Comprehensive Pain Management
This 20-hour certificate training program is designed to equip pharmacists with a comprehensive training on pain, pain management, and substance use disorder. Pharmacists will gain training in four domains that will cover clinical pharmacologic knowledge, tools for caring for patients in practice, various aspects of care for patients with substance use disorder, and the shifting landscape surrounding pain and opioids from a legal, regulatory, public health and payor perspective. Learners will complete a self-paced 14-hour core module then select at least 5 elective modules before completing the final assessment to earn a certificate.
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Program Goals and Navigation Instructions
Prepare pharmacists to:
- Differentiate between various nonpharmacologic and pharmacologic treatment modalities for management of pain and/or substance use disorder.
- Develop a comprehensive, personalized treatment plan for patients with pain or substance use disorder.
- Summarize best practices and practical strategies pharmacists can use to mitigate patient harm, manage risk, and ensure legal compliance related to pain, opioids and medications for opioid use disorder.
How this Program Works:
APhA's Comprehensive Pain Management certificate training program consists of core modules and elective modules. In addition to the core and elective modules there is a required final post-assessment. The following steps are required to complete the program:
Step 1: Complete all required core modules which includes a pre-test to identify knowledge gaps. The purpose of the core modules is to provide foundational knowledge every pharmacist should have surrounding pain management and substance use disorder. There is an associated assessment with each module that each participant is required to pass. You will have two opportunities to successfully complete and achieve a passing score of 70% or better on the assessment. The core modules are approved for 14.0 hours (1.4 CEUs) of continuing pharmacy education credit.
Step 2: Select 5 individual elective modules to complete based on interest and/or perceived knowledge gaps. Each individual elective module is approved for 1.0 hour (0.1 CEUs) of continuing pharmacy education credit. The purpose of the elective modules is to dive deeper into a topic of interest that you would like to learn more about that may be beneficial to your practice. You may take more than 5 elective modules if you desire additional continuing pharmacy education credits. There is an associated assessment with each module that each participant is required to pass. You will have two opportunities to successfully complete and achieve a passing score of 70% or better on the assessment.
Step 3: Successfully pass the final assessment. The material on the final assessment could contain questions from any core or elective module, regardless if the learner took the elective module. You will have two opportunities to successfully complete and achieve a passing score of 70% or better on the final assessment.
Step 4: Once you have successfully completed the core modules, 5 elective modules, and passed the final assessment, you have completed the program and will be eligible to receive a Certificate of Completion for APhA's Comprehensive Pain Management certificate training program. The Certificate of Completion will be available to you online for immediate printing.
Learning Level: Level 3
Learning Objectives
This 20-hour home study learning activity is designed to ensure that all participants understand both pharmacologic and non-pharmacologic treatment options for pain management and the role of pharmacists as patient advocates and community resources. The home study program includes a short self-assessment after each module and real-life case studies that are designed to help reinforce and evaluate participants' understanding of key information and concepts. The learner will receive their certificate for this program after successfully completing all core courses and 5 elective courses. The final assessment will contain material from all core and elective courses, therefore there may be material on the exam from an elective course that you did not take so choose your elective courses based on areas of need. You may take more than the 5 required elective courses.
Core Modules
Introduction to opioids
At the completion of this activity, participants will be able to:
- Identify pharmacology and available dosage forms of opioids for pain management.
- Describe common adverse events and drug-drug interactions associated with opioids for pain management.
- Discuss patient counseling and education strategies that support appropriate use of opioids.
The ins and outs of opioid equianalgesia and opioid conversion
At the completion of this activity, participants will be able to:
- Identify clinical reasons for changing opioid therapy.
- Using an equianalgesic dosage table, calculate an equianalgesic opioid dose.
- Recognize factors that complicate a standardized approach to opioid conversion.
Introduction to non-opioid pharmacology
At the completion of this activity, participants will be able to:
- Identify pharmacology and available dosage forms of non-opioid medications for pain management.
- Describe common adverse events and drug-drug interactions associated with non-opioid medications for pain management.
- Discuss patient counseling and education strategies that support appropriate use of non-opioid medications for pain management.
Combining your options: Multi-modal pain management
At the completion of this activity, participants will be able to:
- Define nociceptive, neuropathic, inflammatory, and nociplastic pain.
- Describe the PQRSTUV method for pain assessment.
