MaryAnne Visit 2: A middle-aged woman with persistent pain and depression

Title:

MaryAnne Visit 2: A middle-aged woman with persistent pain and depression
Topic: Psychiatry
Relevant Terms: Fibromyalgia, Mood Disorders, Pain Management
Primary Audience: Psychiatrists
Launch Date: 22-Feb-10
Credits: 1 AMA PRA Category 1 Credit™
Expiration Date: The accreditation for this activity has expired.
Curriculum Name: Meet and Treat MaryAnne

Learning Objectives

Upon completion of the activity, participants should be able to:

  1. Utilize a combination of ACR criteria, physical examination, and patient history in the diagnosis of fibromyalgia.
  2. Describe two central nervous system pathways, which may contribute to the pathophysiology of fibromyalgia.
  3. Review the current evidence-based recommendations for the treatment of fibromyalgia.
  4. Implement evidence-based use of treatment regimens in patients with fibromyalgia.

    Faculty

    Lesley M. Arnold, MD
    Professor of Psychiatry
    Director, Women's Health Research Program
    University of Cincinnati College of Medicine
    Cincinnati, Ohio     Michael R. Clark, MD, MPH
    Associate Professor & Director
    Chronic Pain Treatment Programs
    Department of Psychiatry & Behavioral Sciences
    The Johns Hopkins Medical Institutions
    Baltimore, Maryland     Daniel J. Clauw, MD
    Professor of Medicine
    Division of Rheumatology
    Associate Dean for Clinical and Translational Research
    Director, Chronic Pain and Fatigue Research Center
    Michigan Institute for Clinical and Health Research
    University of Michigan
    Ann Arbor, Michigan     Chaim Putterman, MD; Course Director/Peer Reviewer
    Guest Faculty
    Professor, Departments of Medicine (Rheumatology), Microbiology and Immunology
    Chief, Division of Rheumatology
    Albert Einstein College of Medicine
    Bronx, New York
    COURSE VIEWING REQUIREMENTS
    PC
    Internet Explorer (v6 or greater), or Firefox
    		 MAC
    Safari





    ESTIMATED TIME TO COMPLETE THIS ACTIVITY:     1.00 hour

    SPONSOR
    This activity is sponsored by Albert Einstein College of Medicine in collaboration with SciMed and RealCME.


    INTENDED AUDIENCE    : Psychiatrists interested in learning more about the management of their patients with fibromyalgia.

    STATEMENT OF NEED
    Despite increasing incidence and public awareness, recognition of fibromyalgia by psychiatrists can be poor. Psychiatrists inherently fail to identify and appreciate the cumulative symptoms of fibromyalgia, resulting in significant delays in diagnosis and treatment, as well as diminished patient quality of life.

    Contrary to the most recent data on the pathophysiology of fibromyalgia, many psychiatrists continue to believe that fibromyalgia is a somatoform disorder. Due to the rapid increase in understanding of fibromyalgia pathophysiology, many psychiatrists are often unaware that fibromyalgia has a defined neurological etiology that is quantifiable, which may delay diagnosis, and result in inappropriate treatment and poor health outcomes.

    Psychiatrists fail to adhere to fibromyalgia evidence-based treatment regimens, and are not informed of innovative therapies indicated for the treatment of fibromyalgia. Poor understanding and implementation of the latest advancements in fibromyalgia treatment regimens may lead to patients with unmanaged pain and fatigue, resulting in diminished patient quality of life and poor health outcomes.

    ACCREDITATION STATEMENT
    This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and SciMed. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

    CREDIT DESIGNATION
    Albert Einstein College of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

    DISCLOSURE STATEMENT
    The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical or equipment company. Any presenter whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity, or who refuses to provide all their conflict of interest information, will not be permitted to present.

    Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product, or device, not yet approved for use in the United States.

    Albert Einstein College of Medicine CCME Staff, and the staff of RealCME have no conflicts of interest with commercial interest related directly or indirectly to this educational activity. Shari Fallet, D.O., employed by SciMed and a member of the planning committee, has disclosed that she owns stock with Pfizer.

    FACULTY DISCLOSURES
    Lesley M. Arnold, MD: Allergan, Boehringer Ingelheim, Cypress Biosciences Inc, Eli Lilly and Company, Forest Laboratories, Pfizer Inc, Wyeth (Grants/Research); Allergan, AstraZeneca, Boehringer Ingelheim, Cypress Biosciences Inc, Eli Lilly and Company, Forest Laboratories, Pfizer Inc, sanofi-aventis, Takeda Pharmaceuticals, Theravance, UCB Pharma, Wyeth (Consultant); Forest Laboratories, Eli Lilly and Company, Pfizer Inc (Speakers Bureau).
    Michael R. Clark, MD:     Eli Lilly and Company (Consultant); Eli Lilly and Company (Speaker's Bureau).
    Daniel J. Clauw, MD: Forest Laboratories, Pfizer Inc (Grants/Research); AstraZeneca, Cypress Biosciences Inc, Eli Lilly and Company, Forest Laboratories, Pfizer Inc, Pierre Fabre USA, UCB Pharma, Wyeth (Consultant).
    Chaim Putterman, MD: Biogen Idec (Grants/Research); Rosetta Genomics (Consultant).

    OFF-LABEL PRODUCT DISCUSSION
    Faculty have indicated that this activity will include the following off-label discussions: a) Use of pregabalin for sleep; b) slower dose titration for pregabalin; c) use of fluoxetine in a fibromyalgia patient; d) use of the broad terms "SNRI" and "alpha 2 delta ligand" for treatment of fibromyalgia; e)use of non-pharmacological treatments for fibromyalgia including exercise, CBT, and education; f) use of NSAIDs in fibromyalgia patients

    METHOD OF PARTICIPATION AND RECEIVING CME/CE CREDIT
    There are no fees for participating in and receiving credit for this activity. The participant must read the objectives and enduring material and must answer the multiple-choice online post-test. Please complete the evaluation form, which provides each participant with the opportunity to comment on the quality of the instructional process, the perception of enhanced professional effectiveness, the perception of commercial bias, and his/her views on future educational needs. A score of at least 70% is required to successfully complete this activity. The participant may take the test until successfully passed. Credit is available through February, 2011.

    DISCLAIMER
    The opinions and recommendations expressed by faculty in this activity are their own and do not necessarily represent the views of Albert Einstein College of Medicine, Montefiore Medical Center, and SciMed. Please review complete prescribing information for specific drugs or combination of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

    COPYRIGHT INFORMATION
    Copyright © 2010 Albert Einstein College of Medicine. All rights reserved. No part of this material may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations.

    PRIVACY POLICY
    Albert Einstein College of Medicine, Center for Continuing Medical Education (Einstein) protects the privacy of personal and other information regarding participants and educational collaborators. Einstein will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the ACCME.

    Einstein maintains physical, electronic, and procedural safeguards that comply with federal regulations to protect against the loss, misuse or alteration of information that we have collected from you.

    Additional information regarding Albert Einstein College of Medicine's Privacy Policy can be viewed at http://www.mecme.org/site/privacy.php.

    If you have questions about this CME activity, please contact Albert Einstein College of Medicine at 1-718-920-6674 or cme@montefiore.org.
    RELEASE DATE: February 22, 2010
    TERMINATION DATE: February 21, 2011

    ACKNOWLEDGEMENT
    This activity is supported by an educational grant from Pfizer.