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Chronic Pain Management

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Pain is the number one symptom prompting Americans to seek medical care, and it is a leading cause of disability in the U.S. Chronic pain affects 100 million U.S. adults – more than the number affected by heart disease, diabetes, and cancer combined. Chronic pain has a major impact on quality of life and often impairs the afflicted person’s ability to function as a family member or employee. Up to 35 - 50% of chronic pain patients also suffer from depression. A conservative estimate of the economic burden of pain in the U.S., including both healthcare costs and lost work productivity, is $560-635 billion annually.

A number of treatment options are available, including medications, surgery, physical therapy, psychotherapy, and alternative therapies. On average, treatment reduces pain by only 30% in about half of those treated. The main goal of therapy is improvement in daily function. Prolonged use of opioid analgesics has become a typical scenario, due in part to a growing consensus that opioids are appropriate for some patients with chronic noncancer pain. Sales of opioid analgesics increased 4-fold between 1999 and 2010; the misuse and abuse of opioid medications has also increased. In 2010, 75% of the deaths due to prescription drug overdose involved opioid analgesics. Widespread media and political attention to this issue has led to increased regulation and monitoring of opioid prescriptions, shifting the focus away from the needs of chronic pain patients.

Because of their accessibility to patients, community providers can play a particularly important role in chronic pain management – by assessing pain control, managing drug therapy, and educating patients. Helping patients and prescribers strike a balance between analgesic misuse/abuse and legitimate chronic pain treatment is an important component of management. This issue presents an overview of the appropriate use of medications for chronic pain, including pain assessment and basic principles for nonopioid and opioid use.


Publication Date: 12/18/2013
Expiration Date: 12/18/2016
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Disclosure Statement

The editors report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists .

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the approach to treatment of chronic nociceptive pain, including assessment and treatment goals. Discuss the safety and roles of acetaminophen, NSAIDs, and COX-2 inhibitors.
    2. Discuss the controversy about opioid use for chronic noncancer pain. List 3 types of opioids used for chronic pain and specify which formulations should be avoided in opioid-naïve patients.
    3. Describe common and serious opioid side effects, including complications of chronic use. Explain the differences between physical dependence, tolerance, and addiction. Counsel patients about the management of opioid-induced constipation.
    4. Discuss recommendations for opioid initiation, titration, maintenance, monitoring, rotation, and discontinuation.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-14-001-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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