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CADTH » Resources » Academic Detailing Templates » Supporting Information - Appendices » Appendix 17b : RxFiles Chronic Non-Malignant Pain & Role of Opioids Detailer Training - Agenda

Appendix 17b : RxFiles Chronic Non-Malignant Pain & Role of Opioids Detailer Training - Agenda

CHRONIC NON-MALIGNANT PAIN - & ROLE OF OPIOIDS

RxFiles Detailer Training Day

Monday, September 26, 2005

Loren Regier, Brent Jensen, Pam Karlson, Dennis Derbowka, Brenda Schuster, Jurgen Maslany (Anesthesia resident)

Saskatoon City Hospital – Room 1932 (near Main Entrance – Rependa Wing)

AGENDA

0855 Pre-meeting Refreshments & Smalltalk

0900 RxFiles – Introduction to Day & CNMP Quiz [Loren]

0910 Therapeutic Issues from RxFiles Newsletter [Loren]

  • Background: Features of Chronic Pain Patients
  • Types of Chronic Pain & Drugs Used to Treat
  • (RxFiles NMCP Charts)
  • Issues: Role of Opioids / Treatment Agreements etc.

1005 Overview of New Drugs (may discuss earlier as necesarry)

  • Pregabalin [Brenda]
  • Tramacet [Brenda]
  • Cannabinoids (Sativa, etc) [Brent]

1020 Short Stretch Break

1030 Opioids: Pseudoaddiction, Dependence, Methadone, etc. [Dr. Peter Butt]

1130 Break to pick up lunch

1145 Working Lunch [Dr. Anita Chakravarti]

  • Integrated Pain
  • Specialist Perspectives (Anesthesiology/Pain Clinic)

1300 Family Physician Perspectives/Issues [Dr. T. Laubscher]

1345 College Of Physician Perspectives [Dr. Karen Shaw]

1430 Refreshment Break

1445 Wrap-Up: Outstanding Issues / Cases [Loren]

1530 What’s New?

  • RxFiles Charts 5th Edition; ASCOT-BPLA [Brent]

1605 Adjourn with a smile!


DISCUSSION ITEMS

Email from Ray Joubert

While I appreciate the context of the newsletter, I wonder if it is feasible to add some commentary about the limits of using exempted codeine compounds. Our reason for asking is that we want to set a benchmark upon which to base a change in policy. To explain, members have been asking that they be allowed to add sales to the ADAPT database so that patient profiles can be accessed through the viewer being developed for the Pharmaceutical Information Program Network. The only way that government is authorized to collect this data and make it avaialbe is for prescription drugs. Therefore, we are seriously considering making these compounds prescription drugs in Saskatchewan along with giving pharmacists legal authority to prescribe them. While this accomplishes the same thing from a patient access perspective, it addresses the legal technicality allowing government to collect the data and make it available to members via PIP. In addition, we need to determine the standards that apply. For example, each prescription would be patient specific, and how should members handle requests for use by other members of the family? Documentation and record keeping - should we ask members to document the indication, including whether or not it varies from the limitations or rational indications for use as described in this Rx Files newsletter? Ray

Weight change: gabapentin

3.3.3.E. Weight change finding

1. Summary:

a. Weigh loss associated with ANOREXIA and weight gain related to INCREASED APPETITE have been reported in up to 5% of gabapentin- treated patients (Prod Info Neurontin(R), 2003a; Anon, 1990b).

2. Literature Reports:

a. Twenty-eight of 44 patients treated for seizure disorder with gabapentin experienced weight change (Toledo et al, 1997). Ten patients gained more than 10% of their baseline weight, 15 patients gained 5% to 10%, 16 patients had no change, and 3 patients lost 5% to 10% of their initial weight. Weight increase started between the second and third months of therapy and stabilized after 6 to 9 months.

Weight change: pregabalin

1. Incidence: 4% to 12%

2. During controlled clinical trials, weight gain was commonly reported among all indications. Following the use of pregabalin at doses ranging from 75 to 600 milligrams/day, weight gain occurred in 4%, 4%, and 12% of patients with neuropathic pain associated with diabetic peripheral neuropathy, neuropathic pain associated with postherpetic neuralgia, and epilepsy, respectively (Prod Info Lyrica, 2005).

Trigeminal neuralgia, also called tic douloureux, is a condition that affects the trigeminal nerve (the 5th cranial nerve), one of the largest nerves in the head. The trigeminal nerve is responsible for sending impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes. Trigeminal neuralgia is characterized by a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek. The disorder is more common in women than in men and rarely affects anyone younger than 50. The attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, chewing, or swallowing. The attacks may come and go throughout the day and last for days, weeks, or months at a time, and then disappear for months or years.