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ComprehensiveReview of Pain ManagementAugust 5-9, 2019Very good conference. I really likedthe questions and answer sessionin between to keep us alert andmaking sure the subject matter isconveyed well. All the speakerswere very knowledgeable. I wouldhighly recommend this conferenceto my fellows and peers.I really enjoyed the course. Ithas been one of the most helpfulcourses I have attended in a longtime.I always learn a great deal from thiscollective group of pain experts.Thank you for putting this on.The Fluno Center for Executive EducationMadison, WisconsinCourse Director: Nalini Sehgal, MDCourse Co-director: Aleksandra Zgierska, MD, PhD
The ConferenceStatement of NeedThe University of Wisconsin School of Medicine and PublicHealth faculty in Pain Medicine, Family Medicine andCommunity Health, Anesthesiology, Neurology, Orthopedicsand Rehabilitation, and the University of Wisconsin–MadisonInterprofessional Continuing Education Partnership (ICEP)are pleased to offer the 17th Comprehensive Review of PainManagement at the Fluno Center in Madison, Wisconsin, onAugust 5-9, 2019.The current national opioid epidemic has highlighted gapsin prevention, assessment and treatment of pain and opioidrelated harms at all levels. Under-treatment as well asinappropriate pain management have contributed to suboptimaltreatment outcomes, opioid misuse and use disorders,overdose, patient and provider dissatisfaction, and escalatingnational costs. This activity addresses knowledge and existingpractice gaps in education and training in pain medicine.Highlights: Review of best clinical practices in pain management byexpert multidisciplinary faculty Education on judicious and balanced opioid use, riskassessment, mitigation, monitoring, strategies for opioidtaper, and opioid-sparing treatment approaches Education about issues overlapping pain and opioid usedisorder (OUDs), the diagnosis and treatment of OUD, andpain management approaches in individuals with OUD Overview of current evidence on applications ofcannabinoids to pain care Up-to-date, intensive review of Pain Medicine and relateddisorders for board certification/recertification Focus on topics of interest to Primary Care and otherinterdisciplinary clinicians on Wednesday, August 7 Friday, August 9 Describe pain management approaches in children, elderly,pregnant and lactating women, and those with cancer. Describe the assessment and management of headache,complex regional pain syndrome (CRPS), neuropathic pain,myofascial pain, fibromyalgia, and pelvic pain. Recognize, interpret and clinically correlate radiologicalabnormalities in common musculoskeletal pain disorders ofthe spine and peripheral joints. Outline a multimodal treatment plan for common painconditions incorporating pharmacological, rehabilitation,behavioral/psychological, complementary and alternativemedicine, interventional, and surgical treatments. Describe analgesic pharmacology and clinical applicationsof opioid and non-opioid analgesics and otherpharmacotherapies for acute and chronic pain. Review the anatomy, indications, and contraindications forregional anesthetic blocks, different types of peripheral andspinal nerve blocks, and other advanced pain treatments forheadache and facial pain, spinal pain, CRPS, osteoarthriticmusculoskeletal and neuropathic pain conditions. Describe role of spinal cord stimulators and pumps in painmanagement. Summarize the evidence for regenerative medicinetreatments for musculoskeletal pain conditions. Discuss integrative medicine approaches to treating pain. Discuss opioid therapy and related issues in painmanagemento State approaches aimed at improving safety andefficacy of pain management with opioids: how toinitiate, maintain, monitor compliance, taper anddiscontinue opioids. 37.5 hours of instructiono Discuss pain management in patients on long-term,high-dose opioid therapy.Target Audienceo Describe adverse effects of long-term opioid therapy.This activity has been planned by and for an interprofessionalaudience of clinicians, including pain medicine, addictionmedicine, and primary care physicians; physician assistants,nurse practitioners, nurses, and pharmacists interested inobtaining an overview of pain management.o Discuss the problems of prescription opioid misuse/opioid use disorder in chronic pain.Elements of CompetenceThis CE activity has been designed to the interprofessional (IP)areas of values/ethics for IP practice, roles/responsibilities,interprofessional communication and teams/teamwork.ObjectivesAt the conclusion of this educational activity, clinicians will beable to: Review neuroanatomy and neurophysiology of painpathways. Describe pathophysiology of acute and chronic pain. Learn to communicate with patients effectively. Describe comorbid psychiatric conditions, discusspsychological evaluation and summarize evidence forcommon behavioral treatments such as mindfulnessmeditation, cognitive behavioral therapy, relaxation,biofeedback, hypnosis.o Explain the role of urine drug testing and discuss theinterpretation of results.o Summarize diagnosis and treatment of opioiduse disorder, and discuss approaches to reduceaddiction-related harm.o Describe strategies to manage pain without opioids,including IV lidocaine and ketamine infusions, nerveblocks, neuromodulation, integrative medicine andnon-pharmacologic approaches.o Describe policies and DEA regulations pertaining toprescribing controlled substances, and appropriaterecord keeping.o Discuss the potential of cannabinoids as an opioidsparing approach to the management of pain and thetreatment of comorbid mental health conditions.