- Discuss nonpharmacologic and pharmacologic options for multimodal pain management depending on pain syndrome identified.
- Identify risk factors and monitoring needed when using multiple pharmacotherapeutic options for pain.
Buprenorphine and pain management: What every pharmacist needs to knows
At the completion of this activity, participants will be able to:
- Explain the pharmacology of buprenorphine and how it relates to its use in chronic pain.
- Consider aspects of buprenorphine for use in chronic pain management.
- Apply principles of buprenorphine management to common patient scenarios.
Gathering all the facts: Assessing your patient's pain
At the completion of this activity, participants will be able to:
- Identify quantitative and qualitative strategies for comprehensive pain assessment.
- Describe the utility of a proper pain assessment in determining the appropriateness of a given treatment regimen.
- Recognize communication strategies to optimize accuracy of pain assessment.
Identifying and managing opioid-induced constipation and opioid-induced respiratory depression
At the completion of this activity, participants will be able to:
- Describe the pathophysiology and incidence of opioid-induced constipation (OIC).
- Discuss nonpharmacologic and pharmacologic interventions to relieve OIC.
- Describe the pathophysiology of risk factors for, and clinical presentation of, opioid-induced respiratory depression (OIRD).
- Identify a patient at risk for OIRD.
- Recognize interventions pharmacists can make to prevent OIRD.
How to taper opioids safely and effectively
At the completion of this activity, participants will be able to:
- Recognize health-related issues which impact the decision to taper chronic opioid therapy.
- Recognize effective approaches and proper communication techniques when discussing potential tapers with patients.
- Discuss appropriate methods to taper chronic opioid therapy as part of an interdisciplinary team.
- Differentiate between different biopsychosocial and patient-specific factors that are important to consider and monitor throughout all parts of the taper process.
Addressing opioid stigma and related social determinants of health
At the completion of this activity, participants will be able to:
- Describe where patients encounter stigma.
- Identify barriers to treatment and recovery.
- Explain the intersections of social determinants of health with barriers to substance use disorder treatment.
- Recommend strategies to reduce stigma within ourselves, our institutions, and our patients/caregivers.
Screening, brief intervention, and referral to treatment
At the completion of this activity, participants will be able to:
- Define the components of screening, brief intervention, and referral to treatment (SBIRT).
- Discuss techniques to work with patients that are resistant to change.
- Identify how to incorporate SBIRT into practice.
MOUD 101: Understanding medications for opioid use disorder
At the completion of this activity, participants will be able to:
- Describe the pharmacology and pharmacokinetics of medications used to treat opioid use disorder.
- Describe a patient-specific pharmacotherapy treatment plan for opioid use disorder, including medication selection, dosing, clinical pearls, and monitoring parameters.
- Identify strategies to overcome barriers to effective implementation of medications for opioid use disorder treatment.
Everything you need to know about naloxone
At the completion of this activity, participants will be able to:
- Identify risk factors for drug-related overdose.
- Describe naloxone’s pharmacology, pharmacokinetics, available dosage formulations, and potential for adverse effects.
- Discuss when and how to use naloxone in an emergency situation.
- Recognize patient-centric communication strategies to improve naloxone distribution.
- Review strategies and legislation aimed at reducing the growth of opioid-related overdose.
Family matters: Understanding and addressing the impact of addiction on family units
At the completion of this activity, participants will be able to:
- Discuss the impact of addiction on family and the stages of family recovery.
- Explain the protective factor of denial as a survival skill in all members and breaking of the No Talk-No Trust-No Feel rules to enter the recovery process.
- Describe the roles of 12-step support including Al-Anon, the value of the healing communities, and the role of health care providers.
CDC opioid guidelines 2022 update
At the completion of this activity, participants will be able to:
- Describe major updates to the 2022 CDC Clinical Practice Guideline for Prescribing Opioids from the 2016 guidelines.
- Relate updates to possible implications for patients and providers.
- Explain how to use concepts from the updated guidelines when evaluating appropriateness of opioid prescriptions for patients.
Managing pain and scrutiny: The pharmacist's legal and ethical responsibilities
At the completion of this activity, participants will be able to:
- Define relevant statutes and regulations about controlled substances relevant to pharmacists.
- Identify “red flags” to consider when filling prescriptions for opioid controlled substances.
- Identify signs of drug diversion among health care professionals.
