Management of Uncontrolled Pain

Physicians often do not focus on pain management as a primary goal when they are working to diagnose, cure, or reduce the impact of disease. Although almost all pain in patients can be controlled with the wide range of currently available treatments, 30% to 70% of terminally ill patients may be inadequately treated for pain. By performing a thorough pain assessment and understanding how to appropriately manage the different available treatments, hospitalists can help improve patient outcomes. The following module examines the role of the hospitalist in the treatment and management of hospitalized patients with pain. Principles for titrating pain medications for severe pain and the use of patient-controlled analgesia are discussed, along with methods for performing conversions between different opioids and routes of administration. Barriers to adequate pain control are identified, in addition to methods for managing opioid therapy in patients with renal and hepatic diseases.

To provide hospitalists with up-to-date information regarding the treatment and management of hospitalized patients with pain.

This activity is designed for hospitalists. No prerequisites required.

After completing the module, the participant should be able to:

1. Describe pain assessment in hospitalized patients.
2. Explain the principles for titrating pain medications for severe pain.
3. Discuss the use of patient-controlled analgesia.
4. Perform conversions between different opioids and routes of administration.
5. Identify barriers to adequate pain control.
6. Discuss opioid management in patients with renal and liver dysfunction.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: December 2007 Expiration date: December 2009

Estimated time to complete activity: 1 hour

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

*Assistant Professor, Johns Hopkins University School of Medicine, Division of Geriatric Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.

†Assistant Professor, Health Policy and Management, Health Services Research, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.

Conflict of Interest: Dr Cordts and Dr Dy report having no significant financial or advisory relationships with corporate organizations related to this activity.

Off-Label Product Discussion: All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Grace A. Cordts, MD, MPH, MS, Assistant Professor, Johns Hopkins University School of Medicine, Division of Geriatric Medicine, The Johns Hopkins Medical Institutions, 5505 Hopkins Bayview Circle, Baltimore, MD 21224. E-mail: [email protected].

Click here to download the references for this educational program.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.