Course DirectorCourse Co-directorAleksandra Zgierska, MD, PhDVisiting FacultyMichael R. Clark, MD, MPH, MBA; Chair, Department ofPsychiatry, Inova Fairfax Hospital, Falls Church, VAEdward C. Covington, MD; Emeritus Staff, Cleveland ClinicFoundation; Former Director, Neurological Center for Pain;Shaker Heights, OHTimothy R. Deer, MD, DABPM, FIPP; President and CEO,The Spine and Nerve Center of The Virginias, Charleston, WVOscar A. de Leon-Casasola, MD; Professor ofAnesthesiology and Medicine; Senior Vice-Chair, Departmentof Anesthesiology, University at Buffalo, School of Medicine;Chief, Division of Pain Medicine and Professor of Oncology,Roswell Park Cancer Institute, Buffalo, NYRob Edwards, PhD, MSPH; Associate Professor, Departmentof Anesthesiology, Brigham and Women’s Hospital, HarvardUniversity, Boston, MAJohn R. Ewing, MD; Medical Co-Director of AddictionMedicine, UnityPoint Health–Meriter, NewStart Addiction andSubstance Abuse Treatment Program, Madison, WIThomas Faull, DO, DC; Division Chief, Pain ManagementSSM Health, Dean Medical Group, Madison, WIDavid Galbis-Reig, MD, DFASAM; Medical Directorof Addiction Medicine, Ascension Wisconsin All Saints;President-Elect, Wisconsin Society of Addiction Medicine; VPMD, Wisconsin Medical Society Foundation; Racine, WICara R. King, DO, MS; Division Director of BenignGynecologic Surgery, Associate Program Director of MinimallyInvasive Gynecologic Surgery Fellowship, Cleveland Clinic,Cleveland, OHMichael Larson, PhD; Health / Pain Psychologist, MarshfieldClinic Health System; Director of Controlled Medication Policy,Marshfield Clinic Health System, Minocqua, WIMichael McNett, MD; Aurora Pain Management Leader:Medical, Aurora Health System, Milwaukee, WITony L. Yaksh, PhD; Professor, Departments ofAnesthesiology and Pharmacology, University of California,San Diego, La Jolla, CAAnnette M. Zaharoff, MD; Medical Director, Non-SurgicalCenter of Texas, San Antonio, TXUniversity Of Wisconsin–Madison FacultyRitu Bhatnagar, MD, MPH; Clinical Adjunct Professor,Department of Psychiatry; Medical Director and AddictionPsychiatrist, UnityPoint Health-Meriter NewStartMiranda J. Bice, MD; Clinical Assistant Professor,Department of Orthopedics and RehabilitationDonna G. Blankenbaker, MD; Professor, Department ofRadiologyTimothy W. Casias, MD; Assistant Professor, Department ofAnesthesiology; Medical Director of Pediatric Chronic PainJune L. Dahl, PhD; Professor Emerita of NeuroscienceSteven J. Garlow, MD, PhD; Professor, Department ofPsychiatryAaron M. Gilson, MS, MSSW, PhD; Health Policy ResearchScientist/Senior Scientist, Sonderegger Research Center,University of Wisconsin-Madison School of PharmacyPaul R. Hutson, PharmD, BCOP;* Professor, School ofPharmacyCheryl J. Kaltenberg;* ConsultantElizabeth Lake, MD; Clinical Assistant Professor,Department of NeurologyJames W. Leonard, DO, PT;* Associate Professor,Chair Division of Rehabilitation Medicine, Department ofOrthopedics and RehabilitationSarah E. McAchran, MD, FACS; Associate Professor,Departments of Urology and Obstetrics & GynecologyThomas S. McDowell, MD, PhD; Associate Professor,Department of AnesthesiologyShilagh A. Mirgain, PhD; Distinguished Psychologist, ClinicalAdjunct Assistant Professor, Department of Orthopedics andRehabilitationTracy Mrochek, MPA, RN; Continuing Education ProgramCoordinator, Continuing Education in Nursing, Universityof