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Recognizing and Managing Chronic Pain in Primary Care

  • Authors: Larry Culpepper, MD, MPH
  • CME Released: 9/16/2011
  • Valid for credit through: 9/16/2012
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Target Audience and Goal Statement

This activity is intended for primary care providers including physicians, pharmacists, and nurses who are involved in the care of patients with chronic pain.

The goal of this activity is to improve the recognition and management of various types of chronic pain in patients presenting to primary care.

Upon completion of this activity, participants will be able to:

  1. Describe the effective use of pain screening and assessment tools
  2. Enumerate the risks for serious sequelae when chronic pain is left untreated
  3. List key factors to be probed in effective patient conversations that will guide treatment selection and monitoring strategies
  4. Design effective pain management care plans that integrate different care team members to coordinate and monitor ongoing care, including monitoring for abuse risk


As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Larry Culpepper, MD, MPH

    Professor and Chairman, Department of Family Medicine, Boston University School of Medicine; Chief, Department of Family Medicine, Boston Medical Center, Boston, Massachusetts


    Disclosure: Larry Culpepper, MD, MPH, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: AstraZeneca Pharmaceuticals LP; Forest Laboratories, Inc.; Labopharm Inc.; Pfizer Inc.; Trovis Pharmaceuticals, Inc.
    Served as a speaker or a member of a speakers bureau for: Merck & Co., Inc.
    Owns stock, stock options, or bonds from: Labopharm Inc.

    Dr. Culpepper does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States.

    Dr. Culpepper does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.


  • Lynne Schneider, PhD

    Freelance medical writer, Boca Raton, Florida


    Disclosure: Lynne Schneider, PhD, has disclosed no relevant financial relationships.


  • Priscilla Scherer

    Scientific Director, Medscape, LLC


    Disclosure: Priscilla Scherer has disclosed no relevant financial relationships.

CME Reviewer

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Peer Reviewer

The peer reviewer has disclosed no relevant financial relationships.

Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this enduring material for a maximum of 2.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape Education encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.


Recognizing and Managing Chronic Pain in Primary Care

Authors: Larry Culpepper, MD, MPHFaculty and Disclosures

CME Released: 9/16/2011

Valid for credit through: 9/16/2012


Editor's note: This activity is part of a set of resources for Improving the Assessment of Pain, a Performance Improvement (PI) CME initiative on Medscape Education. PI CME offers physicians the opportunity to earn up to 20 AMA PRA Category 1 credits by evaluating their practice in a specific clinical area, identifying opportunities for improvement and implementing change, and measuring the results. The first step is a self-assessment. To learn more about PI CME, click here.

The following test-and-teach case is an educational activity modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and will then read evidence-based information that supports the most appropriate answer choice. Please note that these questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the case, there will be a short post-test assessment based on material covered in the activity.

Case 1: Patient History

Tom is a 57-year-old married man with 2 adult children. He is executive vice president of an advertising firm. At his recent annual visit, he is found to be slightly hypertensive (138/92 mm Hg), mildly diabetic (glycated hemoglobin [A1c] level, 7.2%), and to have gained 12 lbs in the last year. During the course of the physical examination, he complains that he has been struggling with insomnia and has needed to take over-the-counter sleep aids at least 1-2 nights per week for a few months. He and his doctor joke about their respective golf handicaps, and Tom admits that he has not been able to play golf in the past few months because of nagging intermittent low back pain.

The primary care provider (PCP) addresses the immediate medical concerns of hypertension, diabetes, and weight gain, and recommends specific lifestyle modifications including exercising, choosing a healthier diet to stabilize blood sugar levels and promote weight loss, and reducing his alcohol consumption. The PCP also sends Tom for blood tests and a cardiac stress test, and prescribes a mild antihypertensive and a sleep aid.

When Tom returns in 6 weeks for his follow-up visit, he has made some progress: He has lost 4 lb, reports walking a mile or so 2-3 times per week, and is within his target blood glucose level. All of his test results (cholesterol, stress test) are within normal limits. His blood pressure is down to 125/86 mm Hg. However, he is feeling increasingly fatigued and complains of loss of concentration at work and reduced libido, most of which he attributes to his chronic low back pain (CLBP). Tom is given a standard depression screener to complete and is found to be mildly depressed. He complains about the added stress of his medical problems and admits that he recently missed a few days of work because he "hurt too much to get out of bed." The PCP notices that Tom is having a difficult time sitting comfortably during the consultation.

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