Activity 1: Assessment and Management of Chronic Pain

Pain is one of the most common reasons for seeking medical advice — nearly half of Americans seek care or treatment for persistent pain at some point during their lives1. Unfortunately pain management is not straightforward and treatment gaps persists. A high percentage of patients continue to experience pain on a daily or monthly basis that negatively impacts their functional and emotional status2.

Key elements to improving processes and outcomes in pain management include prompt recognition and treatment of pain, improved pain treatment patterns, monitoring treatment response, reassessing and adjusting pain management strategies, effective management of pain in patients with current, past, or potential for substance abuse, and risk management.

  1. U.S. Department of Health and Human Services. Health, United States, 2006.
  2. American Pain Foundation. Pain Facts & Figures.

Learning Objectives

After completing this activity, the learner will be able to:

  • Describe the underlying pathophysiology of chronic pain
  • Identify and treat chronic pain in a more timely manner
  • Perform pain assessment at initiation and throughout treatment
  • Establish specific functional goals in collaboration with the patient
  • Distinguish legitimate need from drug-seeking behavior
  • Explain the advantages and disadvantages of individual and combination therapies
  • Aggressively treat pain, including prescribing opioids when appropriate
  • Anticipate and manage breakthrough pain


Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Associate Director, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Planning Committee

Neil Skolnik, MD, Chair
Professor of Family and Community Medicine
Temple University School of Medicine
Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Jeffrey T. Kirchner, DO, FAAFP
Associate Director – Family Medicine Residency Program
Lancaster General Hospital / Temple University School of Medicine
Lancaster, PA

Dawn A. Marcus, MD
University of Pittsburgh Medical Center
Pittsburgh, PA

Penny Tenzer, MD
Vice Chair, Director of the Residency Program
University of Miami, Miller School of Medicine
Chief of Service for Family Medicine
University of Miami Hospital
Miami, FL

Editorial Team

Leigh McKinney
Project Manager
American Academy of Family Physicians

Kristi Eidsvoog, PhD
Content Manager
MedEd Architects, LLC

AAFP Contact

Susanna Guzman
Acting Director
Online and Custom Publishing
American Academy of Family Physicians

CME Accreditation

This Enduring Material activity, Assessment & Management of Chronic Pain, has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. AAFP accreditation begins September 16, 2010. Term of approval is for one year from this date with the option of yearly renewal. This activity has been renewed from September 16, 2011 through September 16, 2012.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this Enduring Material activity for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Introduction and Opening Remarks
Module 1: Assessing the Patient with Chronic Pain
Module 2: Developing a Management Plan for the Patient with Chronic Pain
Module 3: Integrating Adjuvant Pain Medications into a Chronic Pain Management Plan
Closing Remarks


It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interests and, if identified, they are resolved prior to confirmation of participation. Only these participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity.

Dr. Neil Skolnik has returned a disclosure form indicating that he has no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material. The program planning committee, as well as the AAFP and MedEdArchitects staff involved in producing this activity, have indicated that they have no relationships to disclose relating to the subject matter.

Please note that faculty is required to disclose all relevant relationships prior to the beginning of the activity.

Note About Medications and Off-label Uses

The faculty for this activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation. Information regarding medications (e.g., administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and delivery systems is subject to change; and the reader is advised to check the manufacturer's insert and medical references for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering any medication.

The faculty will discuss common but off-label uses of medications in this activity. See the list of medications discussed.


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