Wisconsin-Madison School of Nursing; University ofWisconsin–Madison ICEPPeggy S. Riley, MN, MPH, RN;* Director, Pediatric Pain andPalliative Care Programs, American Family Children’s Hospital;Adjunct Faculty, UW School of NursingAdam Rindfleisch, MD, MPhil; Associate Professor,Department of Family Medicine and Community Health;Medical Director, UW Integrative Medicine ProgramNathan J. Rudin, MD, MA;* Professor, Department ofOrthopedics and Rehabilitation*Planning Committee memberSusanne Seeger, MD; Associate Professor and Vice Chair;Director, Headache Program, Department of NeurologyAlaa Abd-Elsayed, MD;* Assistant Professor, Department ofAnesthesiology; Medical Director, UW Health Pain Services;Medical Director, UW Pain ClinicNalini Sehgal, MD;* Professor, Department of Orthopedicsand Rehabilitation; Fellowship Director, Pain Medicine; ViceChair & Director Clinical Services, Rehabilitation MedicineJacquelyn Adams, MD; Assistant Professor, Department ofObstetrics and GynecologyShawna K. Wheeler, PA-C; Department of NeurologyChristi Ann Albert, PharmD BCPS; Clinical Pharmacy, UWHealth, University HospitalSreevalli Atluru, MD; Assistant Professor, Department ofFamily Medicine and Community HealthMiroslav “Misha” Backonja, MD;* Emeritus Professor ofNeurology, University of Wisconsin Senior Medical Director,Worldwide Clinical Trials, Seattle WAAleksandra E. Zgierska, MD, PhD;* Associate Professor,Departments of Family Medicine and Community Health,and Population Health Sciences; Board of Directors member,Wisconsin and American Societies of Addiction MedicineFacultyNalini Sehgal, MDTerese M. Bailey;* Senior Outreach Specialist, Office ofContinuing Professional Development in Medicine and PublicHealth, University of Wisconsin–Madison ICEP
ScheduleMonday, August 57:00Registration & Breakfast7:30-7:45Welcome7:45-8:15Acute Pain Management: Neurobiology of Pain – Applying BasicScience Knowledge to Daily PracticeOscar A. de Leon-Casasola, MD8:15-8:45Managing Pain Postoperatively: Alternatives for Postoperative PainManagement – What Does the Latest Literature Suggest?Oscar A. de Leon-Casasola, MD8:45-9:15Pain Syndromes in CancerOscar A. de Leon-Casasola, MD9:15-9:30Q&A9:30-9:45Break9:45-10:30Management of Acute and Chronic Pain in Cancer and Palliative Care Oscar A. de Leon-Casasola, MD10:30-11:00Receptors, Ion Channels and Channelopathies in Pain11:00-11:15Q&A11:15-11:45Anatomy and Physiology of Pain PathwaysTony L. Yaksh, PhD11:45-12:30Mechanism of Pain StatesTony L. Yaksh, PhD12:30-1:30Lunch1:30-2:00Assessment and Diagnosis of Neuropathic PainMisha Backonja, MD2:00-2:30Neuropathic Pain: Therapeutic ConsiderationsMisha Backonja, MD2:30-3:00Pharmacotherapy of Neuropathic PainJune L. Dahl, PhD3:00-3:15Q&A3:15-3:30Break3:30-4:15Implantable Pumps in Pain ManagementTimothy R. Deer, MD, DABPM, FIPP4:15-5:00Spinal Cord Stimulation in Chronic Pain: Current StatusTimothy R. Deer, MD, DABPM, FIPP5:00-5:15Q&A5:15AdjournThomas S. McDowell, MD, PhDTuesday, August 67:00Breakfast7:45-8:45Musculoskeletal Pain: Clinical and Radiologic CorrelationDonna Blankenbaker, MD &James Leonard, DO8:45-9:45Chronic Spinal Pain: Clinical and Radiologic CorrelationDonna Blankenbaker, MD &James Leonard, DO9:45-10:30Chronic Spinal Pain: Spinal InjectionsNalini Sehgal, MD10:30-10:45Break10:45-11:30Chronic Spinal Pain: Surgical TreatmentsMiranda J. Bice, MD11:30-12:15CRPS