ACROSS THE CONTINUUM: Optimizing Strategies for Acute to Chronic Pain Management HEALTH-SYSTEM PHARMACIST PERSPECTIVES AGENDA

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1 Optimizing Strategies for Acute to Chronic Pain Management AGENDA 11:30 11:45 AM Conference Goals/Pre-Test J. Richard Brown, PharmD, FASHP 11:45 12:00 PM The Pain Continuum: From Acute Treatment to Chronic Management J. Richard Brown, PharmD, FASHP 12:00 12:40 PM Treatment of Pain: Current Concepts Robert L. Barkin, PharmD, MBA, FCP, DAAPM 12:40 1:15 PM Managing Pain with Opiates: Strategies for Health-System Pharmacists Bruce R. Canaday, PharmD, FASHP, FAPhA 1:15 1:30 PM Closing Comments/Post-Test and Q&A **The slides in this handout may have changed from those presented due to last minute updates or additional faculty input.** ACROSS THE CONTINUUM: 1

2 Optimizing Strategies for Acute to Chronic Pain Management TABLE OF CONTENTS AGENDA OVERVIEW & LEARNING OBJECTIVES PARTICIPATING FACULTY & BIOGRAPHIES CONTINUING PHARMACY EDUCATION INFORMATION Intended Audience Accreditation Statement Credit Designation Statement Grievance Policy Activity Format Full Disclosure Policy Affecting CPE Activities Off-Label Product Discussion Disclaimer Copyright Information PRESENTATIONS The Pain Continuum: From Acute Treatment to Chronic Management J. Richard Brown, PharmD, FASHP Treatment of Pain: Current Concepts Robert L. Barkin, PharmD, MBA, FCP, DAAPM Managing Pain with Opiates: Strategies for Health-System Pharmacists..28 Bruce R. Canaday, PharmD, FASHP, FAPhA NOTES University of Tennessee Advanced Studies in Pharmacy

3 Optimizing Strategies for Acute to Chronic Pain Management OVERVIEW Health-system pharmacists are an integral part of the interdisciplinary team that is critical in the management of pain. Increasingly involved in many aspects of patient care, these pharmacists are uniquely positioned to contribute substantially to pain management throughout the continuum of care, from acute treatment through chronic pain management. This educational activity will focus on the critical dilemmas that are woven within treatment decisions throughout the pain continuum. Health-system pharmacists will be educated on: (1) how to distinguish acute from chronic pain; (2) how to choose optimal treatment strategies; and (3) when to safely and effectively utilize opiates in their patients pain management regimes. Through dynamic presentations and interactive cases, attendees will walk away with the skills to apply this current information to their clinical practice. LEARNING OBJECTIVES The University of Tennessee College of Pharmacy takes responsibility for the content, quality, and scientific integrity of this CPE activity. Upon the conclusion of this activity, the participant should be able to: EXPLAIN the clinical, psychological, and economic impact of acute pain, with particular attention to special populations (ie, elderly). REVIEW current and emerging pharmacologic treatments for acute pain, including efficacy, mechanisms of action, and adverse effects including addiction. IDENTIFY the role of the pharmacist in the interdisciplinary team for optimal management of acute pain. RECOGNIZE the economic impact of inadequate pain management in the health-system setting and formulate strategies to optimize patient and health-system outcomes. ACROSS THE CONTINUUM: 3

