Pain and Addiction Course Looks at Non-Opioid Management Options

A member of the audience asks a question Thursday during the Pain

A member of the audience asks a question Thursday during the “Pain and Addiction Common Threads” course.

The focus and format of one of ASAM’s long-standing education sessions, the “Pain and Addiction Common Threads” course, took a different path Thursday as it explored a variety of treatment pathways and used more speaker and audience interaction. Part of the course’s title was “A World Without Opioids?”

“This year, we changed a lot. In the past it had been focused on opioids or buprenorphine. This year, the title says a lot—a world without opioids,” said R. Corey Waller MD, MS, FACEP, DABAM, Chair of the course. “We went through a myriad evidence-based ways to treat pain in the setting of addiction or pain outside the setting of addiction with non-opioid treatment pathways. Some of those are medications, some are interventions, some are behavioral therapies, and some are physical therapies—and all were discussed.”

The course’s planners also looked at feedback from those who attended the course in the last few years and changed it from a series of didactic presentations to showing attendees how to interact with patients.

“Just hearing people tell you what they know does not always make it easy to translate into somebody’s daily practice,” said Dr. Waller, Director of the Center for Integrative Medicine at Spectrum Health, Grand Rapids, Michigan. “This year, we gave a short overview lecture followed by doctor-patient interaction on stage that allowed attendees to see how you get information from the patient and the best ways to explain to the patient that these are the best ways to do it.

“We did not just present theoretical cases. We actually got to see the back-and-forth interaction between a doctor and one of the other doctors who was playing a patient. This allowed those in the audience to see some of the possible pitfalls as well as tricks of the trade. That will allow them to be able to go back to the office to see a patient and do something differently.”

Another change was that throughout the day, staff and faculty collected questions from physicians about their own patients. Those questions were discussed by a panel of faculty members who directly answered the questions.

“This allowed us to use a real case-based approach instead of a theoretical case, and give them specific answers,” Dr. Waller said. “That allowed us to answer ‘I would use these medications at this dose for this length of time, followed by this physical therapy, and this behavioral therapy.’”

Faculty members also developed specific scenarios based on data from previous course attendees so the faculty could demonstrate how to deal with specific situations. Those scenarios involved motivational interviewing and helping a patient with headaches stop using opioids.

“We had a patient with headaches who we got off of opioids, and we talked through all of the other pathways we could use to treat them, and explained why,” Dr. Waller said. “We talked about a patient who had a real pain that may need opioids, but was unable to use them because they have significant addiction. We had a patient without pain who has addiction, and how you determine that, how you get buy-in from the patient, and what pathway you can use in that setting.”

The course did not end with attendees walking out of the ballroom at the end of the day. They were asked for feedback immediately and will receive emails in the next few weeks for more insights about the course. They also will be contacted within six months “to see if anything we did stuck,” he said.

Materials related to the course also are available at the new ASAM e-Learning Center. Materials include a frequently asked questions section and videos of the course edited into shorter modules.