Pain Review Course with CME

Contents

Bernard M. Abrams, M.D.
Clinical Professor of Neurology; University of Missouri School of Medicine; Kansas City, Missouri
  • Neuropathic Pain
    1. Define the various types of pain.
    2. Describe various neuropathic pain diagnostic scales and pain intensity scales.
    3. Identify the underlying mechanism of various pain disorders.
  • Central Pain States
    1. Clarify the differences between central and peripheral neuropathic pain.
    2. Identify the major types of neuropathic pain.
    3. List the possible treatments for neuropathic pain.
  • Headache
    1. Explain the anatomical basis of headache syndromes.
    2. Recognize the types of headache syndromes.
    3. Identify the available treatments for various headache entities.
  • Anatomy of the Upper & Lower Extremities
    1. Recognize the process of symptomatic, anatomical and etiological diagnosis.
    2. Discuss the process of referred pain.
    3. Discern differences between nociceptive and neuropathic pain.
  • Extremity Pain
    1. Identify the anatomical basis of extremity syndromes.
    2. Discuss the differential diagnosis of extremity syndromes.
    3. List the available treatments for various extremities.
  • Ethical Issues in Pain Management
    1. Define and describe ethical models and principles.
    2. Discuss the interface of law (regulatory agencies and rules) and ethics.
    3. Give examples of ethical challenges in practice.
  • Clinical Neurophysiology
    1. Define and describe aspects of neurophysiology.
    2. Describe physiological basis of tests.
    3. Review the performance of the exam.
    4. Enumerate relevant findings in specific conditions.
  • Facial Pain
    1. Express the anatomical basis of facial pain syndromes.
    2. Recall familiar with the types of facial pain syndromes.
    3. Associate the available treatments for various facial pain entities.
Kenneth D. Candido, M.D.
Professor of Anesthesiology; Professor and Chairman; Department of Anesthesiology; Advocate Illinois Masonic Medical Center; Chicago, Illinois
  • Nociceptive Pain
    1. Explain the origin of nociceptive pain.
    2. List common sites of nociceptive pain.
  • Trauma Pain Management
    1. List different trauma events that might present for pain management.
    2. Review treatment options for pain management in treating these associated injuries.
  • Sympathetic Nervous System Related Pain & CRPS
    1. Review the anatomy and different nerve blocks used for treatment of sympathetic pain.
    2. Discuss assessing completeness of sympathetic blocks.
  • Head and Neck Blocks
    1. Review the different nerve blocks for head and neck pain.
    2. Explain the technique for trigeminal nerve block and gasserian ganglion block in treating facial pain.
  • Brachial Plexus Block Update: State of the Art; PNS vs. US
    1. Define the structures typically encountered during the performance of ultrasound guided interscalene block of the brachial plexus.
    2. Explain how ultrasound use has improved the success rates of some, but not all, brachial plexus block approaches.
    3. Defend the use of ultrasound for providing a reduction in the incidence of ipsilateral hemidiaphragmatic paralysis.
  • Lower Extremity Nerve Blocks: PNS vs. US: State of the Art
    1. Describe the differences in the echogenicity of nerves typically found in the lower extremity, as compared with those above the clavicle.
    2. Appreciate the rationale for why ultrasound use can lead to local anesthesia sparing effects for sciatic nerve block.
    3. Clarify the role of adductor canal blocks in lower extremity orthopedic knee procedures.
  • Spinal & Epidural Blocks
    1. Differentiate between and among opioids used perispinally.
    2. List the pharmacology of adjuvant drugs used spinally.
    3. Define the risks, benefits and alternatives to spinal drug administration.
Daniel M. Doleys, Ph.D.

  • Ethics, Research Design, Elementary Statistics
    1. Review ethical considerations involved in pain research with humans and animals.
    2. Review commonly used research designs.
    3. Outline principles for interpreting research outcomes.
    4. Review basic statistics and statistical tests.
  • "Psychogenic" Pain
    1. Review the concept of 'psychogenic pain'.
    2. Review DSM IV/V diagnoses.
    3. Discuss the impact of various psychological, mood, and personality factors on pain perception.
  • Psychological Assessment of Pain
    1. Review the relationship between pain mechanisms and the psychological assessment of pain.
    2. Discuss some of the more common assessment tools/procedures.
    3. Highlight special concerns with certain patient populations.
  • Psychological Treatment of Pain
    1. Provide an outline of the philosophical basis for psychological therapies.
    2. Describe some of the more common psychological approaches to the treatment of pain.
    3. Briefly review outcome data from psychological treatments.
F. Michael Ferrante, M.D., A.B.P.M.

