Credit Hours: CME 1.00

Target Audience:

This case focuses on an adult with cancer and new pain. A complaint of new or worsening pain in a patient with cancer often signals advancing disease which along with the physical symptoms brings psychological, social and spiritual suffering. Pain from bony metastasis has complex pathophysiology with both nociceptive and neuropathic mechanisms. Teaching points will emphasize comprehensive pain assessment, treatment choices based on knowledge of pain pathways and analgesic mechanisms of action, and collaboration with an interdisciplinary team to optimize pain management in a cancer patient with progressive disease. Teaching also will cover the need to consider non-cancer causes of pain in the patient with cancer. This course is directed to primary care physicians.

Educational Objectives:

Upon completion of this activity, participants should be able to:

Describe the steps involved in taking a complete pain history in a patient with metastatic cancer.
Choose and adjust appropriate medications, based on knowledge of pain pathways and analgesic mechanisms of action to optimize pain relief in a cancer patient with progressive disease
Describe key components of biopsychosocial assessment in the patient with metastatic cancer and pain.

Suggested Additional Reading:

Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research -- Chapter 4, Education Challenges. Washington (DC): National Academies Press (US); 2011. https://www.ncbi.nlm.nih.gov/books/NBK92522/ <br>

Mezei L, Murinson BB. Pain education in North American medical schools. J Pain 2011, 12(12): 1199-208

Authors:

Debra Weiner, MD, CoEPE Co-Director — Associate Professor of Medicine, Psychiatry and Anesthesiology in the Division of Geriatrics at the University of Pittsburgh School of Medicine, Physician in the University of Pittsburgh Institute on Aging. Center of Excellence in Pain Education (CoEPE), Co-Director.
No relationships with industry relevant to the content of this educational activity have been disclosed.

Heiko Spallek, DMD, PhD, MSBA (CIS): CoEPE Co-Director — Associate Dean for Faculty Affairs at the School of Dental Medicine, University of Pittsburgh where he is also appointed as Associate Professor at the Center for Dental Informatics with secondary appointments in the Department of Biomedical Informatics and the School of Information Sciences. Center of Excellence in Pain Education (CoEPE) Co-Director.
No relationships with industry relevant to the content of this educational activity have been disclosed.

Joseph Shega, MD — Senior Vice President and Chief Medical Officer for VITAS Healthcare, Associate Professor of Medicine Section of Geriatrics and Palliative Medicine University of Chicago.
No relationships with industry relevant to the content of this educational activity have been disclosed.

Julie Childers, MD — Associate Professor of Medicine, University of Pittsburgh School of Medicine.
No relationships with industry relevant to the content of this educational activity have been disclosed.

Monica Malec, MD — Associate Professor of Medicine, Geriatric and Palliative Medicine, Primary Care, The University of Chicago Medicine.
No relationships with industry relevant to the content of this educational activity have been disclosed.

Zsuzsa Horváth, PhD, CoEPE Director — Assistant Professor in Department of Dental Public Health and Director of Faculty Development in the Office Faculty Affairs at the School of Dental Medicine. Dr. Horváth is also Director of the Academic Career Track Area of Concentration (ACT ARCO) and serves on the editorial board of the Journal of Dental Education. Center of Excellence in Pain Education (CoEPE), Director.
No relationships with industry relevant to the content of this educational activity have been disclosed.

Authors disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above. No other planners, members of the planning committee, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits^™. Each physician should only claim credit commensurate with the extent of their participation in the activity.

The University of Pittsburgh is an affirmative action, equal opportunity institution.