4 Optimizing Strategies for Acute to Chronic Pain Management PARTICIPATING FACULTY & BIOGRAPHIES J. Richard Brown, PharmD, FASHP (Chair) Professor, Clinical Pharmacy University of Tennessee Memphis, Tennessee J. Richard Brown, PharmD, FASHP, received his bachelor of science degree in biology from Lincoln Memorial University in He received additional bachelor of science and doctor of pharmacy degrees from the University of Tennessee College of Pharmacy in 1974 and He completed a post-graduate residency in adult medicine in 1976 at the City of Memphis Hospitals. He retained board certification as a Phamacotherapy Specialist from 1993 to Dr Brown's Vietnam era active duty military career allowed him to serve as a US Army Medic Instructor at the Military's Medical Training Center at Fort Sam in Houston, Texas from 1970 to He served veteran patients as a Clinical Pharmacy Specialist in Internal Medicine and was Director of Drug Information Services at the Veterans Affairs (VA) Medical Center in Memphis, Tennessee from 1976 until his retirement in He is currently Professor in both the University of Tennessee (UT) Colleges of Medicine and Pharmacy. He was active as an instructor trainer in cardiac resuscitation for the American Heart Association and was an instructor in smoking cessation for the Memphis VA Medical Center for 20 years. Dr Brown has published several articles in peer-reviewed journals and in over 3 decades, has been invited to make numerous presentations at state and national meetings on drug-related subjects. In 1995, he was elected a Fellow in the American Society of Health-System Pharmacists. He is the recipient of several honors and awards, including the Outstanding Clinician Award from the College of Pharmacy in 1982, the Omega Chapter of Phi Delta Chi Alumnus of Year in 1993, the 1994 recipient of the Association of Military Surgeons of United States National Award for Excellence in Clinical Pharmacy Practice, and the College of Pharmacy's Preceptor of the Year Award in He is a past President of the Memphis Area Association of Pharmacists, the 1994 to 1995 President of the Tennessee Society of Hospital Pharmacists (TSHP), and recipient of the TSHP's Distinguished Service Award in Dr Brown received the UT Student Government Association's Excellence in Teaching Award in 1994 and He was recognized in 1997 as the University of Tennessee College of Pharmacy's Outstanding Alumnus. He was honored by the graduating Class of 2007 as "The Most Admired Preceptor" and as "Distinguished Preceptor" by the Class of Robert L. Barkin, PharmD, MBA, FCP, DAAPM Professor, Rush Medical College Faculty of Anesthesiology, Family Medicine, and Pharmacology Rush University Medical Center Clinical Pharmacologist, Northshore University Health System Skokie, Evanston Hospitals, Pain Centers, and The Department of Anesthesiology Chicago, Illinois Robert L. Barkin, PharmD, MBA, FCP, DAAPM, is a Professor with the Faculty of Anesthesiology, Family Medicine, and Pharmacology at Rush University Medical Center in Chicago, Illinois. He is the Pain Clinical Pharmacologist for Northshore University Health System in Evanston and Skokie Hospital. He also serves as faculty in the Department of 4 University of Tennessee Advanced Studies in Pharmacy