- Describe different enforcement trends that DEA is using to ensure that pharmacists appropriately exercise their corresponding responsibility obligations.
- Describe best practices and practical strategies pharmacists and pharmacy organizations can use to ensure legal compliance related to pain and opioids.
Risk assessment and mitigation strategies to prevent diversion
At the completion of this activity, participants will be able to:
- Describe best practices and practical strategies pharmacists can use to mitigate patient harm and manage risks related to pain and opioids.
- Discuss the rationale for using urine drug testing, prescription drug monitoring programs, and medication contracts to support patient adherence to prescribed therapy and prevention of controlled substance diversion.
The pharmacist's role in safe medication disposal
At the completion of this activity, participants will be able to:
- Describe ways in which improper drug disposal can cause patient harm directly and indirectly.
- Explain how common drug disposal systems work.
- Identify ways in which pharmacists can assist patients in disposing of drugs properly.
- Describe the pharmacist’s role in public health partnerships to increase medication disposal options.
Elective Modules
Medical cannabis and pain
At the completion of this activity, participants will be able to:
- Review cannabis pharmacology and proposed mechanisms of action for management of pain.
- Describe formulations and doses patients could use based on inferred evidence and pharmacokinetic profiles.
- Identify clinical studies discussing the efficacy of medical cannabis for treating pain.
- Discuss adverse effects and drug interactions associated with cannabis use.
Using precision medicine in treatment of pain
At the completion of this activity, participants will be able to:
- Identify metabolic pathways and transporters involved in opioid and NSAID metabolism and disposition.
- Review available practice guidelines supporting opioid and NSAID selection based on pharmacogenomic results.
- Given a patient case where pharmacogenomic results are available, determine appropriateness of opioid and/or NSAID therapy considering the clinical scenario and clinical practice guidelines.
The delicate balance: Pain management in recovering patients
At the completion of this activity, participants will be able to:
- Explain some of the challenges of opioid use in recovering patients.
- Review strategies for safe treatment and monitoring of patients with pain and opioid use disorder (OUD)/substance use disorder (SUD).
- Identify strategies for shared decision-making when addressing treatment related concerns of patients and family members.
Gabapentinoid abuse and regulation changes
At the completion of this activity, participants will be able to:
- Describe how the mechanism of action of gabapentinoids relate to their abuse potential.
- Identify potential risk factors for and signs and/or symptoms of gabapentinoid abuse, including withdrawal.
- Analyze changes in key states’ regulatory status and laws related to gabapentin prescribing.
- Recognize risk mitigation strategies for gabapentinoid prescribing and dispensing.
Needles and pins: Examining chronic neuropathy
At the completion of this activity, participants will be able to:
- Explain the pathophysiology of peripheral neuropathy.
- Outline nonpharmacologic treatment options of peripheral neuropathy.
- Compare and contrast pharmacologic treatment options for peripheral neuropathy.
- Given a patient case, select the most appropriate pharmacologic treatment option for management of peripheral neuropathy.
The stepwise approach to treating your patients with osteoarthritis
At the completion of this activity, participants will be able to:
- Explain the pathogenesis, classification, and risk factors for development of osteoarthritis.
- Outline nonpharmacologic treatment options for osteoarthritis.
- Compare and contrast pharmacologic treatment options for osteoarthritis.
- Given a patient case, select the most appropriate nonpharmacologic and pharmacologic treatment options for management of osteoarthritis.
Common chronic spinal pain
At the completion of this activity, participants will be able to:
- Review common spinal pathology conditions and their symptoms.
- Identify spinal pathology symptoms that may indicate a medical emergency.
- Discuss evidence-based and guideline recommendations for low back pain.
- Explain conservative therapy for spinal pain and multimodal approaches to treatment.
- Determine appropriate pharmacotherapy approaches for spinal pain conditions.
Management of end of life cancer pain
At the completion of this activity, participants will be able to:
- Explain barriers to effective relief of pain and ways to overcomes that at the end of life.
- Given a patient case, select appropriate nonpharmacologic and pharmacologic therapies to manage pain at patients at end of life.
- Outline a plan to monitor and adjust a patient’s therapeutic regimen if needed at end of life.
Data-driven metrics that health plans, CMS, and state governments use to review a provider's practice
At the completion of this activity, participants will be able to:
- Describe how payors measure and address patient risk related to opioid use.
