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Case Challenges in Chronic Pain: A Focus on Diagnosis and Management

  • Authors: Lee Radosh, MD
  • CME / ABIM MOC / CE Released: 8/17/2018
  • Valid for credit through: 8/17/2019, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for neurologists, rheumatologists, primary care physicians, and nurses.

The goal of this activity is to review effective measures to assess and diagnose chronic pain, and selecting appropriate analgesic regimens to manage patients diagnosed with a chronic pain condition.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Diagnosis of common chronic pain conditions
    • Emerging investigational approaches for the treatment of chronic pain conditions
  • Have greater competence related to
    • Selection of an appropriate analgesic regimen in a patient properly diagnosed with a common chronic pain condition
    • Appropriate assessment of a patient who presents with a potential chronic pain condition


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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.


  • Lee Radosh, MD

    Faculty Associate
    Family Medicine Residency
    Reading Hospital of Tower Health
    Reading, Pennsylvania


    Disclosure: Lee Radosh, MD, has disclosed no relevant financial relationships.

    Dr Radosh does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

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


  • George Boutsalis, PhD

    Scientific Director, Medscape, LLC 


    Disclosure: George Boutsalis has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Amy Bernard, MS, BSN, RN-BC, CHCP

    Lead Nurse Planner, Medscape, LLC


    Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

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Case Challenges in Chronic Pain: A Focus on Diagnosis and Management

Authors: Lee Radosh, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 8/17/2018

Valid for credit through: 8/17/2019, 11:59 PM EST


The following cases are 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 read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

Patient Case 1 -- Patient With Knee Osteoarthritis Pain

Patient Image

HL is a 43-year-old woman with left knee pain that is not well controlled with acetaminophen. She has no history of recent injury. She has a history of 2 previous left knee surgeries that were performed during her teens (possibly arthroscopies) due to participation in athletics. She is obese (body mass index [BMI] = 36), with a history of several unsuccessful attempts at weight loss. She also has seasonal allergies (for which she takes seasonal fluticasone) and hyperlipidemia (for which she is currently taking a statin).

HL began taking over-the-counter analgesics for her knee pain approximately 1 year ago. Although she cannot provide details about the specific medications and dosages, she describes a pattern of increasing frequencies and higher doses over the last 6 to 8 months. She also says that she has tried "stretching." She had an urgent care visit 2 weeks ago for worsening pain. She underwent plain radiography of the knee (you reviewed the report from the urgent care clinic), which suggested a diagnosis of osteoarthritis (OA). She was given a prescription for meloxicam and told to follow-up with her primary care physician.

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