Pain Management Series
American Medical Association
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Pain Management Online Series

Original Release: 2003
Revised: 2007 and 2010
Updated: June 2013
Expiration date: June 30, 2016

Unrelieved chronic or persistent pain is a significant public health problem in the U.S., with prevalence estimates ranging from 15% to 30%. A World Health Organization (WHO) survey of primary care patients found 21.5% suffered severe pain for most of a 6-month period during the previous year. Persistent pain significantly impacts quality-of-life and is often accompanied by anxiety, depression and sleep disorders, all of which complicate management.


Educational Objectives

  • Utilize a basic approach to the evaluation and assessment of the patient with persistent nonmalignant pain.
  • Describe the evidence related to chronic opioid therapy for persistent non-cancer pain.
  • Apply the basic nonpharmacological and pharmacological approaches to the management of persistent pain.


To begin the program, read the information below and check the acknowledgement statement; then click "Start Module."

Copyright © 2013 American Medical Association.  All rights reserved.  The contents of this CME program may not be reproduced in any form without written permission from the AMA.  This CME program does not define a standard of care, nor is it intended to dictate an exclusive course of management.  Standards of medical care are determined on the basis of all the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns evolve.

The products appearing in this continuing medical education program are given for information purposes only.  Their inclusion does not imply AMA endorsement, nor does omission of any product indicate AMA disapproval.

The American Medical Association designates this education activity for a maximum of 2 AMA PRA Category 1 Credit™. Physician should only claim credit commensurate with the extent of their participation in the activity.

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This continuing medical education program is intended for primary care physicians and those physicians who care for patients experiencing pain.

Financial Support

The original development of this CME module was supported in 2003 through an educational grant from Purdue Pharma L.P. and produced in accordance with the AMA Standards for Industry-Supported Multimedia Continuing Medical Education and Other Communications. The June 2013 revision of this activity is supported by a grant from the American Academy of Addiction Psychiatry’s Prescribers’ Clinical Support System for Opioid Therapies, a three-year grant funded by the Substance Abuse and Mental Health Services Administration and the Center for Substance Abuse Treatment.

CME Principal Faculty

Russell K. Portenoy, MD, Contributing Author, Planning Committee
Chairman, Department of Pain Medicine
and Palliative Care, Beth Israel Medical Center
New York, NY
Professor of Neurology and Anesthesiology
Albert Einstein College of Medicine
Bronx, NY

Arthur G. Lipman, PharmD, FASHP, Clinical Content Reviewer
University Professor, Department of Pharmacotherapy, College of Pharmacy
Adjunct Professor, Department of Anesthesiology, School of Medicine
Director of Clinical Pharmacology, Pain Management Center, University Health Care
University of Utah Health Sciences Center
Editor, Journal of Pain & Palliative Care Pharmacotherapy

Charles E. Argoff, MD, Reviewer
Professor of Neurology
Albany Medical College
Director, Comprehensive Pain Center
Albany Medical Center
Albany, NY

Jonathan S Berek, MD, MMS, Clinical Content Reviewer
Professor and Chair
Department of Obstetrics & Gynecology
Stanford University School of Medicine
Director, Stanford Women's Cancer Center
Stanford Cancer Institute
Stanford, CA

Reed Thompson, MD , FACS, Clinical Content Reviewer
Associate Professor, Donald W. Reynolds Department of Geriatrics
University of Arkansas for Medical Sciences
Little Rock , AR  

Karen Knox, PhD, RN, ARNP, MSN, MPH, ACNS-BC
Advanced Practice Registered Nurse, Clinical Content Reviewer
Associate Professor, College of Nursing
Allen College
Waterloo, IA

Vitaly Gordin, MD, Reviewer
Director for Pain Division, Department of Anesthesiology
Penn State Hershey Medical Center
Hershey, PA

Martin Grabois, MD, Reviewer
President, American Academy of Pain Medicine,
Baylor College of Medicine
Department of Physical Medicine and Rehabilitation
Houston, Texas

Bill McCarberg, MD, Reviewer
Adjunct Assistant Clinical Professor, University of California
San Diego, CA
Founder, Chronic Pain Management Program, Southern California Permanente Medical Group
Escondido, CA

Cheryl L. Lambing, MD, Reviewer
Assistant Clinical Professor
University of California , Los Angeles
Medical Director for Professional and Community
Education and Outreach
Ventura County Health Care Agency
Ventura, CA

