Optimizing Chronic Pain Management: Integrating Pharmacokinetics & Pharmacodynamics

Faculty

Needs Statement

Chronic pain is prevalent in nearly 25% of the US population, yet it continues to be undertreated and mismanaged. Surveys show that more than 40% of patients with chronic pain and nearly 60% of patients with severe pain failed to achieve adequate pain relief. The systematic undertreatment of pain represents a public health crisis in this country. Although all health care professionals must have knowledge of the tools used to help treat pain, pharmacists have a particularly significant role because they are highly visible and accessible members of the health care team. Their role in the health care system makes them invaluable in monitoring pharmacotherapy and the education of patients and health care providers. Optimal management of chronic pain necessitates that pharmacists understand the magnitude of chronic pain in the United States and the treatment barriers that must be surmounted to ensure effective care. Because analgesic agents vary widely in their pharmacodynamic and pharmacokinetic properties, the pharmacist must be knowledgeable about a drug’s pharmacokinetics and formulation in order to support monitoring an analgesic regimen that can control pain while minimizing the side effects and interactions with any concurrent medication as well as instituting any formulation substitutions.

Pharmacists play a critical role in patient access to medications and patient safety. The number of available medications and formulations grows every year. Analgesic agents vary widely in their potency as well as side-effect profiles. Furthermore, pain management plans typically include treating comorbid illnesses and disability. Pharmacists serve as the “gatekeepers” who must determine whether dispensing a prescription order will alleviate pain without compromising safety. Pharmacists are in a privileged position to gather data regarding adverse responses to prescribed medication or incidents of medication mishaps. By informing clinicians of possible adverse effects or drug interactions, they have a critical role in a patient’s overall health as well as the chain of drug distribution to the patient. Pharmacists who lack knowledge about pain management could be a weak link if they make decisions that break the chain of distribution of valid prescriptions for analgesics, thereby contributing to the epidemic of the undertreatment of pain. Communication between patients, clinicians, and pharmacists is an important factor in the pain management process; the best therapeutic outcomes may be obtained through an alliance among these individuals.

Target Audience

This activity has been developed for community pharmacists who have expressed an interest in enhancing their knowledge and understanding of available pharmacotherapies for chronic pain.

Objectives

1. Describe the vital role of the community pharmacist in the management of patients’ chronic pain;
2. Discuss the prevalence and consequences of the undertreatment of chronic pain;
3. Explain the concept and intent of “rational polypharmacy” and the relevance of pharmacokinetics/pharmacodynamics to this concept;
4. Compare and contrast the characteristics and appropriate clinical applications of the various drugs available to treat chronic pain;
5. Describe the influence of pharmacokinetic/pharmacodynamic properties on formulation substitution.

Accreditation

CPE
The University of Kentucky College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

This knowledge-based activity has been assigned ACPE # 022-999-09-028-H01-P and will award 1.00 contact hour (0.1 CEU) of continuing pharmacy education credit in states that recognize ACPE providers.

Statements of credit will indicate hours and CEUs based on participation and will be issued online at the conclusion of the activity. Successful completion includes completing the activity, its accompanying evaluation and/or posttest (score 70% or higher) and requesting credit online at the conclusion of the activity. The College complies with the Accreditation Standards for Continuing Pharmacy Education.

Faculty Disclosure

Dr. Bainbridge discloses that she is a member of the paid speaker’s bureau for Bayer Corporation, Ortho-McNeil-Janssen Pharmaceuticals, Inc, and UCB Pharma. She has received contract research support from UCB Pharma.

Dr. Fudin discloses that he is a member of the paid speaker’s bureau for Alpharma Inc and PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.

Dr. McCarberg discloses that he is a member of the paid speaker’s bureau for Alpharma Inc, Cephalon, Inc, Endo Pharmaceuticals, Eli Lilly and Company, Merck & Co, Inc, Pfizer Inc, PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. and Purdue Pharma LP.

The following Scion planners and managers—Stef Stendardo, Medical Writer; Jeffrey M. Palmer, PhD, Scientific Director, Medical Education; Nicole Guidera, Project Manager; and Lina Cresci, Assistant Project Manager—hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

Activity Sponsorship

This activity is jointly sponsored by the University of Kentucky and Scion Educational Resources. Supported by an unrestricted educational grant from PriCara, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC.