Chronic Pain Management
Clicking the "View this Article" button will open the issue as a resizable PDF. To take the test for
the issue, return to this Introduction page and click the "Take the Test" button. The Introduction
page will remain open after you open this issue.
You may need to re-size or close the issue in order
to see the Introduction page.
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.
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.
This accredited program is targeted to
Goals & Objectives
At the conclusion of this program, participants will be able to:
- 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.
- 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.
- 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.
- Discuss recommendations for opioid initiation, titration, maintenance, monitoring, rotation, and discontinuation.
The Rx Consultant is a publication of Continuing Education Network, Inc.
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.
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
Editorial and Review Board
Chief Editor and CE Administrator
Terry M. Baker, PharmD
Tracy Farnen, PharmD
James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
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
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
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
Visiting Associate Professor and Lecturer
Samuel Merritt University
Pamela Mausner, MD
Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Senior Editorial Advisor
Gerard Hatheway, PharmD, PhD
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
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.
Any hardware that supports Microsoft Windows, Apple Mac OS, iOS, or Android, and meets the software requirements.
Browser that supports TLS 1.1 + and PDF files.
This includes Microsoft Internet Explorer 11, Google Chrome 38, Google Android OS 5.0 Browser, Apple Safari (version 7 for desktop, 5 for mobile), Mozilla Firefox 27, newer versions of these browsers, as well as some earlier versions that may require additional configuration.
Adobe Acrobat Reader is recommended, and is required for some browsers.
Note: TLS 1.1 and 1.2 support is required for browser security. Click here for TLS browser support details.
Required. Broadband recommended. (T1, DSL, Cable, G4 or higher.)