5 Optimizing Strategies for Acute to Chronic Pain Management PARTICIPATING FACULTY & BIOGRAPHIES (CONT D) Anesthesiology at the Northshore University Health System. Dr Barkin has his boards and is a Diplomate of the American Academy of Pain Medicine, Diplomate of the American Academy of Forensic Sciences, Diplomate of the American Academy of Forensic Examiners, and Diplomate of the American Academy Psychologic Specialties in Psychopharmacology. He is also a Fellow with the American College of Clinical Pharmacology and has been granted scientific membership status with the American Academy of Pain Medicine. Dr Barkin has authored over 150 publications (articles, books, book chapters, and CD-ROMs) and serves on the editorial board as an editor and reviewer for several journals. Dr Barkin maintains both an extensive inpatient and outpatient practice with an anesthesiologist in 2 multidisciplinary comprehensive pain centers. For over 2 decades, Dr Barkin has designed patient-specific treatment plans for acute pain, postoperative pain, and all chronic pain syndromes. Dr Barkin has been an invited lecturer for 1-month cycles in India, Hong Kong, China, Taiwan, the Philippines, Australia, Puerto Rico, and other international locations. He has also been an invited speaker at national conferences for anesthesiology, family medicine, psychiatry, physiatry, neurology, neurosurgery, and opioid treatment. Dr Barkin has a doctorate from Indiana University/Purdue University Medical Center, a master of business administration from DePaul University, and a Nursing Home Administration license in Illinois through George Washington University. His teaching experience includes anesthesiology, family medicine, psychiatry, and pharmacology in both medical and pharmacy colleges. His special interests include pain medicine, pharmacology, neuropsychopharmacology, drug information, drug interactions, forensics, side/adverse effect evaluations, urine drug testing, toxicology, substance abuse, literature contribution, and healthcare provider education. Bruce R. Canaday, PharmD, FASHP, FAPhA Clinical Professor and Vice-Chair Division of Pharmacy Practice and Experiential Education University of North Carolina Eshelman School of Pharmacy Chapel Hill, North Carolina Bruce R. Canaday, PharmD, FASHP, FAPhA, is currently a Clinical Professor and Vice-Chair in the Division of Pharmacy Practice and Experiential Education at the University of North Carolina School of Pharmacy. He is Director of the Department of Pharmacotherapy at the South East Area Health Education Center in Wilmington, North Carolina, where he teaches and precepts doctor of pharmacy students and residents; coordinates, conducts, and presents continuing education programs; and maintains a clinical practice in association with the Internal Medicine Teaching Service of New Hanover Regional Medical Center. His major interest area is pain management. He received his bachelor's degree in pharmacy from Purdue University and his doctor of pharmacy degree from the University of Tennessee. Dr Canaday is a fellow of the American Society of Health-System Pharmacists (ASHP) and served as President and Chair of the board from 1998 to He also served 3 terms as Chairman of the ASHP House of Delegates and served on the Board of Directors in that capacity from 1994 to He is a fellow of the American Pharmacists Association (APhA) through the Academy of Pharmacy Practice and Management and served as the Chairman of the Academy's Clinical/Pharmacotherapy Section. He served on the APhA Board of Trustees from 2002 to 2008 and as APhA President and Chairman of the Board from 2006 to ACROSS THE CONTINUUM: 5

6 CONTINUING PHARMACY EDUCATION INFORMATION INTENDED AUDIENCE This activity is designed for pharmacists attending the 44th ASHP Midyear Clinical Meeting and Exhibition. No prerequisites required. ACCREDITATION STATEMENT The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education to provide continuing education for pharmacists. CREDIT DESIGNATION STATEMENT The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this application-based educational activity will provide 2.0 contact hours credit (0.2 CEUs). A statement of CE credit will be mailed within 4 weeks following successful completion of the educational activity. Successful completion includes attending the session, signing the attendance sheet, and completion of the educational activity evaluation form. ACPE Program # L01-P. This educational activity is available at no charge. GRIEVANCE POLICY A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an educational activity sponsored or cosponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level review. ACTIVITY FORMAT This educational activity is a live meeting consisting of approximately 2 hours of clinical presentations and discussions. This activity is designed to engage the audience and encourage dialogue with the presenters. Thus, audience participation is critical to enhancing the open exchange of opinions and ideas that facilitate the flow of knowledge. FULL DISCLOSURE POLICY AFFECTING CPE ACTIVITIES As an accredited provider by the Accreditation Council for Pharmacy Education (ACPE), it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The faculty reported the following: J. Richard Brown, PharmD, FASHP, reports having no relevant financial or advisory relationships with corporate organizations related to this activity. Robert L. Barkin, PharmD, MBA, FCP, DAAPM, reports serving as an educator (teaching, publishing, and lecturing) for Cypress Dominion Diagnostics, Eli Lilly and Company, Endo Pharmaceuticals, Forrest laboratories, PriCara, Sanofi-Aventis, and Wyeth. Bruce R. Canaday, PharmD, FASHP, FAPhA, reports having no relevant financial or advisory relationships with corporate organizations related to this activity. OFF-LABEL PRODUCT DISCUSSION All faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices. DISCLAIMER The opinions and recommendations by faculty and other experts whose input is included in this educational activity are their own. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients. COPYRIGHT INFORMATION All rights reserved. No part of this syllabus may be used or reproduced in any man- 6 University of Tennessee Advanced Studies in Pharmacy

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