Untitled Document

OVERVIEW
Chronic pain affects an estimated 100 million Americans and many of these patients receive opioid analgesics to palliate moderate to severe pain. Constipation is one of the most frequent and persistent adverse effects of opioids and can impair patients' quality of life to a point where it prevents sufficient pain control. It is estimated that opioid-induced constipation (OIC) is experienced by a large proportion of patients, and that constipation and other gastrointestinal symptoms may dissuade patients from using the required analgesic dose to achieve effective pain relief. Opioids have several effects on normal gastrointestinal function, and the inhibition of colonic transit and intestinal and colonic secretion results in constipation. Clinicians, including pain specialists, physicians, pharmacists, nurses, and other allied healthcare professionals, must understand and recognize these symptoms and take a proactive approach to minimize the risk of opioid-induced constipation.

LEARNING OBJECTIVES
Upon completion, learners should be able to:

Recognize the burden and consequences of OIC
Identify patients who would benefit from a more targeted approach to treat OIC
Summarize the latest clinical strategies in the appropriate management of OIC

TARGET AUDIENCE
This activity is designed to meet the educational needs of physicians, pharmacists, and other healthcare professionals involved in the care of patients experiencing moderate to severe pain. This activity would be especially beneficial for clinicians who are treating patients who receive opioid analgesics and who experience opioid-induced constipation.

EDUCATIONAL FORMAT
This Expert Interview Digest is designed to increase awareness and provide answers to the frequently asked questions on risks of opioid-induced constipation and its appropriate management. This activity is divided into a series of four Audio Modules to guide you through various aspects of pathophysiology, consequences, and management of OIC.

AUDIO MODULE 1:
In this episode, Dr. Gregory Holmquist describes the pathophysiology of opioid-induced constipation by discussing the mechanism of OIC, how it is different from other types of constipation, and the risk of OIC with different types of opioids.

AUDIO MODULE 2:
In this episode, Dr. Bill McCarberg discusses some of the clinical and economic consequences of opioid-induced constipation and the burden associated with OIC to both the patient and the healthcare system.

AUDIO MODULE 3:
In this episode, Dr. Gregory Holmquist and Dr. Bill McCarberg discuss some of the current strategies, guidelines, and treatments when managing patients with opioid-induced constipation.

AUDIO MODULE 4:
In this episode, Dr. Gregory Holmquist and Dr. Bill McCarberg discuss the options currently available for clinicians when laxatives are not sufficient and an alternative treatment is needed.

FACULTY

	Gregory L. Holmquist, PharmD, CPE Pain and Palliative Care Specialist Certified Pain Educator Palliative Care Strategies Seattle, WA
	Bill H. McCarberg, MD Founder, Chronic Pain Management Program Kaiser Permanente San Diego Adjunct Assistant Clinical Professor University of California San Diego San Diego, CA
	Medical Interviewer Marco P. Cicero, PhD Senior Director, Scientific Affairs Vemco MedEd, LLC Bridgewater, NJ

Accreditation
Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Center for Independent Healthcare Education and Vemco MedEd, LLC. Center for Independent Healthcare Education (Center) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Center for Independent Healthcare Education designates this Enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacists
Center for Independent Healthcare Education (Center) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Center has assigned 1.0 contact hours (0.1 CEUs) for this activity.

ACPE Universal Activity Number: 473-999-12-001-H01-P
Type of Activity: Knowledge-based

Release Date: 04/23/2012
Credit Expiration Date: 04/23/2013

Method of Participation and Instructions for Credit

Review the entire CME/CE information including target audience, learning objectives, and disclosures.
Review each Audio Module.
Complete the Post Test, Evaluation, and Credit Application form.
Please note that to receive credit you must achieve a score of at least 80%.
Mail the completed Post Test, Evaluation, and Credit Application form to Vemco MedEd, 245 US Highway 22, Suite 304, Bridgewater, NJ 08807 Or Fax to (908) 450-3300 Or email to bhassid@vemcomeded.com.

Documentation of credit will be mailed within 4 weeks of receipt of the completed Post Test, Evaluation, and Credit Application form.

Disclosure of Conflicts of Interest
Center for Independent Healthcare Education requires faculty, planners, and others who are in a position to control the content of continuing education activities to disclose to the audience any real or apparent conflict of interest related to the activity. All identified conflicts of interest are reviewed and resolved to ensure fair balance, objectivity, and scientific rigor in all activities. The faculty is further required to disclose discussion of off-label uses in their presentations.

Disclosure: Faculty
Gregory L. Holmquist, PharmD, CPE
Speaker’s Bureau: Salix Pharmaceuticals

Bill H. McCarberg, MD

Speaker’s Bureau: Endo Pharmaceuticals, PriCara, NeurogesX, Forest Laboratories

Disclosures: Planning Committee Members
Marco P. Cicero, PhD
Nothing relevant to disclose.

Off-label Disclosure Statement
During this activity, the following off-label use of a medication is discussed: methylnaltrexone for the treatment of opioid-induced constipation in the absence of advanced illness.

Disclaimer
The opinions expressed in this educational activity are those of the faculty and do not reflect the views of Center for Independent Healthcare Education (Center) and Vemco MedEd. This educational activity may discuss off-label and/or investigational uses and dosages for therapeutic products/procedures that have not been approved by the United States Food and Drug Administration (FDA). Center and Vemco MedEd do not recommend the use of any product/procedure outside of the labeled indications. Clinicians should verify all information and data before treating patients or employing any therapies described in this continuing education activity. Please refer to the prescribing information for each product/procedure for approved indication, contraindications, and warnings.

Joint Sponsorship
This activity is jointly sponsored by Center for Independent Healthcare Education and Vemco MedEd.

Commercial Support
This activity is supported by educational grant from

Fee
There is no fee to participate in this activity.

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