policies and Advocacy
ACPE: 0204-0000-24-743-H08-P
1 contact hour
Learning Objectives:
- Apply legislation in an organizational workflow to optimize pain management and opioid safety.
- Compare prescriber adherence to state regulations for opioid prescribing across different departments.
- Summarize methods to obtain stakeholder and medical staff engagement for opioid stewardship policies, quality improvement, and patient safety.
- Develop a strategy for opioid medication shortages.
- Analyze strategies for detecting drug diversion.
Opioid Stewardship Quality Improvement and Metrics
ACPE: 0204-0000-24-744-H08-P
2 contact hours
Learning Objectives:
- Construct quality improvement opportunities based on opioid stewardship initiative practice examples.
- Define outcome measurement that reflects evidence-based care and patient functional pain management goals.
- Identify opioid stewardship program goals and metrics.
- Use data to track metrics and inform opioid stewardship program direction and focus.
- Evaluate the use of balancing measures to assess opioid stewardship interventions.
- Discuss the 2018 Joint Commission Pain Assessment and Management Standards.
Use and Integration of Technology and Data
ACPE: 0204-0000-24-745-H08-P
2 contact hours
Learning Objectives:
- Evaluate opportunities for integration of relevant opioid data to inform safe prescribing.
- Use predictive analytics to identify opioid-related risks and inform optimal management strategies.
- Compare pain management order sets and treatment pathways that build in safe practices while utilizing shared decision-making strategies.
- Develop methods to share opioid-prescribing data with clinicians.
- Analyze patient-centric options using virtual healthcare strategies and digital health in opioid stewardship.
- Differentiate between traditional and contemporary diversion prevention solutions.
Opioid Stewardship Healthcare Team Education and Training
ACPE: 0204-0000-24-746-H08-P
3.25 contact hours
Learning Objectives:
- Analyze the needs of patients with opioid use disorder for use in creating harm reduction and treatment resources.
- Apply evidence-based guidelines to multidisciplinary staff training and education on safe opioid usage.
- Analyze currently available opioid educational resources for use in educating the multidisciplinary staff at your institution.
- Evaluate how context contributes to the complexity of pain management in special populations.
- Use concepts of pain management for special populations in a patient case.
- Apply academic detailing services to support healthcare provider education and promote prescriber behavioral change to improve safe pain care, risk mitigation, and opioid use disorder (OUD) treatment.
Patient and Family/Caregiver Education and Engagement and Community Outreach
ACPE: 0204-0000-24-747-H08-P
1.75 contact hours
Learning Objectives:
- Apply patient and caregiver educational models on functional outcomes, expectations, and management plans.
- Analyze resources currently available to patients within the community for harm reduction.
- Apply educational strategies that inform patients and family members of the risks and side effects of opioids and reducing the potential for overdose.
- Recommend patient-centered resources for comprehensive pain management.
- Apply effective communication strategies for discussing pain management plans.
Pharmacist Practitioner Roles in Pain Management and Opioid Stewardship
ACPE: 0204-0000-24-748-H08-P
2.5 contact hours
Learning Objectives:
- Outline the foundational components for the pharmacist practitioner scope of practice and collaborative practice agreements as part of team-based care.
- Describe the roles of the pharmacist practitioner as part of the collaborative care team in pain management and opioid safety.
- Describe methodologies of strong stewardship practices for cross-organizational implementation.
- Apply leadership engagement strategies to opioid stewardship program development.
- Describe the pharmacist practitioner role in safe pain care and opioid stewardship across acute and chronic care settings, including transitions of care.
- Use evidence-based screening tools and population health strategies for identifying patients at risk for long-term opioid use, opioid use disorder (OUD), and potential overdose.
- Design a clinical care process that incorporates OUD screening, brief intervention, and referral for treatment (SBIRT), as appropriate.
- Compare the role of the pharmacist practitioner in patient care delivery and as an opioid stewardship champion.
- Design a clinical pharmacy practice model that incorporates pain management and opioid stewardship foundational components.