and Sympathetic BlocksNalini Sehgal, MD12:15-12:30Q&A12:30-1:30Lunch1:30-1:45Headache: Clinical AssessmentShawna Wheeler, PA-C1:45-2:00Headache: Trigemino-cervical ComplexElizabeth Lake, MD2:00-2:45Primary Headache Disorder: Approach to Diagnosis and TreatmentSusanne Seeger, MD2:45-3:15Secondary Headache DisordersElizabeth Lake, MD3:15-3:30Q&A3:30-3:45Break3:45-4:30Headache and Atypical Facial Pain: Cranial Nerve Blocks andRadiofrequency AblationAlaa Abd-Elsayed, MD4:30-5:30Approach to Female Patient with Chronic Pelvic Pain5:30-5:45Q&ACara King, DO, MS &Sarah McAchran, MD5:45AdjournWednesday, August 77:00Breakfast7:45-8:45Psychiatric Comorbidity in Chronic PainMichael Clark, MD, MPH, MBA8:45-9:45Treatment of Depression, Anxiety and Sleep ProblemsMichael Clark, MD, MPH, MBA
Break10:00-10:45Psychological Evaluations in Chronic Pain10:45-11:30Complex Psychiatric Comorbidity in the Context of Pain Management Rob Edwards, PhD, MSPH11:30-12:15Psychological Interventions in Chronic Pain12:15-12:30Q&A12:30-1:30Lunch1:30-2:00Pain in Children: AssessmentPeggy Riley, MN, MPH, RN2:00-2:30Chronic Pain in Children: ManagementTimothy W. Casias, MD2:30-3:15Pain in the Elderly: Assessment and ManagementNathan J. Rudin, MD, MA3:15-3:30Break3:30-4:15Myofascial Pain SyndromeNathan J. Rudin, MD, MA4:15-5:00Acetaminophen, Antiinflammatory, and Antispasmodics Medicationsin Pain CareChristi Albert, PharmD BCPS5:00-5:45Fibromyalgia and Other Central Sensitization Pain SyndromesNathan J. Rudin, MD, MA5:45AdjournShilagh A. Mirgain, PhDShilagh A. Mirgain, PhDThursday, August 87:00-8:00Breakfast8:00-8:45Opioid Analgesics: Mechanisms of Action, Pharmacology andAdverse EffectsPaul Hutson, PharmD, BCOP**8:45-9:30Opioid Therapy for Chronic Pain: Is There a Role? Why, When, andHowMichael McNett, MD**9:30-10:15Legacy Patients – Ethical, Safe, and Compassionate Management ofThose Highly Tolerant to OpioidsEdward C. Covington, d Use Disorder: Diagnosis and TreatmentRitu Bhatnagar, MD, MPH**11:30-12:15Interpretation of Urine Drug Testing: Abnormal Results – What Now?John Ewing, MD**12:15-12:30Q&A12:30-1:30Lunch1:30-2:15Efforts at Curbing Opioid Harms: Learning from a Decade ofInterventions at Marshfield Clinic Health System in WisconsinMichael Larson, PhD**2:15-3:00Opioid Sparing Strategies: A Role for Lidocaine and KetamineInfusions?Nalini Sehgal, MD &Steven J. Garlow, MD, PhD**3:00-3:15Q&A3:15-3:30Break3:30-4:30Pain Management in Patients with Opioid Use DisorderDavid Galbis-Reig, MD, DFASAM**4:30-5:305:30Cannabinoids and Pain ManagementDavid Galbis-Reig, MD, DFASAM**Adjourn**All Thursday lectures may meet opioid related CME required by State of Wisconsin and count towards 2 hours of continuing education on Rational Opioid Prescribing pending approval from the Medical Examining Board.Friday, August 97:00-7:45Breakfast7:45-8:30Regenerative Medicine Treatments for Chronic Musculoskeletal PainAnnette M. Zaharoff, MD8:30-9:15Integrative Therapies for Chronic Pain: Evidence and ApplicationAdam Rindfleisch, MD9:15-9:30Q&A9:30-10:15Regional Anesthetic Blocks for Acute and Chronic sment and Management of Pain in Pregnant WomenSreevalli Atluru, MD &Jacquelyn Adams, MD11:15-11:45Management of Pain in Breastfeeding WomenSreevalli Atluru, MD &Jacquelyn Adams, MD11:45-12:30DEA Regulations and Lawful Prescribing of Controlled Substances:Focus on OpioidsAaron Gilson, MS, MSSW, PhD12:30Adjourn & Box LunchThomas J. Faull, DO, DCSchedule9:45-10:00
