DEA Requirement for Opioid Use Disorder Management

Embark on a journey to understand and manage pain with our comprehensive Pain Management Course. In this enlightening series of lectures, we delve deep into the intricate mechanisms of pain, exploring its various types, causes, and the fascinating pathways through which our bodies interpret and respond to it. This course includes:

Lecture 01: Pain Management - Lateral Spinothalamic Tract (Pain Part 1)

Following topics are covered in this lecture:

1. Understand the subjective nature of pain and its emotional underpinnings.

2. Explore the epidemiology of pain, its receptors, and triggering factors.

3. Examine the intricate pathways involved in pain sensation.

4. Delve into the threshold for temperature receptors and the phenomenon of spatial summation.

5. Grasp the concept of allodynia and its implications.

6. Explore the role of the lateral spinothalamic tract in transmitting pain signals.

7. Gain insights into pain inhibitory neurotransmitters shaping our perception and modulation of pain

 

Lecture 02: Muscle Pain (Pain Part 2)

Following topics are covered in this lecture:

1. Identify various types of pain fibers involved in muscle pain transmission.

2. Explore receptors on free nerve endings and their role in sensing ATP and acidic conditions.

3. Examine the effects of nerve compression on muscle pain pathways.

4. Understand the contributions of bradykinin and PGE2 in creating sensitization in muscles.

5. Differentiate between allodynia and hyperalgesia as manifestations of muscle pain.

6. Analyze acidic tissue pH as a key activating factor in muscle pain, considering factors such as chronic ischemic states, tonic contractions, myofascial trigger points, postural abnormalities, and myositides.

 

Lecture 03: Neuropathic Pain and The Role of Sensory Ganglion (Pain Part 3)

Following topics are covered in this lecture:

1. Understand the clinical features, diagnosis, and potential mechanisms of Complex Regional Pain Syndrome (CRPS).

2. Grasp the historical development of neuropathic pain research, key concepts, and current scientific understanding.

3. Differentiate the roles of neurons, nociceptors, and peripheral nerves in pain transmission, with emphasis on their involvement in neuropathic pain pathways.

4. Distinguish between the anatomical and functional characteristics of spinal and peripheral nerves for accurate pain pathway mapping.

5. Master the current International Association for the Study of Pain (IASP) definition of neuropathic pain, enabling differentiation from other pain types.

6. Explore the cellular and molecular changes within sensory ganglia that contribute to chronic pain after peripheral nerve injury.

 

Lecture 04: Opioids and Opioid Receptors (Pain Part 4)

Following topics are covered in this lecture:

1. Understanding the types and structure of opioid receptors. 

2. Opioid receptor signaling.

3. Distribution of opioid receptors in the brain.

4. Opioid receptor agonist and antagonist drug list.

 

Lecture 05: Opioid Receptor Activation and Tolerance (Pain Part 5)

Following topics are covered in this lecture:

1. Grasp opioid receptor concepts: desensitization, dependence, addiction, withdrawal.

2.  Identify μ receptors, understanding desensitization.

3.  Differentiate tolerance levels specific to opioid actions across organs and systems.

4.  Understand the effects of opioid withdrawal at the levels of tolerance, dependence, and addiction

5.  Summarize DSM-5 criteria for opioid use disorder.

 

Lecture 06: Mechanism of Opioid Induced Analgesia (Pain Part 6)

Following topics are covered in this lecture:

1.  Recognize opioid mechanisms in pain modulation at supraspinal, spinal, and peripheral levels.

2.  Identify the pivotal role of Mesencephalic Periaqueductal Gray (PAG) in supraspinal opioid analgesia.

3.  Analyze the clinical implications of opioid-induced disinhibition of the medulla spinal tract.

4.  Explore the effects of opioids at spinal levels, encompassing calcium channel modulation, neurotransmitter release, and hyperpolarization.

5. Recognize direct opioid effects on peripheral pain thresholds.

 

Lecture 07: Mood Alteration and Rewarding Properties of Opioids (Pain Part 7)

Following topics are covered in this lecture:

1.  Assess opioid effects on the mesolimbic-dopamine circuit.

2.  Explore opioid modulation of the GABA inhibitory system in the mesolimbic pathway.

3.  Differentiate between opioid-induced hedonic experiences and reinforcement mechanisms.

4.  Analyze the traditional reward circuit and the neurobiological basis of opioid reinforcement.

5.  Recognize the precise mechanisms influencing dopaminergic pathways in normal and opioid-influenced states

 

Lecture 08: Opioid-Induced Respiratory Depression (OIRD) (Pain Part 8)

Following topics are covered in this lecture:

1.  Opioid-induced respiratory depression (OIRD)

2.  Respiratory center overview

3.  Respiratory rhythm-generating neurons (Pre-Botzinger complex)

4.  Effects of opioids on respiratory components:

5.  Central chemoreceptors

6.  Peripheral chemoreceptors

7.  Chest wall

8.  Airway patency

 

Lecture 09: More Effects of Opioids Part 1 (Pain Part 9)

Following topics are covered in this lecture:

1. Exacerbating factors for opiate-induced respiratory depression.

2. Opioid-induced hyperalgesia.

3. Sedation.

4. Neuroendocrine effects.

5. Effects on sex hormones.

6. Miosis.

7. Seizures and convulsions.

8. Nausea and vomiting.

 

Lecture 10: More Effects of Opioids - Part 2 (Pain Part 10)

Following topics are covered in this lecture:

1.  Understand the cardiovascular effects of opioids.

2.  Recognize the impact of opioids on skeletal muscle tone.

3.  Comprehend the effects of opioids on the gastrointestinal system.

4.  Identify the influence of opioids on the ureter and urinary bladder.

5.  Understand the impact of opioids on the uterus.

6.  Recognize the effects of opioids on the skin.

7.  Understand the influence of opioids on the immune system.

8.  Recognize the impact of opioids on temperature regulation.

 

Lecture 11: Diagnosing and Classifying Substance Use Disorder (DSM-5 TR) - (Pain Part 11)

Following topics are covered in this lecture:

1.  Gain an introduction to the Diagnostic and Statistical Manual of Mental Disorders, Version 5 Text Revision (DSM-5 TR).

2.  Understand the concept of substances in the context of diagnosing and classifying Substance Use Disorder (SUD).

3.  Familiarize with the diagnostic criteria points, including impaired control criteria (DSM-5 criteria 1-4), social impairment (DSM-5 criteria 5-7), risky use (DSM-5 criteria 8 and 9), and pharmacological criteria (DSM-5 criteria 10 and 11).

4.  Learn how to classify substance use disorders into mild, moderate, and severe classes.

 

Lecture 12: Opioid Use Disorder - (Pain Part 12)

Following topics are covered in this lecture:

1.  Understand the prevalence of Opioid Use Disorder.

2.  Familiarize with the 11 diagnostic criteria for Opioid Use Disorder.

3.  Recognize situations when the diagnostic criteria are not met.

4.  Learn about severity assessment in Opioid Use Disorder.

5.  Understand the notes for specifiers in the diagnosis of Opioid Use Disorder.

6.  Identify the ICD-10 codes associated with the current severity/remission of Opioid Use Disorder.

7.  Recognize diagnostic markers related to Opioid Use Disorder.

8.  Explore additional resources for further reading on Opioid Use Disorder.

 

Lecture 13: Opioid Intoxication (Pain Part 13)

Following topics are covered in this lecture:

1.  Understand diagnostic criteria for opioid intoxication.

2.  Recognize specifiers and their significance in clinical diagnosis.

3.  Master accurate ICD-10-CM coding for opioid intoxication.

4.  Identify associated features and their implications.

5.  Gain insight into the development and course of opioid intoxication.

6.  Learn to differentiate opioid intoxication from other conditions through differential diagnosis

 

Lecture 14: Opioid Withdrawal (Pain Part 14)

Following topics are covered in this lecture:

1.  Understand DSM-5 criteria for opioid withdrawal.

2.  Recognize symptoms indicative of opioid withdrawal.

3.  Assess for clinically significant distress or impairment.

4.  Differentiate between ICD-10-CM codes for varying severity of opioid use disorder.

5.  Describe diagnostic features and course of symptoms in opioid withdrawal.

 

Lecture 15: Opioid Alternatives (Pain Part 15)

Following topics are covered in this lecture:

1.  Understand the use of non-opioid pharmacologic alternatives like acetaminophen and NSAIDs for pain management.

2.  Explore medicated topical agents and interventional pain management techniques, including spinal cord stimulation.

3.  Assess the benefits of complementary therapies, rehabilitation exercises, and behavioral treatments for pain relief and functional improvement.

4.  Recognize the application of non-opioid anesthesia in surgical settings to enhance patient outcomes.

 

Lecture 16: Naloxone and Naltrexone (Pain Part 16)

Following topics are covered in this lecture:

1.  Understand opioid overdose management, including FDA and EDA guidelines.

2.  Define Naloxone and Naltrexone and their roles in opioid reversal.

3.  Describe the pharmacological properties of Naloxone and Naltrexone.

4.  Identify the effects of Naloxone and Naltrexone in the absence of opioid agonists.

5. Recognize the effects of Naloxone and Naltrexone in the presence of opioid agonists.

6.  Explain the effects of Naloxone and Naltrexone in opioid-dependent patients.

7.  Discuss the absorption, distribution, metabolism, and elimination of Naloxone and Naltrexone

 

Lecture 17: Therapeutic Uses of Opioid Antagonists (Pain Part 17)

Following topics are covered in this lecture:

1.  Treatment of opioid overdoses with naloxone.

2.  Management of opioid-induced constipation with peripherally restricted opioid antagonists.

3.  Use of naloxone for neonatal respiratory depression.

4. Management of postoperative ileus with alvimopan.

5.  Therapeutic uses of naltrexone for alcohol and opioid dependence.

6.  Pharmacogenomics of opioid antagonist therapy.