Activity 2: Managing the Chronic Pain Patient at Risk or with a History of Addiction

CME certification of this program has expired. The program is still available for viewing, but is no longer eligible for CME credit.

Program Overview

Managing chronic pain in patients who are at risk or have a history of addiction presents a particular treatment challenge for many family physicians. These patients, like all chronic pain patients, benefit substantially from appropriate management, which can include the use of opioids. To optimize care and minimize risk, it is important that family physicians recognize the clinical nuances to pain management in this patient population, especially the importance of appropriate monitoring and documentation of the treatment plan.

During this activity faculty will address primary concerns of family physicians regarding the management of chronic pain in patients at risk or with a history of addiction. Emphasis will be placed on risk assessment, treatment approach, diversion and addiction behaviors, and medical legal considerations when prescribing opioid therapy in high-risk patients. Discussants will review tools and resources available to assist the family physician throughout this process.

Intended Audience

This continuing medical education program is intended for family practitioners and other healthcare professionals who manage pain management.

Learning Objectives

After completing this activity, participants will be better able to:

  • Recognize and address challenges often encountered in the management of chronic pain in patients at risk for or with a history of addiction.
  • Understand the role of standard opioid therapies, as well as alternatives (i.e., methadone), for the treatment of chronic pain in patients at risk for or with a history of addiction.
  • Appreciate the role of adjunctive therapies and mental health in the management of chronic pain patients with a history of or at risk for addiction.
  • Appropriately monitor and document the treatment of pain in patients receiving chronic opioid medications.
  • Distinguish potential “red flags” of abuse and diversion of opioid medications.


Gerald Hansen, MD
Director, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Raymond Pomm, MD
Medical Director, Professional’s Resource Network
Medical Director, River Region Human Services
Medical Director, Gateway Community Services
Jacksonville, FL

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

CME Accreditation

This activity, Managing the Chronic Pain Patient at Risk or with a History of Addiction, has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. AAFP accreditation begins November 1, 2008. Term of approval is for two years from this date with the option of yearly renewal. This activity has been renewed from November 1, 2010 through November 1, 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 education 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: Identification and Assessment of the Patient at Risk for Addiction
Module 2: Treatment Options and Considerations for at Risk Patients
Module 3: Medical and Legal Aspects of Prescribing Chronic Opioid Therapy
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.

The AAFP and MedEd Architects staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Drs. Skolnik, Kirchner, Marcus, Tenzer, Hansen, and Pomm have returned disclosure forms indicating that they have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material.

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


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