Bruce Ferrell, MD, Director, Reviewer
UCLA Adult Palliative Care Services
University of California, Los Angeles
Los Angeles, CA

Seddon R. Savage, MD, MS, Reviewer
Pain Consultant, Manchester VAMC
Adjunct Associate Professor of Anesthesiology, Department of Anesthesiology, Geisel School of Medicine at Dartmouth College
Hanover, NH

Planning Committee

Rita LePard, CME Program Committee
American Medical Association

Barry D. Dickinson, PhD
Secretary, Council on Science & Public Health
American Medical Association

Janet Williams
Senior Policy Analyst
American Medical Association


Disclosure Policy
In order to assure the highest quality of certified CME programming, and to comply with the ACCME Standards for Commercial Support, the AMA requires that all faculty, planning committee and AMA CME Program Committee members disclose relevant financial relationships with any commercial or proprietary entity producing health care goods or services relevant to the content being planned or presented. The following disclosures are provided:

CME Advisory Board

Dr. Argoff:

Consultant, Speaker’s Bureau, Grant support: Endo, Forest, Lilly, Neurogenex, Pfizer, Consultant: Insys Pharmaceuticals, Gruenthal Pharmaceuticals, King, Sanofi-Aventis, Nuvo Research, Jazz, Shinogi, Iroko, Zogeniz,
Consultant, Speaker’s Bureau: Ameritox, Covidien, Depomed, Millenium, Quest Diagnostics
Speaker’s Bureau: Horizon

Dr. Berek: Nothing relevant to disclose
Dr. Ferrell: Nothing relevant to disclose
Dr. Gordin: Nothing revelant to disclose
Dr. Grabois: Consultant: Pfizer
Dr. Knox: Nothing relevant to disclose
Dr. McCarberg:

Consultant: Endo, Insys Pharmaceuticals, Neurogenex, Pfizer, Purdue Pharma, QRx Pharma, Salix, Sucampo, Teva

Dr. Lambing: Nothing revelant to disclose
Dr. Lipman: Nothing revelant to disclose
Dr. Portenoy:

Grant support: Boston Scientific, Covidien Mallinckrodt, Endo, Medtronic, ProStrakan, Purdue Pharma, Salix, St. Jude
Speaker’s Bureau: Grupo Ferrer

Dr. Savage: Nothing revelant to disclose
Dr. Thompson: Nothing revelant to disclose

AMA Staff

Dr. Dickinson: Nothing revelant to disclose
Ms. LePard: Nothing revelant to disclose
Ms. Williams: Nothing revelant to disclose

AMA CME Program Committee members have no relevant relationships to disclose.

Disclosure of Off-Label Uses
The content of this CME publication may contain discussion of off-label uses of some of the agents mentioned. Please consult the product prescribing information for full disclosure of labeled uses.

Art and Illustration
Copyright © American Medical Association


I acknowledge that I have read the information above, including the disclosure information.

Hardware and Software Requirements

  • Internet Access Speed Minimum: DSL or better+
  • Operating System: Windows XP, Windows Vista, Win 7, Mac
  • Browser Minimum: Internet Explorer 7.0 or better
  • Screen Resolution Minimum: 1024 X 768
  • Color Depth Minimum: HiColor(16bit)
  • Soundcard Required: Yes
  • Flash Plug-in Version 9.0 or better
  • Browser Feature Enabling Required: Cookies, JavaScript, Java Applets, Images, Audio
  • Processor Speed Minimum: 1.4Ghz
  • Processor Type: Pentium 4
  • RAM Minimum: 1 Gig



  • Instructions for CME Credit

    To obtain AMA PRA Category 1 Credit™ for this module you will need to:

    1. Review the CME Information front matter

    2. Read the module content

    3. Complete the online self-assessment and evaluation. A minimum score of 70% is required in order to be eligible to claim credit.

    4. If you scored at least 70% on the self-assessment, click the “submit” button

    5. The CME certificate will then appear and can be printed out. All data from the online forms will be automatically reported to the AMA. Your name will be stored in the AMA CME database for future transcript requests. You need do nothing further once you have completed the forms and printed your certificate.

  • Contact Information

    Please click here to access the Module in the AMA Online Learning Center.

    Should you have technical questions, please contact the AMA Unified Service Center at 1-800-621-8335.

    Should you have questions regarding the content,
    please contact Barry Dickinson at or 312-464-4549.

Last updated: June 2013
Content provided by: Health and Science Group