Principles of Pain and Pain Experience

1. Apply knowledge of pain physiology and pathophysiology to differentiate pain mechanisms and guide treatment selection.
2. Differentiate between acute, chronic, neuropathic, nociceptive, nociplastic, and mixed pain.
3. Interpret clinical presentations of pain to determine etiology and classification.
4. Integrate patient-reported pain experiences with objective assessment methods to develop a patient-centered approach to pain management.

Practice Management

1. Demonstrate effective communication strategies for educating patients, healthcare providers, and stakeholders about pain management. 
2. Apply general pain management guidelines to support clinical decision-making. 
3. Evaluate the impact of insurance coverage and formulary management on pain management treatment selection. 
4. Use collaborative practice agreements, independent prescribing principles, and clinical informatics tools to optimize pain management workflows. 

Pain Stewardship

1. Apply pain management stewardship principles to optimize therapeutic outcomes. 
2. Implement opioid stewardship strategies to enhance patient safety.
3. Evaluate resource use in pain management to optimize clinical outcomes and safety.
4. Examine the impact of pain management policies on patient safety, health equity, and clinical effectiveness.
5. Demonstrate an understanding of The Joint Commission regulatory standards and Institute for Safe Medication Practices guidelines in pain management practices.

Research, Quality Improvement, and Ethics

1. Apply principles of epidemiologic study design, randomization, blinding, and statistical inference to critically assess pain management research.
2. Interpret FDA analgesic drug guidance to judge whether trial designs, endpoints, and treatment effects meet current regulatory expectations.
3. Analyze the ethical implications of placebo and nocebo effects as related to research critique and everyday clinical communication.

Opioids I

1. Apply pharmacologic principles of opioid analgesics to assess dosing, efficacy, and safety considerations in pain management.
2. Evaluate the impact of pharmacogenetic variations on opioid metabolism and patient response.
3. Calculate opioid doses and conversions to ensure safe and effective pain management.
4. Identify potential drug interactions, contraindications, and safety concerns associated with opioid use.
5. Select an appropriate opioid for a given patient.

Opioids II

1. Compare the mechanisms of action, pharmacokinetics, and pharmacodynamics of nontraditional opioid analgesics.
2. Assess the role of pharmacogenetics in patient response to methadone, buprenorphine, tramadol, and other nontraditional opioids.
3. Determine appropriate opioid dose conversions for methadone, buprenorphine, and other nontraditional agents.
4. Evaluate safety concerns, contraindications, and drug interactions unique to nontraditional opioids.
5. Integrate knowledge into patient-specific cases.

Non-opioid Pharmacologic Options

1. Evaluate the appropriateness of non-opioid analgesics on the basis of patient-specific factors.
2. Recommend appropriate dosing of non-opioid medications using pharmacokinetic, pharmacodynamic, and pharmacogenetic principles.
3. Assess the efficacy and safety of non-opioid analgesics on the basis of available clinical evidence and drug properties.
4. Select appropriate non-opioid analgesics for pain management on the basis of pain type, therapeutic goals, and indications.
5. Apply evidence-based guidelines to optimize non-opioid analgesic use.

Nonpharmacologic, Complementary, and Integrative Therapies

1. Distinguish between mind-body, active physical, and passive physical interventions on the basis of their mechanisms, benefits, and risks in pain management.
2. Analyze the impact of cognitive and behavioral therapies, including cognitive behavioral therapy (CBT) and mindfulness, on chronic pain management.
3. Examine the effectiveness of active physical interventions, such as physical therapy and structured exercise, in treating pain conditions.
4. Determine the appropriate use of passive physical interventions, including acupuncture, chiropractic care, and transcutaneous electrical nerve stimulation (TENS), on the basis of clinical evidence.
5. Integrate findings from key clinical studies to support the use of nonpharmacologic therapies in comprehensive pain management plans.

Pain Management Challenges in Ambulatory Care

1. Apply evidence-based pain scales and risk factor identification to assess acute pain in ambulatory patients.
2. Implement appropriate methadone, naltrexone, or buprenorphine management in the perioperative pain plan for ambulatory surgery patients with opioid use disorder.
3. Select appropriate analgesic strategies for acute dental pain in the ambulatory setting.
4. Recommend appropriate analgesic strategies, including dosing and breakthrough pain management, for ambulatory patients with renal colic.
5. Determine appropriate monitoring values and criteria for escalation of care in the follow-up of ambulatory patients with acute pain. 

Acute and Critical Pain Management

1. Recommend pharmacotherapeutic strategies for acute pain in trauma patients.
2. Implement evidence-based pain management strategies for ICU patients with complex conditions (eg, burns, pancreatitis) to achieve optimal pain control. 
3. Assess pain in critically ill patients using validated assessment tools and by interpreting physiological indicators and behavioral cues.

