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Pain Management Strategies in the Elderly Inpatient

Course Description | Faculty | Accreditation | General Information

Course Description

Acknowledgement: This module is supported by a grant from the Donald Reynolds Foundation.

This activity meets the criteria of the Massachusetts Board of Registration in Medicine for 2 credits of Risk Management Study. This includes:

2 Credits of Opioid Education and Pain Management Training and
2 Credits of End-of-Life Care Studies

Please check your individual state licensing board requirements before claiming these credits.



The management of pain in hospitalized elderly patients represents a clinical challenge for many clinicians and most trainees. Appropriate analgesic choice and dosing require knowledge of the unique characteristics of older patients that affect their response to medications and susceptibility to its side effects. This web-based, interactive virtual patient program aims to educate clinicians on the multi-modal management of pain in geriatric patients. The module consists of two cases that tackle the principles of managing acute peri-operative pain in cognitively intact patients and demented patients. In the first case, a 78-year old male presents to the ED with nausea, vomiting and groin pain. The learner will learn the optimal treatment for peri-operative pain, gain confidence in using an opiate equianalgesic dosing table, list pain medications that are inappropriate for elderly patients and learn the relationships between pain, analgesic medications and delirium. The second case consists of an 85-year old female with dementia who presents with pain from an orthopedic injury. The learner will gain skills in opioid dose titration, application of pain-assessment tools in cognitively impaired patients and the use of non-pharmacologic modalities for acute pain in the elderly. Questions are interspersed within each case and text and/or video feedback are provided to reinforce learning. At the completion of the module, the learner is presented with a teaching summary that emphasizes the most salient points of the module. References are provided with links to full PubMed abstracts.

Original Release: 11/7/2008
Most Recent Update: 9/11/2014
Termination Date: 9/11/2017

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

COST: $40.00 for the average learner. Participants living in emerging nations receive a 50% discount or can register for free. See our International Pricing Page for details.

OVERALL LEARNING OBJECTIVES:

  1. The learner will recognize that the assessment of pain may be more difficult in the elderly due to an increased frequency of patients who lack the ability to report pain verbally.
  2. The learner will recognize that the management of pain may be more difficult because of an increased frequency of patients who are able to report pain but are unable to manage it due to dementia or delirium.
  3. The learner will recognize that older patients typically have lower opiate requirements to achieve comfort due to changes in pharmacodynamics and pharmacokinetics with opioids and aging.
  4. The learner will recognize that the patient's comorbid illnesses frequently affect the choice of adjuvant analgesics, and sustained-release formulations can also be problematic.

CLINICAL LEARNING OBJECTIVES:

  1. The learner will use multi-modal pain control whenever possible to treat post-operative pain.
  2. The learner will be able to list pain medications that are considered inappropriate for use in the elderly.
  3. The learner will be able to pick appropriate initial acute pain management regimen in older adults.
  4. The learner will be able to use an opiate equianalgesic table to calculate dosing of opiates and make appropriate changes from one opiate to another.
  5. The learner will demonstrate knowledge of evidence regarding the interaction of pain, treatment of pain and delirium in the acute hospital setting.

METHOD OF PARTICIPATION:

Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.

COMBINATION OF MEDIA USED:

This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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Faculty
KATHRYN AGARWAL, MD
Course Co-Director
Dr. Agarwal has focused her work on development of programs to improve care of hospitalized elders, and on education for interdisciplinary teams. At Beth Israel Deaconess Medical Center, she directed the Acute Care for the Vulnerable Elderly Unit and the Geriatrics Consult Service. She is actively involved in physician and nursing education, as well as research on how to improve the educational process. This educational module was created as part of the Advancements in Geriatrics Education Program sponsored by the Donald W. Reynolds Foundation at Harvard Medical School. Dr. Agarwal received her medical degree from the Baylor College of Medicine, where she also completed her residency training in Internal Medicine. She completed a Fellowship in Geriatric Medicine at Harvard Medical School/Beth Israel Deaconess Medical Center, and is board certified in Internal Medicine with Certificate of Added Qualifications in Geriatric Medicine. She is also board certified in Hospice and Palliative Care Medicine. Dr. Agarwal is now at Baylor College of Medicine again as an Assistant Professor of Medicine in the Section of Geriatrics.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



