Understanding Pain Management and Opioids - A Case-Based Curriculum-Webinar Recording

Video Transcription

Video Summary

The presentation introduces the CORE (Consortium for Opioid REMS Education) curriculum, aligned with the FDA opioid prescribing blueprint and CDC guidance, and notes the 2023 MATE Act requirement for ongoing controlled-substance training. The program’s aim is patient-centered pain care that balances adequate analgesia with safety amid an evolving overdose crisis. It reviews the “waves” of the epidemic (prescription opioids, heroin, illicit fentanyl, and rising stimulant deaths) and emphasizes fentanyl’s lethality and prevalence in counterfeit pills.<br /><br />Using three longitudinal cases—Frank (diabetic neuropathy with depression and adverse childhood experiences), Susan (pregnant, widespread pain, self-medicating with street oxycodone), and Ralph (metastatic prostate cancer with severe pain, PTSD, alcohol risk)—the speaker models a multidimensional pain assessment: thorough history and exam, function-focused measures (e.g., PEG), screening for depression/anxiety/trauma and social determinants, PDMP checks, and urine drug testing. A major theme is stigma reduction through person-first language and open-ended, nonjudgmental conversations, because stigma reduces engagement and increases overdose risk.<br /><br />The talk differentiates nociceptive, neuropathic, and nociplastic pain, highlighting that nociplastic pain (e.g., fibromyalgia) generally does not respond to opioids. Treatment should be multimodal (nonpharmacologic, nonopioid medications, and selected opioid trials when benefits outweigh risks), with shared decision-making (SHARE). Opioid safety strategies include starting with immediate-release agents, avoiding benzodiazepine co-prescribing, co-prescribing naloxone and bowel regimens, safe storage/disposal, careful monitoring and tapering, and using equianalgesic conversion with dose reductions for incomplete cross-tolerance. For opioid use disorder, the presentation encourages evidence-based MOUD—especially buprenorphine, now broadly prescribable—integrated with ongoing pain management and referral when needed.

Keywords

CORE curriculum

Opioid REMS education

FDA opioid prescribing blueprint

CDC opioid prescribing guideline

MATE Act 2023 training requirement

overdose epidemic waves

illicit fentanyl counterfeit pills

multidimensional pain assessment

PEG functional pain scale

PDMP prescription monitoring

urine drug testing

stigma reduction person-first language

nociceptive neuropathic nociplastic pain

multimodal pain management shared decision-making

buprenorphine MOUD for opioid use disorder