Primary Care Talk

[kstarm]

So I have been asked to give about a 45min to one hour talk on basically anything related to pain that I would like to do. The audience is about 150-200 primary care providers. This is a CME for them on pain. My understanding is that they would like something dealing with opioids but that is as specific as they have given me so far.

What sort of things would you think would be important to include in a pain/opioid talk to primary care providers noting that I have about 45-60 minutes?

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[VA Hopeful Dr]

So I have been asked to give about a 45min to one hour talk on basically anything related to pain that I would like to do. The audience is about 150-200 primary care providers. This is a CME for them on pain. My understanding is that they would like something dealing with opioids but that is as specific as they have given me so far.

What sort of things would you think would be important to include in a pain/opioid talk to primary care providers noting that I have about 45-60 minutes?

Get a nerf bat. Hit each PCP (of which I am one) over the head 5 times while screaming "No narcotics for chronic pain". You can alternate with "Don't combine narcotics and xanax" if you'd like.

 

[ultm8frisbee]

I would focus on interventions for pain syndromes. You can hit pharmacotherapy briefly, but thats a boring subject and won't net you the referrals you want-

 

[Ducttape]

i disagree.

i would begin by discussing the dangers of opioids, for patients and providers, and spend roughly the first 1/3rd of the lecture on that. discuss recent "standards of care" regarding monitoring, screening, the risks of patients with MEDs over 120. its what affects them the most. not in a confrontational way, but "this is what we in the pain world do for patients on meds, and it is what should be done to protect your patients and, potentially, your license".

then, i would segueway into the other treatments that you could offer - including interventions, non-opioid medications, therapies that can help manage pain, PT/CBT etc.

stick around after the end to discuss aspects that really bother them, if they want to ask questions. violent patients. how to handle insistent requests for meds, how to refer to addictionologist, what makes a good referral, etc.

 

[SSdoc33]

Get a nerf bat. Hit each PCP (of which I am one) over the head 5 times while screaming "No narcotics for chronic pain". You can alternate with "Don't combine narcotics and xanax" if you'd like.

a NERF bat?

 

[pharmer]

If the pcps want opioid talk then give it to them with a twist. Don't focus on the different opioid choices, pharmacokinetics, doses, etc as that is boring. I also feel like it is throwing gasoline on a fire. Focus on appropriate opioid prescribing, ie not chronic non terminal pain. Explain to them some of the theory behind chronic pain such as wind up and pain centralization syndrome. Tie that into why opioids do not work in that setting. Talk about opioid induced hyperalgesia and some of the thoughts/theory on how it arises. Provide info on adjuvant medications such as gabapentin, lyrica, cymbalta. Push info about CBT and multidisciplinary approaches to chronic pain including interventional.

 

[nvrsumr]

I would focus on interventions for pain syndromes. You can hit pharmacotherapy briefly, but thats a boring subject and won't net you the referrals you want-

Unless you want to be the go to guy for pain meds for the patients of 200 PCPs I'd follow ultimates advice.

 

[Ducttape]

Unless you want to be the go to guy for pain meds for the patients of 200 PCPs I'd follow ultimates advice.

That's why you should talk drugs first, to let thrm know that it rarely the right tx. Talk injections, they will think. "all this guy wants to do are shots. Won't do me any good to send pts to him. "

On the other hand.... "Opioids aren't safe , here is why, here is what I can help you with - and it won't be to take over opioid s".