Chronic Non-Malignant Pain

Marengo, IA US
November 18, 2015


The purpose is to provide a review of the current evidence based standards for chronic pain evaluation, management, and documentation. Healthcare providers should be able to compare their current practices with these recommendations and make any changes as they see necessary to improve their management of this important and prevalent condition. 

Practice Gap

The Iowa Board of Medicine found that during 2009-2010, the Board charged five physicians and issued confidential reprimands to another six for inappropriate pain medication practices, such as prescribing controlled substances to drug-seeking patients. At the start of 2011, the Board had 25 open cases involving similar allegations. On August 17, 2011, the Iowa Board of Medicine amended the Iowa Administrative Code 653 Chapter 11, requiring physicians to complete continuing medical education on chronic pain medication management. This administrative rule was changed in an effort to assist physicians in reducing patients' abuse and misuse of pain medications. Based on this information, it has been concluded that physicians are in need of training regarding the prescribing, monitoring and if needed, the discontinuing of treatment, for patients with chronic pain.

Target Audience

Healthcare providers who regularly provide primary health care to patients, all emergency physicians, family medicine, general practice physicians, internists, neurologists, pain medicine specialists, psychiatrists, pediatricians, and any other physicians who regularly provides primary health care to patients.


  1. Discuss an evidence based approach to managing chronic non-malignant pain.
  2. Discuss the approaches to different types of chronic pain (i.e. mechanical, inflammatory, myofascial, neuropathic).
  3. Explore tools for evaluating various aspects of a chronic pain treatment plan.
  4. Explore tools to help the provider determine if chronic opiates are an appropriate option.
  5. Discuss the components and importance of a comprehensive treatment plan.
  6. Discuss the recommendations for evaluation and documentation of chronic pain as set forth by the Federation of State Medical Boards.
  7. Discuss the components of an ongoing chronic pain treatment plan and follow up.
  8. Explore non-opioid medications and interventions.
  9. Review case studies of patients with chronic pain and a recommended approach to these patients.
  10. Discuss the importance informed consent when prescribing chronic opiates.
  11. Discuss the importance and elements of a patient agreement to prevent abuse and misuse of controlled substances.
  12. Discuss the role of random drug screening as a tool to prevent abuse and misuse of controlled substances.
  13. Discuss the role of the state Prescription Management Program (PMP) as a tool to prevent abuse and misuse of controlled substances.



Joshua Stubblefield, DO, FAAFP
Faculty Physician, Broadlawns Family Medicine Residency; Assistant Professor, University of Iowa College of Medicine; Adjunct Faculty, Des Moines University College of Medicine

  • Medical School: Des Moines University College of Osteopathic Medicine, Des Moines, Iowa
  • Residency: Broadlawns Medical Center, Des Moines, Iowa
  • Board Certifications: American Board of Family Medicine
  • Clinical Interests/Additional Certifications: Osteopathic Manipulation, Chronic Disease Management, Non-Surgical modalities for chronic pain

Dr. Stubblefield indicated he has no financial relationships to disclose relevant to the content of this CME activity.

Needs Assesment Sources

  • Zenz, M., Strumpf, M., & Tryba, M. (1992). Long-term oral opioid therapy in patients with chronic nonmalignant pain. Journal of pain and symptom management, 7(2), 69-77.
  • Fishbain, D. A., Cole, B., Lewis, J., Rosomoff, H. L., & Rosomoff, R. S. (2008). What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review. Pain Medicine, 9(4), 444-459.
  • IOM (Institute of Medicine). 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press.
  • ICSI (Institute For Clinical Systems Improvement). 2011. Health Care Guideline: Assessment and Management of Chronic Pain
  • FSMB (Federation of State Medical Boards). 2004. Model Policy for the Use of Controlled Substances for the Treatment of Pain.
  • Portenoy, R. K. (1996). Opioid therapy for chronic nonmalignant pain: a review of the critical issues. Journal of pain and symptom management, 11(4), 203-217.

Continuing Education Credit

  • DO: Des Moines University (DMU) is accredited by the American Osteopathic Association (AOA) and approves this activity for 1.0 Category 1-A CME credit(s).
  • MD: This activity has been planned and implemented in accordance with the accreditation requirements and polici​es of the Iowa Medical Society (IMS). Des Moines University (DMU) is accredited by the IMS to provide continuing medical education for physicians. DMU designates this live activity for 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • Other: This live activity is designated for 1.0 AMA PRA Category 1 Credit(s)™.
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credits
  • 1.00 AOA Category 1­A
  • 1.00 CE Contact Hour(s)
Course opens: 
Course expires: 
Event starts: 
11/18/2015 - 12:30pm CST
Event ends: 
11/18/2015 - 1:30pm CST
Marengo Memorial Hospital
300 May Street
Marengo, IA 52391
United States

Available Credit

  • 1.00 AMA PRA Category 1 Credits
  • 1.00 AOA Category 1­A
  • 1.00 CE Contact Hour(s)


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