Activity 5: Practical Aspects of Chronic Pain Management: A Case-based Approach

CME certification of this program has expired. The program is still available for viewing, but is no longer eligible for CME credit.

Program Overview

Chronic pain is a common and often difficult to treat compliant in family practice. It is estimated that nearly half of the 76.2 million Americans with chronic pain suffer on a daily basis 1, 2. In 42%, that pain has lasted longer than 1 year 1. Undertreated, chronic pain has significant personal, economic, and social impact. Patients with chronic pain experience decreased function, productivity, and socialization as well as psychological complications such as depression and anxiety. Pain management is not straightforward and there is often difficulty in determining etiology of pain and discomfort when prescribing treatment.

In Practical Aspects of Chronic Pain Management: A Case-based Approach, three case vignettes are used to demonstrate and reinforce issues and challenges family physicians often encounter when treating patients with chronic pain: 1) managing a new patient requesting a refill of pain medication, 2) negotiating treatment goals and managing residual pain, and 3) caring for elderly patients with chronic pain. Knowledge and concepts reviewed in the previous four activities within this series will be applied.

  1. National Center for Health Statistics. Health , United States , 2006, Special Feature on Pain. http://www.cdc.gov/nchs/data/hus/hus06.pdf
  2. Arthritis Foundation. Pain In America : A Research Report. 2000. www.arthritis.org

Intended Audience

This continuing medical education program is intended for family practitioners and other healthcare professionals who manage pain management.

Learning Objectives

After completing this activity, participants will be better able to:

  • Recognize risk factors and red flags associated with drug diversion and apply strategies to manage chronic pain in at-risk patients
  • Accept a patient's assessment of level of pain and function as the best indicator of that pain and gauge of treatment outcome
  • Develop a plan of care that addresses pain as well as emotional and functional status
  • Differentiate the role of long-acting and short-acting opioids in the treatment of chronic pain
  • Assess the risks vs benefits of long-term NSAID use in elderly patients with chronic pain
  • Appreciate the role of family and caregivers in assessing a patient's level pain and function

Faculty

Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Associate Director, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Planning Committee

Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Jeffrey T. Kirchner, D.O., FAAFP
Associate Director – Family Medicine Residency Program
Lancaster General Hospital / Temple University School of Medicine
Lancaster, PA

Dawn A. Marcus, MD
Associate Professor
University of Pittsburgh Medical Center
Pittsburgh, PA

Penny Tenzer, MD
Vice Chair, Director of the Residency Program
University of Miami, Miller School of Medicine
Chief of Service for Family Medicine
University of Miami Hospital
Miami, FL

Special thanks to:
The Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

And these individuals for their contribution to the program:
Dr. Brian Barrett
Dr. Justine Bello
Dr. Amy Clouse
Dr. Natalie Lingenfelter
Dr. Mackenzie Mady
Dr. Ibrahim Mian
Dr. Gabor Pernyeszi
Ernestine Robison

CME Accreditation

This activity, Practical Aspects of Chronic Pain Management: A Case-based Approach, has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. This activity conforms to the AAFP criteria for evidence-based CME clinical content. AAFP accreditation begins March 1, 2009. Term of approval is for two years from this date with the option of yearly renewal. This activity has been renewed from March 1, 2011 through March 1, 2013.

The EB CME credit awarded for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this education activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Agenda

Introduction and Opening Remarks
Module 1: Assessing the New Patient
                  Case 1 – New Patient Requesting Pain Medications
Module 2: Follow-up of the Pain Patient
                  Case 2 – Patient with Residual Pain
Module 3: Chronic Pain Management in the Elderly
                   Case 3 – Elderly Patients with Chronic Pain
Closing Remarks

Disclosures:

It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interests and, if identified, they are resolved prior to confirmation of participation. Only these participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity.

The AAFP and MedEd Architects staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Drs. Skolnik, Kirchner, Marcus, Tenzer, and Pomm have returned disclosure forms indicating that they have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material.

Please note that faculty is required to disclose all relevant relationships prior to the beginning of the activity.

 

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