Faculty Information
Stephanie Abel, PharmD, BCPS
Opioid Stewardship Program Coordinator
University of Kentucky HealthCare
Lexington, Kentucky
Elizabeth Bentley, PharmD, MSJ, BCPS
Director, Inpatient Pharmacy Services
Kaiser Permanente Northwest
Clackamas, Oregon
Marisa Brizzi, PharmD, BCPS, AAHIVP
Pain Stewardship Clinical Pharmacist
UC Health
Cincinnati, Ohio
Melissa Christopher, PharmD
National Director, Pharmacy Benefits Management Academic Detailing Services
Department of Veterans Affairs
San Diego, California
Rachael Duncan, PharmD, BCPS, BCCCP
Associate Director
The Naloxone Project
Golden, Colorado
Mighty Fine, MPH, CHES
Associate Executive Director
Division of Public Health Policy and Practice
American Public Health Association
Washington, DC
Virginia Ghafoor, PharmD, MBA
Pharmacy Clinical Specialist, Pain Management
MHealth Fairview
Minneapolis, Minnesota
Amanda Hays, PharmD, MHA, BCPS, CPHQ, DPLA, FASHP
Director, Medical Affairs
Becton & Dickinson (BD)
St. Louis, Missouri
Christopher M. Herndon, Pharm.D., FASHP
Professor
Southern Illinois University Edwardsville
Edwardsville, Illinois
Julianne Himstreet, PharmD
National Clinical Program Manager
VHA PBM Academic Detailing Services
Eugene, Oregon
Dara Johnson, PharmD, BCPP, BCACP
Clinical Pharmacy Supervisor
Providence Medical Group
Affiliate Faculty
Oregon Health and Sciences University
Portland, Oregon
Terri L. Jorgenson, RPH, BCPS
National Program Manager, PBM Clinical Pharmacy Practice Office
Department of Veterans Affairs
Washington, DC
Courtney Kominek, PharmD, BCPS
Clinical Pharmacist Practitioner - Pain Management
Harry S. Truman Memorial Veterans' Hospital
Colombia, Missouri
Michele Matthews, PharmD, BCACP, FASHP
Professor of Pharmacy Practice
Massachusetts College of Pharmacy and Health Sciences
Advanced Practice Pharmacist - Pain Management
Brigham and Women's Hospital
Boston, Massachusetts
Mary Lynn McPherson, PharmD, PhD, MA, MDE, BCPS, FAAHPM
Professor
Executive Director, Graduate Studies in Palliative Care
University of Maryland School of Pharmacy
Baltimore, Maryland
Hesham Mourad, PharmD, BCPS, BCCCP, CPHIMS
Medication Management Informaticist
Mayo Clinic
Assistant Professor of Pharmacy
Mayo Clinic College of Medicine
Jacksonville, Florida
Suzanne Nesbit, PharmD, FCCP, FASHP
Clinical Pharmacy Specialist, Pain Management
The Johns Hopkins Hospital
Baltimore, Maryland
James Ray, PharmD, CPE
Clinical Associate Professor
University of Iowa College of Pharmacy
Iowa City, Iowa
Elsie Rizk, PharmD
Pharmacy Administrative Specialist in Clinical Research
Houston Methodist Hospital
Assistant Research Professor of Surgery
Houston Methodist Research Institute
Houston, Texas
Tanya Uritsky, PharmD, BCPP
Opioid Stewardship Coordinator
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Julie Waldfogel, PharmD, BCGB
Clinical Pharmacy Specialist
The Johns Hopkins Hospital
Baltimore, Maryland
Relevant Financial Relationship Disclosure
In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company.
An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience.
The following persons in control of this activity’s content have relevant financial relationships:
- Amanda Hays: Becton & Dickinson (BD)
As defined by the Standards of Integrity and Independence in Accredited Continuing Education definition of ineligible company. All relevant financial relationships have been mitigated prior to the CE activity.
Methods and CE Requirements
Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity.
Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity.
Important Note – ACPE 60 Day Deadline:
Per ACPE requirements, CPE credit must be claimed within 60 days of being earned. To verify that you have completed the required steps and to ensure your credits have been reported to CPE Monitor, check your NABP profile account to validate that your credits were transferred successfully before the ACPE 60-day deadline. After the 60-day deadline, ASHP will no longer be able to award credit for this activity.
ASHP Professional CertificatesSM contain learning activities that are ACPE-accredited knowledge and application-based continuing education. This is not an ACPE Certificate Program. Upon successful completion of the activities, the learner will be able to download an ASHP Professional Certificate.
System Technical Requirements
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