WINNIE SUEN, MD, MSc
Course Co-Director
Winnie Suen, M.D., MSc is a geriatrician and palliative care physician in the Division of Geriatrics at the Cambridge Health Alliance. She is an Instructor of Medicine at Harvard Medical School. She received her medical degree from the University of Hawaii John A. Burns School of Medicine, completed her Internal Medicine residency and Geriatrics fellowship at Boston Medical Center, and her Palliative Care fellowship at the Massachusetts General Hospital and Dana Farber/Brigham and Women’s Hospital. Dr. Suen is active in medical student, resident, and fellow teaching. Her practice focuses on providing home care for frail homebound elderly and on improving the quality of life of those living with life-limiting illnesses.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



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Reviewers
CAROL BATES, MD
Reviewer
Carol Bates, M.D. is general internist in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and an Associate Professor of Medicine at Harvard Medical School. She received her medical degree from the Johns Hopkins University School of Medicine. Dr Bates is the Primary Care Program Director at Beth Israel Deaconess Medical Center. During her tenure, more than 100 residents have graduated from the primary care track; most of them remain practicing general internists. Dr Bates has been very active in the Society of General Internal Medicine. She has served as New England Regional President and as co-chair of the annual scientific meeting of the society in 2000. Dr Bates has an active practice focused in particular on women's health.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



KAREN J. CARLSON, MD
Reviewer
Dr. Carlson is Assistant Professor of Medicine at Harvard Medical School and Director of Women’s Health Associates at Massachusetts General Hospital. She is co-editor of a medical textbook, Primary Care of Women, and a comprehensive book on women’s health, The Harvard Guide to Women’s Health. Dr. Carlson is Assistant Professor of Medicine at Harvard Medical School and Director of Women’s Health Associates at Massachusetts General Hospital. She is co-editor of a medical textbook, Primary Care of Women, and a comprehensive book on women’s health, The Harvard Guide to Women’s Health.

DISCLOSURE:
Company: UpToDate Inc.



JIM FOODY, MD, FACP
Reviewer
Dr. Jim Foody is a General Internist in Chicago. He is Professor of Medicine at Northwestern University Feinberg School of Medicine and Vice Chairman for Clinical Affairs of the Department of Medicine. He is Governor for the Illinois Northern Chapter of the American College of Physicians. Dr. Foody is co-director of Pri-Med Midwest.

DISCLOSURE:
Company: Medscape Type of Relationship: Advisory Board Content Area: Internal Medicine



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Course Planners
SANJIV CHOPRA, MD
Planner
Dr. Sanjiv Chopra is Professor of Medicine at Harvard Medical School. He is also the the James Tullis Firm Chief in the Department of Medicine and a Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. He served as Faculty Dean for Continuing Education at HMS for 12 years. Dr. Chopra has more than 150 publications and seven books to his credit. Dr. Chopra is Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world subscribed to by more than 850,000 physicians in 149 countries. He is also the recipient of numerous awards and accolades. For a complete bio, click here.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



ANDI LONG, EdM
Planner
Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



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Accreditation

NUMBER OF CREDITS: 2 

The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate


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General Information

HARDWARE/SOFTWARE REQUIREMENTS

Computers
Any computer running Windows, Mac OS, or Unix machines are supported.


Internet Connection
Your computer should be configured to access the Internet. A high speed internet connection may be required to view some of the large multimedia files.

Browsers
Firefox or Internet Explorer 5.5 or higher are recommended. JavaScript and cookies must be enabled.

Plugins
Some of the multimedia resources in this course require Apple Quicktime, RealMedia, or a Flash player. You will be prompted to download the appropriate plugin when necessary. No plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.


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