  • Painful Medical Conditions
    1. Describe underlying mechanisms and applications to clinical practice for AIDS.
    2. Identify the underlying mechanisms of CNS Diseases: Multiple Sclerosis, ALS, Guillain-Barre, etc.
    3. Explain underlying mechanisms and applications to clinical practice for CV disease/ischemia.
    4. Describe underlying mechanisms and applications for acute and chronic pancreatitis.
    5. Identify the underlying mechanisms for rheumatologic diseases.
    6. Explain underlying mechanisms and applications for Herpes Zoster and Sickle Cell Anemia.
  • Anatomy of the Thorax & Abdomen
    1. Review the anatomy of the thorax.
    2. Describe the anatomy, physiology, and pharmacology of ANS.
    3. Apply the anatomy and physiology of Visceral Afferent NS to clinical practice.
  • Painful Conditions: Thorax and Abdomen
    1. Explain the underlying mechanisms and applications to clinical practice for coronary and non-coronary cardiac pain.
    2. Define the underlying mechanisms and applications to clinical practice for pulmonary embolism.
    3. Describe the underlying mechanisms and applications to clinical practice for GI pain.
    4. List the underlying mechanisms and applications to clinical practice for hepatic and biliary pain.
    5. Explain the underlying mechanisms and applications to clinical practice for pancreatic pain.
    6. Describe the underlying mechanisms and applications to clinical practice for kidney and ureteral pain.
  • Cancer Pain and Symptom Management
    1. Define the underlying mechanisms and applications for direct tumor involvement/invasion in clinical practice.
    2. Describe the underlying mechanisms and applications for Neuropathic, Visceral/obstructive, and metastatic cancer in clinical practice.
    3. List the side effects of diagnosis and therapy for radiation and bone marrow transplantation in clinical practice.
    4. Explain the underlying mechanisms and applications of psychological reactions to cancer.
  • Pelvic Pain
    1. Describe the underlying anatomic principles for genesis of pelvic pain.
    2. Apply anatomic principles to the genesis of chronic painful conditions.
  • Anatomy of the Spine
    1. List the pathological conditions of the vertebrae.
    2. Describe the disorders of posterior structures.
    3. Explain the disease of the 5-joint complex (C-Spine) and 3-joint complex (L-Spine).
    4. Define impingement upon spinal nerve root(s).
    5. Identify disorders of alignment.
    6. Describe changes in the size and/or shape of the canal.
    7. Review disorders of the muscles & fascia.
    8. Review disorders of postural configuration.
  • Radiofrequency Lesioning in Pain Management
    1. Describe the mechanism underlying production of a lesion for the three major classes of radiofrequency.
    2. Describe the anatomy of the actual lesion for the three major classes of radiofrequency.
    3. Describe the innervation of the various joints amenable to radiofrequency.
    4. Describe the anatomic implications of performance of various radiofrequency procedures.
Benjamin Liu, M.D.

  • Imaging of Pain 1 - CT and Plain Films
    1. Review plain film imaging in the spine.
    2. Review computed tomography (CT) imaging in the spine.
    3. Review normal anatomy, degenerative, and nondegenerative back pain pathologies on plain film and CT.
  • Imaging of Pain 2 - MRI
    1. Review basic principles of magnetic resonance imaging (MRI).
    2. Review normal spinal anatomy, degenerative and nondegenerative causes of back pain on MRI.
    3. Review standardized degenerative spine nomenclature.
  • Imaging of Pain 3 - Bone scan, PET scan, Headaches, Fluoroscopy Radiaiton Safety
    1. Review basic principles of nuclear medicine bone scan and positron emission tomography (PET), and their role in imaging causes of back pain.
    2. Review imaging of headache as well as pain diagnosis in other parts of the body.
    3. Review fluoroscopy and radiation safety in the performance of interventional spine procedures.
Ameet S. Nagpal, M.D.

  • Function, Impairment, Disability, & Handicap
    1. Define function and functionality and discuss related measurement scales.
    2. Define impairment according to varied sources and discuss related measurement scales.
    3. Define disability (activity limitation) according to varied sources and discuss related measurement scales.
    4. Define handicap (participation restriction) according to varied sources.
    5. Briefly discuss physical medicine treatment options related to activity limitations and participation restrictions.
  • Trigger Points & Peripheral Joint Injections
    1. Define the terms tender point and trigger point and identify the treatment solutions for both.
    2. Describe the indications for, contraindications of, and appropriate exercise regimens for peripheral injections in the shoulder, elbow, and wrist/hand.
    3. Describe the indications for, contraindications of, and appropriate exercise regimens for peripheral injections in the hip, knee, and ankle/foot.
  • Rehabilitation Medicine Approach to Chronic Pain Management
    1. Describe the role of the heat and cold in the treatment of chronic pain.
    2. Describe the role of the Manual (osteopathic) manipulation and mobilization in the treatment of chronic pain.
    3. Describe the role of electricity; massage; traction; splinting/orthotic devices; and exercise in the treatment of chronic pain.
Maunak Rana, M.D.

  • Opioids, REMS, Prescription Writing
    1. Review the pharmacology and physiology of opioid medications.
    2. Review the REMS program - history and background.
    3. Discuss strategies to mitigate problematic opioid use.
    4. Review prescription writing of opioids.
  • NSAIDs, Muscle Relaxants
    1. Identify the classification of opioids compounds.
    2. Explain the pharmacology of pain transmission and modulation.
    3. Describe the pharmacokinetic and pharmacodynamics properties of NSAIDs and muscle relaxants and identify potential adverse side effects, drug interactions, and indications/contraindications for them.
    4. Assess opioids and an optional treatment of pain.
  • Steroids, Anti-Depressants, and Anti-Convulsants
    1. Review classification of anti-depressants and anti-convulsants and their use in pain states.
    2. Identify potential drug interactions among anti-depressants, anti-convulsants, steroids and other pharmaceutical pain treatment options.
    3. Review the properties of steroids as they pertain to treatment of painful conditions.
  • Complementary and Alternative Medicine
    1. Discuss alternative medical systems and therapies describing the prevalence and evidence base for each.
    2. Review potential implications, costs and side effects of alternative therapies.
    3. Identify complementary therapies for treatment of pain.
  • Hospice and Pain Management in War and Underserved Areas
    1. Review the concept of palliative medicine and hospice care.
    2. Discuss pain management in Hospice patients.
    3. Discuss pain management in underserved populations.
    4. Review pain management and functional rehabilitation in military environments.
  • Pediatric Pain Management
    1. Review physiologic differences between pediatric and adult patients.
    2. Review Pharmaco-kinetic and Pharmacodynamic issues in pediatric patients.
    3. Present the assessment of pediatric pain patients.
    4. Review interventional and non-interventional therapies for pediatric pain patients.
  • Geriatric Pain Management
    1. Review the physiologic changes in Geriatric patients and associated health issues.
    2. Review the Pharmaco-kinetic and Pharmacodynamic issues in Geriatric Patients.
    3. Present the assessment of Geriatric pain patients.
    4. Review interventional and non-interventional therapies for geriatric patients.
Meghan Rodes, M.D.

  • Obstetric Pain Management
    1. Review innervation of the uterus and birth canal.
    2. Discuss analgesic approaches for labor and delivery.
  • Special Concerns in Pregnancy and Lactation in the Management of Pain
    1. Discuss the factors determining the placental transfer of medications to the fetus.
    2. Examine the factors involved in the transfer of medications to breast milk.
    3. Review the effects of medications on the fetus and neonate.
    4. Review the effects of radiation exposure.
    5. Discuss management of common pain conditions in pregnancy.
  • Overview of Neurosurgical Invasive Techniques
    1. Review neurosurgical approaches to pain relief in the pain patient.
    2. Give a brief overview of the role of pain procedures in neurosurgery.
    3. Provide indications for neurosurgical pain procedures.
  • Discectomy and Minimally Invasive Spine Surgery
    1. Review indications, contraindications and risks of invasive spine surgery.
    2. Discuss patient presentation with lumbar pain syndromes.
    3. Discuss indications and options for surgery.
    4. Discuss indications, results and complications of kyphoplasty and vertebroplasty.
  • Neuromodulation
    1. Describe differing types of neuromodulation procedures.
    2. Explain and apply: Indications; Techniques of implantation; Use of common medications/programming and algorithms; Potential problems and complications.
Oren Sagher, M.

Tony L. Yaksh, Ph.D.

  • Biology of Pain Processing
    1. Review basic anatomy of the i) primary afferent; ii) spinal dorsal horn; iii) ascending projection pathways; iv) brainstem-thalamocortical systems involved in pain processing.
    2. Review response properties of primary afferents and dorsal horn neurons that encode nociceptive information.
    3. Define systems that underlie the sensory-discriminative and affective-motivational components of the pain experience.
  • Post Tissue Injury Pain
    1. Response of primary afferent exposed to inflammation.
    2. Spinal properties mediating 1st and 2nd hyperalgesia.
    3. Systems/Pharmacology regulating dorsal horn input/output function in normal and post tissue injury pain states.
    4. Discuss changes in neural processing that lead from an acute (transient) pain state to a persistent pain state.
  • Post Nerve Injury Pain
    1. Response of afferent/DRG and spinal cord to physical and chemical injury of peripheral nerve.
    2. Review mechanisms whereby peripheral nerve injury leads to on going pain sensations (e.g. dysesthesias).
    3. Review changes in spinal processing that underlie development of pain secondary to low threshold mechanical stimulation. (e.g. tactile allodynia).
  • Acute to Chronic Pain
    1. Consider the acute to chronic pain phenotype e.g. transition of an acute injury/inflammatory state to a chronic post inflammatory pain state.
    2. Review current thinking on the mechanism that underlie the acute to chronic pain transition.
    3. Understand the role of innate immunity in the chronic pain phenotype.