Dr. Archibald reviews how opioid addiction affects brain chemistry resulting in hyperalgesia and loss of emotional control, leading to poor decision making when seeking relief from dysphoria. He discusses the negative effects of stigma and the positive results from medication assisted treatment (MAT). Dr. Finn reviews protocols for treating in-patients with standardized screening, buprenorphine order sets in eDH and consultative services. She and Dr. Brackett emphasize the importance of perioperative communication to discuss current opioid use, or if currently in MAT, how to titrate medications pre and post operatively. This optimizes pain control after surgery and reduces the possibility of relapse after discharge.
Christine T. Finn, MD Assistant Professor of Psychiatry Vice Chair of Education Director, Psychiatry Residency Training Program Director, Emergency Psychiatry Service Director, Telepsychiatry Service
Luke J. Archibald, Assistant Professor of Psychiatry Section Chief, Addiction Treatment Center
Charlies D. Brackett, MD Assistant Professor of Medicine Assistant Professor of The Dartmouth Institute Accreditation
Participants will be able to discuss the neurochemistry of addiction and resulting behaviors, and the importance of perioperative communication and planning for effective and sustainable pain control.
In accordance with the disclosure policy of Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.
The following activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Surgery Grand Rounds June 19, 2020 - Perioperative Management of Pain and Addiction in Patients with Opioid Use Disorder have reported the following financial interest or relationship* with various companies/organizations. The Planning Committee role was resolved by altering the individual’s control over content about the products or services of the commercial interest by the Activity Director and determined to be free of commercial bias. All potential conflict(s) were resolved.
~ Richard J. Barth, MD is a major stockholder in CairnSurgical, Inc.
~ M. Shane Chapman, MD, MBA has grant/research support from Abbvie, Inc., Biofrontera, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol Myer Squibb Company, CARA Therapeutics, Celegene Corporation, Eli Lilly, Inc., Elorac, Inc., Galderma Pharmaceuticals, Genetech, Inc., Kiniksa Pharmaceuticals Ltd., Novartis Pharmaceuticals, Pfizer, Inc., Regeneron Pharmaceuticals, Soligenix, Inc., TARGET PharmaSolutions, and USB Biosciences. Dr. Chapman is also a consultant for Celgene and Genentech.
~ John D. Seigne, MD is a stockholder of Johnson & Johnson.
~ Michael E. Zegans, MD has grant/research support from MedImmune.
Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.
There were no individuals in a position to control the content who refused to disclose.
* A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.