At the conclusion of this presentation, the participant should be able to: 

• Cite three common reasons certain patients are unable to obtain adequate pain control utilizing standard techniques.
• Describe the presenting features of the following painful disease states and state the broad-based pharmacological treatments for each:  a.Acute strains / sprains / contusions  b.Osteoarthritis / Rheumatoid arthritis  c. Fibromyalgia  d.Neuropathic pain (e.g. diabetic peripheral neuropathy, low back pain, shingles pain) e. End-of-life pain. 
• State how to assess pain in the following difficult pain populations:  a. Patient with a current or past history of addiction  b. Non-communicative or demented elderly patient  c. Pediatric patient. 
• Formulate a treatment plan for use of the following co-analgesics and adjuvant pain therapies (e.g. antidepressants, anticonvulsants, NSAIDs, topical approaches, antispychotics, NMDA antagonists) in the management of pain refractory to common approaches. 
• Compare and contrast the pharmacology, pharmacokinetics, side effects and clinical utilization of the commercially available opioid products.
• Differentiate addiction, dependence, tolerance, pseudoaddiction, pseudotolerance and hyperalgesia.  
• Describe the patient / chronic pain syndrome which can receive the greatest potential benefit from a trial of opioid therapy and be able to implement this therapeutic approach in a manner that minimize the risks of drug diversion, addiction, and side effects. 
• Describe how to titrate opioid doses to obtain effective analgesia and convert between opioids with equianalgesic doses and maintain analgesia. 
• Describe how to effectively convert patients who fail the oral route to an alternative route for opioids, co-analgesics and adjuvant pain therapies.  
• State common side effects associated with pain medications and be able to recommend strategies to prevent the side effects from impacting the patient’s quality of life.