Continuing Medical Education (CME)

Managing Patients with Chronic Non-Terminal Pain Including Prescribing Controlled Substances

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.

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
	Team Member Company Relationship Daniel W. Berland, MD None   Daniel J. Clauw, MD Cypress Bio-sciences, Forest, Lilly, Pfizer, Pierre  Fabre, Takeda, UCB Consultant   Cypress Bio-sciences, Forest Research Funding 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: William E. Chavey, MD R. Van Harrison, PhD Connie J. Standiford, MD Literature search services: Taubman Medical Library Production of Internet format and web   site maintenance: Ellen Patrick-Dunlavey, 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 educational activity for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was prepared for release in March 2009.  Credit may be awarded for a maximum of three years from its release date, specifically from March 2009 through February 2012.  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.  It will be electronically scored and the correct answers returned immediately for your review.
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.

 

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