Orlando, FL CME Conference at Walt Disney World®

Without a single therapeutic option achieving complete efficacy and safety for those experiencing chronic pain, clinicians are presented with a significant diversity of pharmacologic options to consider. Treatment guidelines have consistently put forward strong recommendations to leverage the analgesic properties of non-opioid medications, but how does one decide between a calcium channel modulator, a serotonin-norepinephrine reuptake inhibitor, or a non-steroidal anti-inflammatory? Attendees of this session will explore the basic neuroanatomy and physiology of nociception, focusing on the mechanism of action of non-opioid medications. By connecting the pharmacologic site of action to a patient's underlying pain condition, a more rational approach will occur in selecting non-opioid medications.

With the isolation of a specific opiate from opium in 1805, the foundation of modern opioid pharmaceuticals was set. Globally, opioids remain important medications, with their position secured on the World Health Organization’s list of essential medicines. Since their initial discovery, a number of opioids have been formulated. The obvious question is, “Are all opioids the same?” This session will review the underlying neuroanatomy and physiology specific to opioids. Building upon the mechanism of action of opioids, specific effects of pharmacogenetics, metabolism-based drug interactions, and opioid receptor binding actions will be uncovered. Individual opioids, especially synthetic opioids, will challenge the concept that all opioids are equivalent.

Despite advances in non-pharmacologic treatments and non-opioid medications for patients with chronic pain, many patients have inadequately managed pain and may be appropriate candidates for opioid therapy. For these patients, careful monitoring is essential and clinical guidelines support using tools such as urine drug monitoring and prescription drug monitoring program data. Like every medical test, these tools have specificities and sensitivities that may yield results that are either consistent or inconsistent with the clinical impressions. This session will examine the various laboratory technologies of drug monitoring, including screening and definitive testing. Connections will be drawn between the laboratory results and unexpected and expected findings from individual opioids, including the impact of pharmacogenetics, drug interactions, and manufacturing impurities. Other monitoring tools, including prescription drug monitoring programs, will be discussed. Finally, attendees will have the opportunity to apply the content to a review of actual case studies of patient aberrant behaviors. Some circumstances are what they seem, and some are not.

Although pharmacologic treatments remain a common component of managing pain, significant advances in interventional pain management have reached a point where patients may successfully reduce medications or may not require them at all. This session will review some of the longstanding approaches, such as epidural steroids and radiofrequency neurotomies, but also increase awareness of understanding of interventional treatment options for joint pain of the knee, hip, and shoulder as well as advances in minimally invasive pain, reliving surgical treatments within the scope of pain management. Attendees will also be introduced to the innovative advances in neuromodulation and targeted intrathecal drug delivery.

Staying out of Death Valley of complications of diabetes is our ultimate goal. Cardo, Kidney metabolic (CKM) diseases are interrelated and must be prevented, screened for and or treated. Data reviewing the medication benefits beyond glucocentric, will be reviewed. Management and referral for micro and macrovascular complications will be discussed.

The oasis in the desert is the advent of “Miracle” medications that treat diabetes, slow and/or prevent renal, cardiovascular, OSA, NAFLD and potentially other related areas. A deep dive into these medications, MOA, adverse events, prescribing, titrating will be discussed with case reviews to enhance critical thinking.

Sunscreen Isn’t Enough will highlight other important strategies to improve outcomes. Patient engagement and empowerment with use of new technology to enhance pattern management and therapeutic adjustments will be reviewed. Continuous glucose sensors, pumps and hypoglycemia treatments are all game changers. People with diabetes (PWD) are driving uptake in these areas.

This presentation will share resources found to be successful for clinicians and educators over decades of practice. Patient handouts, web sites, apps and formulary look up tools will help provide sustenance for the busy practitioner.