General InformationConference Dates and FeesAugust 5-9, 2019 1250 Physicians 895 Fellows, Residents, Others (PA/NP/RN/RPh/PharmD, etc.) 575 UW/VA/Meriter Faculty, Residents, and StaffThe conference fee includes the cost of tuition, breakfasts,refreshment breaks, lunches, and a nonrefundable processingfee of 50.Overall, it was a very well organizedweek of information on painmanagement.Registration Information Visit https://ce.icep.wisc.edu/comprehensive-pain-2019 Select the Register/Enroll Tab Select login or register If you have a UW-Madison NetID: Select “Login with my UWMadison NetID” If you are a Visitor: Select “I already have an account” or“Create an account login and password” Follow any prompts to complete or update profile information Once you are logged in, navigate back 9 Click the Register tab, select your Registration Fee,complete any additional conference registration questions,and click, “Add to Cart” Select “Checkout” and follow the prompts to pay for theconferenceContact help@icep.wisc.edu if you need assistanceCancellation and Refund PolicyRequests for cancellation must be submitted in writing tohelp@icep.wisc.edu. Cancellation requests received byJuly 29, 2019 will allow a full refund except for the 50nonrefundable processing fee. No refunds will be made forcancellations received after July 29, 2019.Conference Location and AccommodationsCourse MaterialsConference materials will be available to registered participants48 hours prior to the event at the conference 019Participants may purchase a paper copy of the syllabus foran additional fee of 94.95 (tax included). Requests must bereceived by Monday, July 15, 2019.If there are any concerns regarding the electronic syllabus,please contact Terese Bailey or Cheryl Kaltenberg prior to theSymposium.ExhibitsRepresentatives from pharmaceutical and equipmentcompanies will display their products and will be availableon Tuesday, August 6; Wednesday, August 7; and Thursday,August 8.Conference AttireSince meeting room temperatures and personal comfort levelsvary, it is recommended that you bring a sweater or jacket.The Fluno Center for Executive Education601 University AvenueMadison, WI 53715Call: 877-77-FLUNO or direct at 608-441-7117Fax: 608-441-7133For Further InformationA block of rooms has been reserved at the Fluno Center.Please call the hotel directly to reserve your accommodation.The room rate is 159. The block of rooms will be held on afirst-come, first served basis and any available rooms that havenot been reserved by Friday, July 5, 2019, will be released.Cheryl J. Kaltenberg, Consultant, kaltenberg@rehab.wisc.eduTerese M. Bailey, University of Wisconsin–Madison ICEP, 750Highland Ave 1171 HSLC, Madison, Wisconsin 53705-2221;telephone 608-265-2046; terese.bailey@wisc.eduMadison, Wisconsin has one major airport (MSN), the DaneCounty Regional Airport. The Fluno Center is approximately20 minutes from the airport.Program ChangesEmergency situations occasionally occur and may necessitatetopic or speaker changes. The University of Wisconsin Schoolof Medicine and Public Health and the University of Wisconsin–Madison Interprofessional Continuing Education Partnershipreserves the right to alter or substitute a topic or speakerwithout prior notification.Excellent conference. Very happyI was able to attend.
