Download Emergency Medicine Primer for Family Physicians

ONTARIO COLLEGE OF FAMILY PHYSICIANS
340 Richmond St. West
Toronto, ON M5V 1X2
Phone: 416-857-9646 ◊ Fax: 416-867-9990
Pain and Addictions Primer for Family Physicians
Saturday March 23, 2013
8:30 am – 4:30 pm
Hawkesbury Fire Department
780 Spence Ave
Hawkesbury, ON K6A 3H9
The Ontario College of Family Physicians is pleased to announce the offering of A Pain and Addictions Primer for Family Physicians
in collaboration with Centres for Pain Management (CPM).
Patients presenting with the complications of opioid addiction and chronic pain are difficult to manage in the context of a family practice. This 1
day course is being offered to family physicians with a comprehensive family medicine practice who care for pain/addictions
patients or those physicians with focused practices in pain and/or addictions care.
Session Date:
Saturday March 23, 2013 (8:30 am – 4:30 pm)
What is being offered?
 1 day course with practical sessions and case-based discussion on addictions and chronic pain
 12 topics on all major systems in addictions and pain management
This program meets the accreditation criteria of The College of Family Physicians of Canada and has been accredited
for 6.5 Mainpro-C credits.
Registration/Contact Information:
Prefix: Dr. First Name: _____________________ Last Name: _____________________
Address: ________________________________________________ City: ____________
Province: ON Postal Code: _____________ Email Address: ________________________
Telephone: _________________________
CFPC Member:
 Yes
 No
Payment Information (check one):
Fax: ______________________________
CFPC Number: _________________________
 Visa
 MasterCard
Card Number: _________________________________
Expiry: ______________
Amount Authorized: $____________________________
Registration Fee: $375.00 (HST Incl.)
Registration Deadline: March 13th, 2013 (or earlier if space is no longer available)
On-site registration will NOT be available
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The OCFP reserves the right to cancel sessions due to unforeseen circumstances or insufficient advance registration. In the event of a cancellation made by
the OCFP, a full refund will be given to the registrants. However, the OCFP cannot accept responsibility for out-of-pocket expenses due to cancellation of a
session. Cancellations made by March 15th, 2013 will be refunded, less 25% the admission fee.
Please address completed Registration Form to: Ontario College of Family Physicians  340 Richmond Street West, Toronto,
ON, M5V 1X2  Attention: Arsela Hoxhaj  Tel: 416-867-9646 ext. 20  Fax: 416-867-9990  [email protected]
A confirmation email will be sent within 2 business days of receiving your registration. If you do not receive confirmation, please contact us.
To better assess your needs and experience, please use the following link to access our questionnaire. If you prefer to
provide us with your answers in a written format, please complete the following forms and fax documents to 416867-9990.
Pre-Course Assessment Questionnaire: https://www.surveymonkey.com/s/33T3DLP
ALL following questions must be completed (incomplete forms will not be processed).
Please note that any information you provide will be kept confidential and will only be reported in grouped form:
1. Current Status:
Family Physician
Focused Practice Physician


