California Medical Association

Pain, Palliation and Politics

Pain Management and End-of-Life Care

In California’s Regulatory Environment

September 12-13, 2003 - Westin Santa Clara – 14 hours of Category 1 Credit

January 9-10, 2004 - Sheraton Gateway at LAX– 14 hours of Category 1 Credit

"The California Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. The California Medical Association designates this continuing medical education activity for 14 credit hours and it may be applied toward the CMA Certification in Medical Education and the AMA Physician's Recognition Award. Each physician should claim only those credit hours that he/she actually spent in the activity."

MODERATORS: Marie Kuffner, MD and Phillip Lippe, MD

DAY ONE Speakers for both September 12-13 and January 9-10 courses are listed.

9:00 am SB 487 and Medicine’s Response -- Marie Kuffner, MD / Phillip Lippe, MD

9:20 Science of pain care – Mark Wallace, MD / Howard Fields, MD

10:10 Evaluation of pain disorders – Bill McCarberg, MD

11:00 Break

11:15 Management of pain disorders: basic principles

-- Steven Richeimer, MD / Scott Fishman, MD

12:10 Tolerance, dependence, addiction – Robert Brody, MD

12:50 Lunch presentation:

Finding the Clinical Balance after Bergman v. Chin

Susan Penney, JD / Steven Richeimer, MD / Scott Fishman, MD

2:00 Workshops: Choose one:

q Cancer pain – Neil Slatkin, MD

q Back Pain – Mark Wallace, MD and Michael Ferrante, MD

3:15 Workshops: Choose one:

q Neuropathic Pain –Howard Fields, MD

q Palliative medicine and end of life care: hospital, home, hospice

Melvyn Sterling, MD / Gary Johanson, MD / Judith Ford, MD

4:30 Workshops: Choose one:

q Peri-operative and traumatic pain – Mark Wallace, MD

q Managing non-pain symptoms -- Neil Slatkin, MD

5:35 pm Adjournment for day one

DAY TWO

9:00 am Models of End of Life and Palliative Care – Melvyn Sterling, MD

9:20 Hospice care – Melvyn Sterling, MD

9:40 Assessing Each Patient for End of Life Care -- Laurel Herbst, MD

10:25 break

10:45 Advance Care Planning – H. Rex Greene, MD

11:30 The Last Hours of Living – Ira Byock, MD

12:15 Lunch presentation:

The Core of Palliative Care – Ira Byock, MD

1:30 Workshops: Choose one:

q Musculo-skeletal pain: pathophysiology and differential diagnosis – Brian Davis, MD

q Headache –Philip O’Carroll, MD

2:35 break

2:45 - Workshops; Choose one:

q Managing pain in the geriatric patient –Bruce Ferrell, MD

q Opioids and non-opioids IN management of chronic pain; – Michael Frederich, MD

3:55 – break

4:05 Closing plenary session:

Panel: How the Law is Enforced in California

Panel members:

Medical Board of California Physician Reviewer

CMA Legal Counsel

5:00 Adjournment

SPEAKERS INCLUDE

In addition to moderators Marie Kuffner, MD, and Phillip Lippe, MD, speakers include:

• Robert Brody, MD, San Francisco General Hospital
• Ira Byock, MD, Director, The Palliative Care Service, Missoula, Montana
• Brian Davis, MD, UC Davis Department of Physical Medicine and Rehabilitation
• Michael Ferrante, MD, Director, UCLA Pain Management Center
• Bruce Ferrell, MD, UCLA Division of Geriatric Medicine
• Howard Fields, MD, Director Wheeler Center for the Neurobiology of Addiction, UCSF
• Perry Fine,MD, University of Utah Pain Management Center
• Scott Fishman, MD, UC Davis
• Judith Ford, MD,
• Michael Frederich, MD, Medical Director, Hospice of VNA of the Inland Counties
• H. Rex Greene, MD, Medical Director, Dorothy Schneider Cancer Center
• Laurel Herbst, MD, San Diego Hospice
• Gary Johanson, MD, Santa Rosa Hospice
• Marie Kuffner, MD, UCLA
• Phillip Lippe, MD, Medical Director, American Society of Pain Medicine
• Bill McCarberg, MD, Director, Chronic Pain Management Program, Kaiser San Diego
• Philip O’Carroll, MD, Director, Newport Beach Pain Treatment Center,
• Steven Richeimer, MD, USC
• Neil Slatkin, MD, Director, Pain Management Program, City of Hope
• Mark Wallace, MD, Director, UCSD Center for Pain and Palliative Medicine

Educational Objectives:

At the end of the program, participants should be able to:

• Describe physicians’ and patients’ rights under California and Federal law related to the treatment of pain, the prescribing of opioid and non-opioid analgesics, and palliative care and end-of-life care.
• Describe pain scales for use with verbal and non-verbal patients.
• Describe the varied epidemiology of pain and identify four common co-morbidities.
• Define tolerance, dependence and addiction and their differing significance in pain management strategies.
• Describe the pharmacology of opioids; identify sources of guidelines for their use.
• Describe appropriate documentation.
• Discuss ethical aspects of pain management; describe the AMA statement of use of placebos.
• Describe adjuvant, complementary and alternative modalities for treatment of pain.
• Discuss the roles of members of a multidisciplinary team.
• Describe hospital, hospice, and home models of end-of-life care.
• Describe appropriate steps in delivering bad news to a patient and the patient’s family.
• Describe key elements of advance directives.
• Describe three common symptoms of patients nearing the end of their lives and discuss appropriate relief for them.

Target Audience California physicians, especially non-pain specialists, seeking clinical information on pain management and end-of-life care.

---