Patient Identification: Risk Mitigation and Monitoring

1. Differentiate key terminology related to opioid use and misuse (eg, aberrant drug behavior, addiction, diversion, tolerance) to accurately assess and communicate patient risks. 
2. Use validated risk assessment tools and clinical strategies to identify and treat patients at high risk of opioid misuse or overdose. 
3. Incorporate prescription drug monitoring program (PDMP) data, informed consent, and harm reduction strategies (eg, naloxone co-prescribing, safe storage) into opioid risk mitigation plans. 
4. Implement risk-reduction measures such as naloxone prescribing, safe storage education, and suicide prevention strategies in clinical practice. 
5. Analyze urine drug screening (UDS) results to differentiate between screening and confirmatory tests, recognize potential false-positives, and assess adherence.  

Pharmacologic Delivery and Interventional Nuances

1. Evaluate parenteral pain management techniques (eg, intravenous, intramuscular) for appropriateness and effectiveness in patients.
2. Apply principles of patient-controlled analgesia (PCA) to assess and adjust pain management strategies.
3. Implement regional and neuraxial analgesia techniques in diverse clinical scenarios.
4. Recommend appropriate routes of administration and delivery devices (eg, intrathecal pumps, intranasal sprays, elastomeric pumps) on the basis of individual patient factors to optimize pain management.

Chronic Pain I   

1. Differentiate peripheral neuropathy, phantom limb pain, post-stroke pain, chronic lower back pain, and chronic spine disorders on the basis of their etiology, pathophysiology, and clinical presentation.
2. Use appropriate pain assessment tools and diagnostic strategies to evaluate and distinguish between these chronic pain conditions.
3. Apply clinical guidelines and relevant trials to support evidence-based diagnostic and monitoring approaches for each condition.
4. Develop patient-centered pain management plans that align with assessment findings and patient goals for these chronic pain conditions.

Chronic Pain II

1. Distinguish complex regional pain syndrome, musculoskeletal pain, osteoarthritis, visceral pain, and fibromyalgia by examining their underlying causes, disease mechanisms, and symptomatology.
2. Implement appropriate pain assessment tools and diagnostic modalities to accurately identify and evaluate these chronic pain syndromes.
3. Integrate evidence from clinical practice guidelines and key studies to inform diagnostic and monitoring decisions for each condition.
4. Formulate individualized pain management strategies that incorporate patient-specific assessment data and therapeutic goals.

Cancer-Related Pain

1. Apply evidence-based strategies for assessing and managing pain in patients with cancer. 
2. Assess opioid and adjuvant analgesic therapies in patients with cancer-related pain. 
3. Integrate palliative care principles into pain management for patients with advanced cancer. 
4. Evaluate challenges in oncologic pain management, including neuropathic pain and bone pain.  

Palliative Care and Hospice

1. Differentiate palliative care, hospice care, and survivorship to guide appropriate patient referrals and interventions.
2. Assess pain and symptom management strategies for patients receiving palliative or hospice care.
3. Apply communication techniques to discuss goals of care, advance directives, and end-of-life decision-making with patients and caregivers.
4. Develop an individualized care plan that addresses physical, emotional, and psychosocial needs in palliative and end-of-life settings.

Novel Non-opioid Pharmacotherapies  

1. Integrate the mechanisms of action, pharmacokinetics, and pharmacodynamics of novel non-opioid analgesics into clinical decision-making for patient-specific pain management strategies. 
2. Assess the safety profiles, side effects, and contraindications of suzetrigine, ketamine, lidocaine, cannabinoids, botulinum toxin, low-dose naltrexone, and magnesium.
3. Evaluate the clinical safety of novel non-opioid analgesics according to kidney and hepatic function considerations.
4. Apply evidence from major clinical studies to support the appropriate use of novel non-opioid analgesics in pain management.

Headaches

1. Differentiate migraine (with and without aura), tension, cluster, and rebound headaches based on pathophysiology, clinical presentation, and diagnostic criteria.
2. Select appropriate assessment tools and diagnostic strategies to evaluate headache disorders and rule out secondary causes.
3. Apply clinical guidelines and evidence-base practices to develop individualized acute treatment plans for various headache types.
4. Develop prophylactic treatment strategies based on patient-specific factors, headache frequency, and comorbid conditions.
5. Implement headache management by incorporating patient-reported outcomes, lifestyle modifications, and pharmacologic/non-pharmacologic interventions.

Special Populations

1. Assess pain management strategies in patients with sickle cell disease.
2. Select appropriate pain management approaches for older adult patients, accounting for age-related physiological changes and medication safety concerns.
3. Implement pain management strategies for pregnant patients.
4. Propose pediatric-specific pain assessment and treatment strategies.
5. Apply strategies to reduce disparities in pain management.

Opioid Use Disorders and Behavioral Health

1. Integrate pharmacologic and nonpharmacologic strategies for managing both pain and mood/psychiatric disorders, as well as opioid use disorder (OUD).
2. Formulate comprehensive treatment plans for patients with comorbid pain and behavioral health conditions like anxiety, depression, insomnia and OUD. 
3. Implement pharmacotherapy for patients with pain with co-occurring and mood/psychiatric disorders, as well as OUD. 
4. Assess the appropriateness and effectiveness of pain management in patients with co-occurring behavioral health conditions.
5. Evaluate challenges of polypharmacy for patients with chronic pain and behavioral health conditions.

Various: See Modules