TYPE OF PRACTICE




a.
b.
c.
d.
Full-Time
Solo
Office
Urban




Part-Time
Group
Hospital
Suburban
 Both
 Both
 Rural
2. How did you hear about the Pain and Addictions Primer for Family Physicians?
_____________________________________________________________
3. How many years of experience do you have in managing pain/addictions patients?
_______________________________________________________________
4. How would you rate your comfort level in prescribing opioids?
Poor
Fair
Good
Very Good
Excellent
1
2
3
4
5
5. How would you rate your current level of confidence in your ability to manage chronic pain?
Not Confident Slightly Confident Fairly Confident Quite Confident Very Confident
1
2
3
4
5
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6. In the past six months, how many patients have you prescribed opioids for chronic non-cancer pain? Please
circle your option
0
1-5
6-10
11-15
16-20
21 or more
7. In the past six months, for how many patients on long-term opioids have you ordered a urine drug screen?
Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
8. In the past six months, for how many patients on long-term opioids have you decreased (tapered) the opioid
dose? Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
9. In the past six months, for how many patients on long-term opioids have you increased the frequency of
dispensing (eg from once every month to once every week)? Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
10. In the past six months, for how many patients on long-term opioids have you referred the patient to an
addiction program (methadone or buprenorphine?) Please circle your option
0
1-2
3-4
5-6
7-8
9 or more
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11. Based on the course outline listed below, do you see this program making a difference in your practice?
 Yes
 No
12. How do you best see yourself integrating this new knowledge into your practice?
13. Please specify the top 3 areas of concern you hope this course will address:
1) ________________________________________________________________
2) ________________________________________________________________
3) ________________________________________________________________
14. How interested are you in learning more about each of the topics listed below?
Not at all
interested
A little
interested
Somewhat
interested
Quite
interested
Extremely
interested
Urine drug testing
Who should receive opioids for CNCP
How do you titrate the opioid dose
Preventing overdose
Tapering the benzodiazepine dose
Tapering the opioid dose
Screening for opioid addiction risk
When to refer for (methadone,
buprenorphine treatment
Buprenorphine prescribing for family
physicians
Sleep issues and pain
Opioids for special populations (elderly,
psychiatric patients etc)
Non-opioid treatments for pain
Comprehensive treatment of pain
Aberrant drug-related behaviours
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4) Please provide a brief outline of a real case or problem related to opioid prescribing you have faced in your
practice that you would like to have discussed during the course:
5) Breakfast and lunch will be provided. Do you have any life threatening or serious food allergies we should be
aware of?
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Course Outline:
1.Introduction to Pain and Addiction

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
Terminology
Epidemiology - pain, addiction, overdose stats, analgesia prescription stats
Neurobiology of Pain
Neurobiology of Addictions
Opioid Prescribing
2.Before Prescribing: Assessment and Patient Selection





Pain assessment
Quality of life assessment / functional assessment / symptom assessment
Risk assessment
Psychiatric assessment
Other drugs of abuse
3.Comprehensive Care in Pain Patients
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
Comprehensive approaches to pain - Message that this includes cognitive behavioral therapy, medical
only approach is flawed
Lifestyle management
Exercise, physiotherapy, acupuncture, massage, chiropractic
Psychological Trauma
Chemical dependence
Dealing with pain patients - challenges in prescribing, anger, expectation, lying, physicians at risk,
boundaries
Countertransference / Transference issues
Untreated psychopathology
Non-opioid treatments
Sleep issues in pain
4.Safe Opioid Prescribing in the Office




Guidelines
Practical Issues with selection / dosing / titration
Methadone, Fentanyl, etc
Switching Medications
5.The Patient on Opioids
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
Dosing
Monitoring and assessment of effect - what is the endpoint in titration
Watchful dose
Activities of daily life
Driving
Side effects - sweating, hypogonadism, etc.
Challenges for patients who need pain treatment / primary care
Workload / time commitment - billing issues, assuming care, emotional issues
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6.Opioid Addiction Approaches


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

Methadone / buprenorphine / Replacement or tapers of opioids
How to stop or taper - guidelines, structured opioid therapy, dispensing
Abuse resistant therapies: tamper-resistant oxycodone and other new agents
CPSO guidelines
Exemptions for temporary or ongoing MMT, Buprenorphine
7.Urine Drug Testing: A Patient Centered Approach
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Why Testing?
When and How to test?
“Testing Strategy” in the clinical use of UDT
Testing Techniques
Drugs of abuse
Drug testing traps and interpretation
Approaching the patient
8.The downside of opioids



Risks
a.Overdose, diversion, addiction, withdrawal
Adverse Effects (AEs)
b.Nausea, constipation, somnolence/drowsiness, dizziness/vertigo, dry skin/itching/pruritis, vomiting
Medical Complications
c.Neuroendocrine abnormalities, Sleep apnea, Opioid-induced hyperalgesia (OIH)
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