Original Publication
Open Access

Primary Care Assessment & Management of Chronic Non-Cancer Pain

Published: July 9, 2007 | 10.15766/mep_2374-8265.606

Included in this publication:

  • CNMP Notes.doc
  • Instructor's Guide.doc
  • Opioids and CNMP.ppt

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Chronic nonmalignant pain is a commonly encountered clinical scenario in primary care. Many medical professional organizations have issued guidelines indicating that opioid analgesics are reasonable to consider as part of the management of moderate-to-severe chronic nonmalignant pain with functional impairment. This lecture presents an approach to the assessment and follow-up of chronic nonmalignant pain with a focus upon the appropriate prescribing and monitoring of opioid analgesics. Topics covered include dose titration, adverse effects, detection of abuse and dependence, the use of pain management agreements, and regulatory oversight. This is a topic area that creates significant anxiety and frustration for residents in the clinic. Residents and medical students have responded very favorably to this discussion; this talk uniformly receives 4s and 5s on a 5-point Likert scale, with an average overall score of 4.9.

Educational Objectives

By the end of this lecture, participants will be able to:

  1. Develop an approach to the general assessment of chronic pain.
  2. Discuss patient historical factors and opioid characteristics that create a setting of greater risk for abuse or dependence.
  3. List the adverse effects commonly encountered with opioid analgesics, and discuss their management.
  4. Distinguish between opioid abuse and dependence and pseudoaddiction, and discuss their detection.

Author Information

  • Randall Brown, MD: University of Wisconsin School of Medicine and Public Health
  • Richard Brown, MD, MPH: University of Wisconsin School of Medicine & Public Health

None to report.

None to report.


  1. Brookoff D. Chronic pain:1. A new disease? Hosp Pract (1995). 2000;35(7):45-52, 59.
  2. Chapman SL, Byas-Smith MG, Reed BA. Effects of intermediate- and long-term use of opioids on cognition inpatients with chronic pain. Clin J Pain. 2002;18(4):S83-S90. http://doi.org/10.1097/00002508-200207001-00010
  3. Collett B-J. Chronic opioid therapy for non-cancer pain. Br J Anaesth. 2001;87(1):133-143. http://doi.org/10.1093/bja/87.1.133
  4. Galski T, Williams JB, Ehle HT. Effects of opioids on driving ability. J Pain Symptom Manage. 2000;19(3):200-208. http://dx.doi.org/10.1016/s0885-3924(99)00158-x
  5. Hendler N, Cimini C, Ma T, Long D. A comparison of cognitive impairment due to benzodiazepines and to narcotics. Am J Psychiatry. 1980;137(7):828-830. https://doi.org/10.1176/ajp.137.7.828
  6. Jamison RN, Schein JR, Vallow S, Ascher S, Vorsanger GJ, Katz NP. Neuropsychological effects of long-term opioid use in chronic pain patients. J Pain Symptom Manage. 2003;26(4):913-921. http://doi.org/10.1016/s0885-3924(03)00310-5
  7. Passik SD, Weinreb HJ. Managing chronic nonmalignant pain: overcoming obstacles to the use of opioids. Adv Ther. 2000;17(2):70-83. http://doi.org/10.1007/bf02854840
  8. Portenoy RK. Opioid therapy for chronic nonmalignant pain: a review of the critical issues. J Pain Symptom Manage. 1996;11(4):203-217. http://doi.org/10.1016/0885-3924(95)00187-5
  9. Tofferi JK, Jackson JL, O’Malley PG. Treatment of fibromyalgia with cyclobenzaprine: a meta-analysis. Arthritis Rheum. 2004;51(1):9-13. http://doi.org/10.1002/art.20076 


Brown R, Brown R. Primary care assessment & management of chronic non-cancer pain. MedEdPORTAL. 2007;3:606. https://doi.org/10.15766/mep_2374-8265.606