Pain: Managing Patients with Chronic Non-Terminal Pain

Introduction to this self-study CME activity

Purpose

Pain is the most common reason for which individuals seek health care.  Fifty to eighty million Americans suffer daily pain symptoms at a cost of approximately $90 billion annually, and chronic pain is the leading cause of disability in the US.  Care for chronic pain can be challenging and resource intensive, and many clinicians feel reluctant or ill-equipped to provide it.  New biological models differentiate three different underlying mechanisms (somatic/nociceptve, neuropathic, central pain/fibromyalgia) that require different treatments.  The use of controlled substances raises special issues with potential addiction and drug diversion. 

The purpose of this clinical guideline is to support clinicians in evaluating and managing patients with chronic pain.  Topics addressed include:
•  Using multi-dimensional approaches for evaluation and treatment
•  Setting treatment goals that focus on realistic improvement of functioning
•  Utilizing non-pharmacologic therapies
•  Managing any associated mood and psychiatric disorders
•  Selecting medications based on presumed pain type and comorbidities
•  Regular follow-up on patients
•  Special issues with opioids
   -  Assessing patients for dependence and addiction risk
   -  Selection and use of opioids
   -  Structuring ongoing opioid therapy to recognize and address addiction and diversion

Appended to the guideline are several tools to assist the clinician in evaluating chronic pain and in structuring the management of ongoing use of opioids.

Objectives

Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies to evaluate and manage patients with chronic, non-terminal pain with special attention to specific principles of opioid management.

Audience

This self-study activity is appropriate for clinicians and other health care providers who provide care for patients with chronic non-terminal pain.

Authors

Team Leaders

  • Daniel W Berland, MD
    General Medicine / Anesthesiology
  • Phillip E Rodgers, MD
    Family Medicine

Team Members

  • Carmen R Green, MD
    Anesthesiology
  • R Van Harrison, PhD
    Medical Education
  • Randy S Roth, PhD
    Physical Medicine & Rehabilitation

Consultants

  • Daniel J. Clauw, MD
    Rheumatology
  • Jennifer A. Meddings, MD
    General Medicine
  • Ronald A Wasserman, MD
    Anesthesiology

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.
Daniel W. Berland, MD
(None)
Daniel J. Clauw, MD
Consultant
Cypress Bio-sciences, Forest, Lilly, Pfizer, Pierre Fabre, Takeda, UCB
Research Funding
Cypress Bio-sciences, Forest
Carmen R. Green, MD
(None)
R. Van Harrison, PhD
(None)
Jennifer A. Meddings, MD
(None)
Phillip E. Rodgers, MD
(None)
Randy S. Roth, PhD
(None)
Ronald A. Wasserman, MD
(None)

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant M. Greenberg, MD, MHSA, MA
  • R. Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick, MA

CME Accreditation and Credit Designation

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

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in March 2009 with credit available through March 2012. It was reviewed for currency of content in March 2012 with availability of credit extended through February 2015. It was reviewed for currency of content in January 2015, and with minor revisions, the availability of credit was extended through December 2017. It was reviewed for currency of content in June 2017, and with minor revisions, the availability of credit was extended through May 2020. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.