- Discuss strengths and weaknesses with using claims analysis to evaluate care.
- Review literature supporting monitored outcomes.
- Identify steps a pharmacist can take to engage patients at risk based on claims or PDMP data.
Identifying pill mills and inappropriate prescribing: Strategies used by payors and regulatory agencies to address risk
At the completion of this activity, participants will be able to:
- Review the history of pill mills and the Oxy Express.
- Describe DEA criteria for pill mills and inappropriate prescribing.
- Discuss the methods that state governments and health plans use to identify aberrant prescribing.
- Identify strategies for pharmacists to identify red flags for opioid prescribing.
Accreditation Information
The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. APhA's Comprehensive Pain Management certificate training program is approved for a total of 20.0 contact hours of continuing pharmacy education (CPE) credit (2.0 CEUs). The ACPE Universal Activity Numbers (UAN) for this activity are listed below.
- Successful completion of the core module component involves passing all assessments following each module with a grade of 70% or higher and will result in 14 contact hours of CPE credit (1.4 CEUs).
- ACPE UAN: 0202-0000-23-174-H08-P
- Release Date: February 1, 2023
- Expiration Date: February 1, 2026 - PLEASE NOTE: NO Home Study credit granted after this date.
- Successful completion of the elective module component involves passing 5 elective course assessments with a grade of 70% or higher and will result in 5 contact hours of CPE credit (0.5 CEUs). If more than 5 electives courses are successfully completed, the learner will earn 1 contact hour of CPE credit (0.1 CEUs) for each additional elective course completion.
- Under construction: Evolving advances in pain management (0202-0000-23-175-H08-P)
- It's complicated: Managing pain in recovery and considerations around gabapentinoid abuse (0202-0000-23-176-H08-P)
- Needles and pins: Examining chronic neuropathy (0202-0000-23-177-H08-P)
- The stepwise approach to treating your patients with osteoarthritis (0202-0000-23-178-H08-P)
- Common chronic spinal pain (0202-0000-23-179-H08-P)
- Management of end of life cancer pain (0202-0000-23-180-H08-P)
- Data-driven metrics that health plans, CMS, and state governments use to review a provider's practice (0202-0000-23-181-H08-P)
- Identifying pill mills and inappropriate prescribing: Strategies used by payors and regulatory agencies to address risk (0202-0000-23-182-H08-P)
- Release Date: February 1, 2023
- Expiration Date: February 1, 2026 - PLEASE NOTE: NO Home Study credit granted after this date.
- Successful completion of the final assessment component involves passing the final assessment with a score of 70% or higher and will result in 1 contact hour of CPE credit (0.1 CEUs).
- ACPE UAN: 0202-0000-23-184-H08-P
- Release Date: February 1, 2023
- Expiration Date: February 1, 2026 - PLEASE NOTE: NO Home Study credit granted after this date.
To obtain 20.0 contact hours of CPE credit (2.0 CEUs) for APhA’s Comprehensive Pain Management certificate training program, the learner must complete all components listed above, and CLAIM credit for each component. Participants will need to have a valid APhA (pharmacist.com) username and password, as well as a CPE Monitor account to claim credit. After credit has been claimed, please visit CPE monitor for your transcript. The Certificate of Achievement will be available online upon successful completion of the necessary activity requirements on the participant’s My Training page.
Development
APhA's Comprehensive Pain Management certificate training program was developed by the American Pharmacists Association. Copyright © 2023 by the American Pharmacists Association.
Acknowledgements:
Advisory Board
Timothy J. Atkinson, PharmD, BCPS, CPE
Clinical Pharmacy Specialist, Pain Management
VA Tennessee Valley Healthcare System
Murfreesboro, Tennessee
Lakesha M. Butler, PharmD, BCPS
Clinical Professor, Department of Pharmacotherapy & Translational Research
University of Florida
Gainesville, Florida
Timothy Cruz, PharmD
PGY2 Pharmacy Resident
Hospice of Southern Illinois
O’Fallon, IL
Thomas S. Franko, PharmD
Associate Professor, Pharmacy Practice
Wilkes University Nesbitt School of Pharmacy
Wilkes-Barre, Pennsylvania
Additional Resources
If you are looking for some additional resources, try visiting our Opioid Use and Misuse Resource Center.