Pain and the Brain

Watch this video featuring expert commentary on patients in clinical settings. See how pain and mood interact and how physical and psychological diagnoses and treatment are intertwined. Help solve clinical dilemmas presented by patients with diabetic neuropathy, lower back pain, and chronic widespread pain who may also have symptoms of depression and anxiety.

	William M. Glazer, MD Glazer Medical Solutions, Key West, Fla
	Rakesh Jain, MD, MPH Psychiatric Research, R/D Clinical Research, Lake Jackson, Tex
	Lesley M. Arnold, MD Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio

Complete the Posttest and Evaluation

To watch the DVD program, choose a chapter below
	Animation: How Pain Travels Through the Body 5-minute video
	Case 1: Diabetic Peripheral Neuropathy 11-minute video
	Case 2: Lower Back Pain 10-minute video
	Case 3: Chronic Widespread Pain 13-minute video
PDF of References List of Abbreviations

Participate in interactive cases based on the DVD program to evaluate and treat patients with maladaptive pain and possible comorbid psychiatric conditions.

Pain and the Brain: Diabetic Peripheral Neuropathy

Rakesh Jain, MD, MPH

Pain and the Brain: Lower Back Pain

Rakesh Jain, MD, MPH

Pain and the Brain: Chronic Widespread Pain

Lesley M. Arnold, MD

CME Background Information

Supported by an educational grant from Eli Lilly and Company.

Objective

After completing this educational activity, you should be able to:

• Understand the pathophysiology of pain and identify different types of maladaptive pain such as diabetic peripheral neuropathy, postherpetic neuralgia, and fibromyalgia

• Implement an individualized, multidisciplinary treatment strategy that incorporates appropriate pharmacologic and psychotherapeutic modalities in order to alleviate the patient’s pain, manage any psychiatric comorbidities, and improve the patient’s functioning and quality of life

Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosures are as follows:

Dr. Glazer is a consultant for Eli Lilly and Schering Plough and is a member of speakers/advisory boards for Eli Lilly.

Dr. Arnold has received grant/research support from Eli Lilly, Pfizer, Cypress Bioscience, Wyeth, Sanofi-Aventis, Boehringer Ingelheim, Allergan, and Forest; is a consultant for Eli Lilly, Pfizer, Cypress Bioscience, Wyeth, Sanofi-Aventis, Boehringer Ingelheim, Sepracor, Forest, Allergan, Vivus, Organon, and Takeda; and is a member of the speakers bureaus for Eli Lilly and Pfizer.

Dr. Jain is a consultant for Addrenex, Impax, Eli Lilly, and Shire; has received grant/research support from Abbott, Addrenex, GlaxoSmithKline, Eli Lilly, Wyeth, Shire, Pfizer, and Forest; has received honoraria from Addrenex, Impax, Eli Lilly, and GlaxoSmithKline; and is a member of the speakers/advisory boards for Cyberonics, Eli Lilly, and Shire.

[top]

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

[top]

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates the DVD educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

[top]

Release, Review, and Expiration Dates

These activities were published in June 2008 and are eligible for AMA PRA Category 1 Credits through June 30, 2011. The latest review of this material was May 2008.

[top]

Statement of Need and Purpose

Chronic pain is a widespread disorder that places a heavy burden on the individual and society. Despite available treatments, this disorder remains difficult to diagnose and treat, and poor pain control is widespread. Furthermore, many clinicians have reported that they consider the treatment of chronic pain to be a problem in their practice. Clinicians need more information on the different causes and manifestations of chronic pain and comorbid psychiatric disorders, as well as information on the best treatment interventions so that they can devise an effective, individualized treatment plan that relieves the patient’s pain, addresses any psychiatric comorbidities, and allows the patient to resume full functioning and achieve optimal quality of life. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on managing the side effects of atypical antipsychotic treatment.

[top]

Disclosure of Off-Label Usage

Dr. Jain has determined that, to the best of his knowledge, amitriptyline, citalopram, clomipramine, desipramine, fluoxetine, fluvoxamine, imipramine, paroxetine, and sertraline are not approved by the U.S. Food and Drug Administration for the treatment of fibromyalgia, chronic headache, and idiopathic pain; amoxapine, bupropion, cyclobenzaprine, doxepin, duloxetine, gabapentin, milnacipran, mirtazapine, and nefazodone are not approved for the treatment of fibromyalgia; and venlafaxine is not approved for the treatment of diabetic peripheral neuropathy.

[top]

Review Process

The entire faculty of the series discussed the content at a peer-review planning session, the Chair reviewed the activity for accuracy and fair balance, a member of the External CME Advisory Board reviewed the activity to determine whether the material is evidence-based and objective.

[top]

Acknowledgment

This activity was developed from the planning teleconference series “Pain and the Brain,” which was held in January and February 2008, and was independently developed by the CME Institute of Physicians Postgraduate Press, Inc., pursuant to an educational grant from Eli Lilly and Company. Editorial assistance and honoraria were provided by Physicians Postgraduate Press, Inc., and production services were provided by Running Pony Productions. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

[top]