Integrative Pain Management: Clinical Approaches

This course is comprised of four sections: Headache, Low Back Pain, Cannabis and Pain, and an Introduction to Pain in Pediatrics.

Headache

Providing care for headache patients can be one of the most challenging, yet rewarding, experiences in medicine. Up to 82% of headache patients turn to complementary medicine (Adams, 2013), although more than half do not discuss such use with their provider (Wells, 2011).

Low Back Pain

Low back pain is the fifth most common reason for physician visits in the United States (Hart, 1995; Deyo, 2006) and globally, chronic low back pain is estimated as affecting up to 25% over the age of 60 (Meucci, 2015). U.S. consumers spend a total of $8.7 billion in out of pocket expenses on complementary approaches to manage back pain. The 2017 American College of Physicians (ACP) recommendations for treatment of low back pain include integrative modalities as first line of care.

Cannabis and Pain

Cannabis is becoming an important adjuvant in the treatment of chronic pain. While the use of this plant as a standard therapy is still somewhat controversial, the evidence for cannabis in chronic pain is often misunderstood. Learning how to effectively and safely council patients on the pros and cons of cannabis is an important aspect of chronic pain management. This course will review the pharmacology of cannabis, the evidence for pain control and other symptoms, its safety profile, as well as the differences between oral and inhaled cannabis.

Introduction to Pain in Pediatrics

We now know that children feel pain as acutely and in some cases more acutely than adults. In neonates the pain pathways are well established, while the inhibitory pathways are still developing. Treatment of pediatric pain differs as well? the WHO guidelines for treatment of mild to severe pain differs with regards to the role of adjuvant and opiate therapies, Further, accurate pediatric pain assessment is complex as it requires using physiologic and behavioral indicators and caregiver assessments.

Addressing chronic pain in childhood is critical because it can continue throughout adulthood if not adequately addressed (APS Position Statement, Assessment and Management of Children with Chronic Pain). As chronic pain is managed optimally with an Integrative approach, this is now utilized in many pediatric pain clinics. Encouraging data from a recent U.S. survey found that 50% of pediatric pain clinics offer some form of Integrative Medicine (Bodner, 2018).

Learning Objectives

At the end of this course, participants will be able to:
  1. Recognize the prevalence of low back pain in the United States and the current impact on the health care system.
  2. Identify and learn the 2017 ACP guidelines for the treatment of Low Back Pain.
  3. Review the spectrum of primary headache disorders and secondary headaches.
  4. Discuss the evidence, use and safety for nutritional approaches, dietary supplements, herbal medicine, traditional Chinese medicine, mind-body approaches, energy modalities, manual medicine and movement therapies in the management of low back pain and headache.
  5. Review the interaction between cannabinoid receptors, endocannabinoids and phytocannabinoids in the use of medical marijuana.
  6. Enumerate three different modes of delivery of cannabis and discuss the different pharmacokinetic and safety profiles.
  7. List three symptoms that may be improved by cannabis medicines.
  8. Understand the importance of pain scales in pediatric pain and which scales are validated.
  9. Review the difference in treating pediatric pain and adult pain with opioid therapy.
  10. Differentiate techniques to stimulate the vagus nerve for different age groups in pediatrics.
  11. Review the data for aromatherapy in pediatric pain.
  12. Learn the evidence for herbal therapies, dietary supplements, manual medicine and acupuncture for pediatric pain.
  13. Review the role of sleep in pediatric pain.

Curriculum

  • Headache
  • Low Back Pain
  • Cannabis and Pain
  • Introduction to Pain in Pediatrics
  • Course Evaluation
  • Exam

Completion Requirements

Complete all the coursework, course evaluation, and the final test with a score of 70% or better. Upon successful completion, you will be able to print your certificate of completion.

Target Audience

This enduring material educational program is intended for physicians, nurse practitioners, nurses, physician assistants, psychologists, and psychiatrists in any specialty. In addition, all healthcare professionals who have an interest in an integrative approach to healing are targeted.

Certificate

When all of the above requirements are met (during the agreed-upon timeline), a link for the completion certificate is available to download and print anytime from "My Account." If a specific credit type was selected at registration, your certificate will indicate earned credits.

Disclaimer

This course does not constitute medical advice. Healthcare providers should exercise their own independent medical judgment.

All case studies and patient scenarios in this course are used for illustrative purposes. All depictions of persons (other than faculty) are models and not actual patients.

Integrative Pain Management
Disclosure & Education Credit Info

COM CME

Accreditation / Credit Designation Statement

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

The University of Arizona College of Medicine — Tucson designates this enduring material for a maximum of 7 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Current CME Approval Period: 2/28/2024 to 2/27/2026

Most Recent Review by Author: 2/20/2024

Commercial Support

None

Relevant Financial Relationships Statement

University of Arizona College of Medicine — Tucson Continuing Medical Education adheres to the ACCME's Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers or others are required to disclose all financial relationships with ineligible entities (commercial interests). All relevant financial relationships have been mitigated prior to the commencement of the activity.

Dr. Abrams has disclosed that he is an advisor for Cannabotech, Cannformatics, Lumen (Relationship has ended), and Wellkasa (Relationship has ended). Dr. Bonakdar has disclosed that he is a consultant for AppliedVR, Metagenics, Standard Process, and Wellkasa. Dr. Chiasson has disclosed grant/research support from Pharmavite (Relationship has ended).

All other individuals in a position to control the content of this CME activity, including faculty, planners, reviewers or others have disclosed that they have no relevant financial relationships with ineligible companies that would constitute a conflict of interest concerning this CME activity.

Faculty / Authors

Donald I. Abrams, M.D. Professor of Clinical Medicine, Step VII, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA

Robert Bonakdar, MD, Director of Pain Management at the Scripps Center for Integrative Medicine. Assistant Clinical Professor at the University of California, San Diego, School of Medicine and is the immediate past president of the American Academy of Pain Management.

Melanie Brown, MD. Associate Professor of Pediatrics, Medical Director, Pediatric Comfort Team, Associate Program Director, Pediatric Residency Program The University of Chicago Medicine, Comer Children's Hospital

Ann Marie Chiasson, MD, Co-Director of the Fellowship, Arizona Center for Integrative Medicine, Assistant Professor, Department of Medicine, University of Arizona College of Medicine-Tucson.

Catherine Stallworth, MD

Planning Committee

Ann Marie Chiasson, MD, Co-Director of the Fellowship, Arizona Center for Integrative Medicine, Assistant Professor, Department of Medicine, University of Arizona College of Medicine-Tucson.

Molly K. Burke, MFA, CMT; Director of Online Education, Andrew Weil Center for Integrative Medicine