Pain is a common problem among elderly individuals with persons over age 60 having a twofold increase in painful conditions as compared to younger individuals. Among the geriatric population, pain results in serious negative impacts including direct suffering, decreased physical function, decreased socialization, depression, sleep disturbances, increased health utilization costs, increased postoperative pulmonary and cardiac morbidity, and increased length of hospitalization. Despite the high prevalence and associated negative outcomes, pain is often poorly assessed and undertreated among elders. Patients with cognitive impairment are particularly vulnerable. Among these individuals, vague complaints are less likely to result in an evaluation for pain compared to similar complaints among cognitively intact elders. In addition, elders with cognitive impairment are prescribed and receive less analgesic medication than cognitively intact individuals.

This web-based, interactive virtual patient program aims to educate clinicians regarding some of the most common issues associated with pain assessment and management in the outpatient setting. The first case focuses on differentiating between neuropathic, somatic, and visceral pain. It also explores various treatment options for neuropathic pain in geriatric patients. The second case reviews possible atypical presentations of pain symptoms in elders with cognitive impairment, presents pain assessment tools appropriate for use in these individuals, and discusses the use of opioid analgesics in this population. In the third case, pain assessment and management issues in elders with severe cognitive impairment are reviewed including use of observational pain assessment scales such as the PAINAD scale. Questions are interspersed within the text of each case and video feedback is provided to reinforce main concepts. At the completion of each case, an expert provides a teaching summary. References are provided with links to PubMed.

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

COST: $40.00
click here for pricing outside the United States of America

OVERALL LEARNING OBJECTIVES:

1. The learner will understand the different types of pain.
2. The learner will understand who to apply World Health Organization (WHO) pain management principles to cognitively impaired individuals.
3. The learner will understand that pain symptoms often present in an atypical manner in cognitively impaired individuals.

CLINICAL LEARNING OBJECTIVES:

1. The learner will understand and be able to select an appropriate treatment option for neuropathic pain.
2. The learner will be able to provide a differential diagnosis of pain symptoms in cognitively impaired individuals.
3. The learner will be able to utilize alternative pain scales to assess pain in cognitively impaired individuals.
4. The learner will be able to select appropriate pain medications for cognitively impaired individuals.

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ANGELA BOTTS, MD Course Director

Throughout her career thus far, Dr. Botts has demonstrated an ongoing commitment to geriatric medical education. Following her internal medicine residency at the Beth Israel Deaconess Medical Center, Dr. Botts completed a geriatric medicine fellowship at Harvard Medical School. She is currently active as a geriatrician at the Beth Israel Deaconess Medical Center and is an Instructor in Medicine at Harvard. Dr. Botts is the recipient of a Hartford Center for Excellence Research Fellowship Award and Geriatric Academic Career Award. Her teaching interests include the development, implementation, and management of an inpatient geriatric pain management curriculum for interdisciplinary housestaff and nurses. In addition, she has been selected as a Rabkin Fellow for the 2008-2009 academic year. DISCLOSURE:

JANET ABRAHM, MD, FACP, Course Contributor

Dr. Janet L. Abrahm trained and practiced for many years as a Hematologist/Oncologist and has been a full-time Palliative Medicine specialist for over 10 years. She is an Associate Professor of Medicine at Harvard Medical School and the Director of the Pain and Palliative Care Program at the Dana Farber Cancer Institute and the Brigham and Women’s Hospital, where she directs the inpatient intensive palliative care unit, and the inpatient and outpatient consultation services. The second edition of Dr.Abrahm’s book, A Physician’s Guide to Pain and Symptom Management in Cancer Patients, was published in 2005 by Johns Hopkins University Press. DISCLOSURE:

MURIEL GILLICK, MD Course Contributor

Dr. Gillick received her B.A. degree from Swarthmore College and her MD degree from Harvard Medical School. She completed a residency in internal medicine at Boston City Hospital and a geriatrics fellowship at Boston Medical Center. Her area of interest is ethical issues near the end of life, a field in which she has published widely, including 4 books for a general audience, the most recent of which was The Denial of Aging: Perpetual Life, Eternal Youth, and Other Dangerous Fantasies (Harvard University Press, 2006). Dr. Gillick is a geriatrician and palliative care specialist with Harvard Vanguard Medical Associates and a Clinical Professor in the Department of Ambulatory Care and Prevention of Harvard Medical School. DISCLOSURE:

WINNIE SUEN, MD, MSC Course Contributor

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:

DAVID TSAI, MD Course Contributor

Bio and Photo Coming Soon. DISCLOSURE:

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DAVID JANFAZA, MD Reviewer

Bio and Photo Coming Soon. DISCLOSURE:

CAROL WARFIELD, MD Reviewer

A native of Watertown, Massachusetts, Dr Warfield worked her way through Jackson College, Tufts University College of Engineering and Tufts Medical School, training in anesthesiology and pain medicine at Massachusetts General Hospital and Beth Israel Hospital at Harvard Medical School. She has been on the faculty at Harvard for over 30 years where she is currently the Lowenstein Professor of Anesthesia and former Chief of the Arnold Pain Management Center and Chair of the Department of Anesthesia, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center. With an international reputation as one of the leading experts in the field of pain medicine, Dr Warfield has lectured worldwide and has authored almost two hundred articles and four textbooks on pain management which have been widely used for training in pain medicine and have been translated into Spanish, Chinese and Italian. Her clinical practice has focused on the treatment of cancer pain and low back pain and her academic practice has focused on teaching optimal methods to relieve pain and suffering from Boston to underserved countries throughout the world and in research relating to new therapies for pain relief. The recipient of many awards and distinctions, Dr Warfield is active in a number of national and international organizations. She was a founding member of the New England Pain Association and has served as an officer, on the board of trustees and/or on committees of numerous organizations including the American Pain Society, the American Society of Anesthesiologists, the American Academy of Pain Medicine, the American Board of Anesthesiology, the International Association for the Study of Pain, the American Society of Regional Anesthesia and the Anesthesia Foundation. She has also served on several editorial boards and as a consultant to the FDA. The first woman to hold an endowed professorship at Beth Israel Deaconess Medical Center and Harvard Medica DISCLOSURE:

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NUMBER OF CREDITS: 2 

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

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

Upon completion of the course you will get a certificate via e-mail within 2 weeks.

Click the image to view a sample of the certificate

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