CreditAccreditation StatementIn support of improving patient care,the University of Wisconsin–MadisonInterprofessional Continuing EducationPartnership is accredited by the AccreditationCouncil for Continuing Medical Education(ACCME), the Accreditation Council forPharmacy Education (ACPE), and theAmerican Nurses Credentialing Center(ANCC) to provide continuing education forthe healthcare team.Credit Designation StatementsAccreditation Council for Pharmacy Education (ACPE)A maximum of 37.5 hours of knowledge-based CE creditcan be earned by successfully completing this live activity.Pharmacists should claim only the credit commensuratewith the extent of their participation in the activity. CE creditinformation, based on verification of live attendance andcompletion of the program assessment and evaluation, will beprovided to NABP within 60 days after the activity completion.Universal Activity NumberJA0000358-0000-19-069-L01-P36.75 hours/3.675 CEUsUniversal Activity NumberJA0000358-0000-19-070-L03-P0.75 hours/.075 CEUsAmerican Academy of Family MedicineApplication for CME credit has been filed with the AmericanAcademy of Family Physicians. Determination of credit ispending.American Board of Addiction MedicineApplication has been made for this conference to be anapproved CME Activity by the American Board of AddictionMedicine (ABAM) for the Maintenance of Certification (MOC)Program for the CME requirement for Part II: Lifelong Learningand Self-Assessment.Wisconsin Medical Examining Board Opioid CMEAn application has been submitted to the Wisconsin MedicalExamining Board for approval to award continuing educationon responsible opioid prescribing guidelines.Policy on DisclosureIt is the policy of the University of Wisconsin–Madison ICEP,that the faculty, authors, planners, and other persons whomay influence content of this CE activity disclose all relevantfinancial relationships with commercial interests in order toallow CE staff to identify and resolve any potential conflicts ofinterest. Faculty must also disclose any planned discussionof unlabeled/unapproved uses of drugs or devices during theirpresentation(s).Detailed disclosures will be available prior to the start of theactivity.American Medical Association (AMA)The University of Wisconsin–Madison ICEP designates thislive activity for a maximum of 37.5 AMA PRA Category1 Credits . Physicians should claim only the creditcommensurate with the extent of their participation in theactivity.American Nurses Credentialing Center (ANCC) & IowaBoard of NursingThe University of Wisconsin–Madison ICEP designates thislive activity for a maximum of 37.5 ANCC and Iowa contacthours. ANCC pharmacotherapeutic contact hours will becalculated and awarded as appropriate to meet the needs ofadvanced practice nurses.The University of Wisconsin–Madison School of Nursing isIowa Board of Nursing provider 350. A copy of the evaluation(s)may be sent to the Iowa Board of Nursing, 400 SW 8th St.,Suite B, Des Moines, IA 50309.Continuing Education UnitsThe University of Wisconsin–Madison, as a member ofthe University Continuing Education Association (UCEA),authorizes this program for 3.75 continuing education units(CEUs) or 37.5 hours.Very educational. As a pharmacist,several of the interventionalprocedure presentations wereabove my scope of practice butstill worth the information. Iam now more informed aboutavailable interventions that maybenefit patients and not just focuson medication therapy. Overallexcellent conference and willrecommend others to attend in thefuture.
University of Wisconsin-Madison ICEP750 Highland Ave 1171 HSLCMadison, WI 53705-2221Nonprofit OrganizationUS PostagePAIDMadison, WisconsinPermit No. 658ComprehensiveReview of Pain ManagementAugust 5-9, 2019Course Director: Nalini Sehgal, MDCourse Co-director: Aleksandra Zgierska, MD, PhDThe Fluno Center for Executive EducationMadison, WisconsinProvided ByUniversity of Wisconsin School of Medicine and Public HealthDepartment of Orthopedics and RehabilitationDepartment of AnesthesiologyDepartment of Family Medicine and Community HealthDepartment of NeurologyUniversity of Wisconsin–Madison Interprofessional ContinuingEducation Partnership (ICEP)NEW THIS YEAR – Earn your 2 Wisconsin Opioid CME creditsAn application has been submitted to the Wisconsin Medical Examining Board forapproval to award continuing education on responsible opioid prescribing guidelines.
Jul 29, 2019 · Community Health, Anesthesiology, Neurology, Orthopedics and Rehabilitation, and the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) are pleased to offer the 17th Comprehensive Review of Pain Management at the
