Chronic Pain: Best Practices in Interdisciplinary Multimodal Management (Part 1 of 2)

Charles E. Argoff, MD; Michael J. Brennan, MD; Paul P. Doghramji, MD; Mark S. Wallace, MD; Deanna M. Janora, MD, FAAPMR, FABEM
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Activity Type

This CME-certified enduring activity is jointly sponsored by UMDNJ-Center for Continuing and Outreach Education and Asante Communications, LLC.

This CME-certified enduring activity is supported by educational grants from Janssen Pharmaceuticals, Inc., administered by Janssen Scientific Affairs, LLC, and Lilly USA, LLC. For further information concerning Lilly grant funding visit

Activity Code: 12MC04 JE01  


Intended Audience

This activity is intended for pain specialists, physiatrists, neurologists, oncologists, and primary care physicians interested or involved in chronic pain management.

There are no prerequisites for this educational activity. 

This activity is the first section of the two-part CME activity Chronic Pain: Best Practices in Interdisciplinary Multimodal Management, which aims to disseminate best practices in the individualized assessment, diagnosis, and management of patients with chronic pain. The second part can be found here

Learning Objectives

At the conclusion of this program, participants should be better able to:

  1. Employ mechanism-based pharmacotherapy for patients with common chronic pain syndromes, such as subacute and chronic low back pain and osteoarthritis
  2. Evaluate the clinical profiles of current and emerging pharmacologic agents based in part on pharmacokinetic and pharmacodynamic profiles, analgesic effectiveness, and treatment-related risks and side effects
  3. Educate patients about the biopsychosocial nature of pain and the effectiveness of mechanism-based therapies, behavioral skill sets, and transparent dialogue with their healthcare team and caregivers
  4. Integrate mechanism-based pharmacotherapy with nonpharmacologic therapies based, in part, on the biopsychosocial factors that shape the intensity, severity, chronicity, and adverse functional consequences of subacute and chronic pain syndromes

Statement of Need / Learner's Gap

Chronic pain is prevalent, heterogeneous, and often inadequately treated.1-3 To obtain more clinically relevant diagnoses and optimize therapeutic strategies that specifically counteract aberrant neural signaling, experts recommend evaluating and treating chronic pain–based pathophysiologic mechanisms, whenever possible.4 Yet diagnosis and appropriate management of pain syndromes are complicated by the subjective nature of pain, the clinical presentation of which is markedly influenced by patient-specific biologic and psychosocial factors.5 Comprehensive assessment of pain-generating mechanisms, patient comorbidity, functional status, and treatment goals is therefore critical, providing a basis for effective and safe treatment strategies.6 Moreover, because chronic pain states result from a diverse set of underlying mechanisms and etiologies, it is not surprising that clinical trials, practice guidelines, and expert experience support multiple pharmacologic agents, particularly when appropriately combined with patient education, psychosocial treatments, and interventional approaches.4,7,8 After methodically considering all treatment options, clinicians must work with patients to construct tailored multimodal management plans and then carefully and longitudinally monitor therapeutic response. This On-Demand ShowCASE™ highlights recent scientific insights into aberrant nociception associated with chronic pain—particularly those factors that support multidimensional assessment, mechanism-based treatment, and multidisciplinary care.


  1. Gore M, et al. Eur J Pain. 2007;11(6):652-664.
  2. Walid MS, et al. Pain Pract. 2008;8(6):417-422.
  3. Chou R. Pol Arch Med Wewn. 2009;119(7-8):469-477.
  4. Woolf CJ. Ann Intern Med. 2004;140(6):441-451.
  5. Gatchel RJ, et al. Psychol Bull. 2007;133(4):581-624.
  6. Maiers MJ, et al. BMC Health Serv Res. 2010;10:298.
  7. Argoff CE, et al. Pain Med. 2009;10(suppl 2):S53-S66.
  8. Lee YC, et al. Arthritis Res Ther. 2011;13(2):211.


Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of UMDNJ-Center for Continuing and Outreach Education and Asante Communications, LLC. UMDNJ-Center for Continuing and Outreach Education is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

UMDNJ-Center for Continuing and Outreach Education designates this Enduring material for a maximum of 1.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Estimated time to complete the activity is 1 hour

Conflict of Interest Statement

In accordance with the disclosure policies of UMDNJ and to conform with ACCME and FDA guidelines, individuals in a position to control the content of this educational activity are required to disclose to the activity participants: 1) the existence of any relevant financial relationship with any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients, with the exemption of non-profit or government organizations and non-healthcare related companies, within the past 12 months; and 2) the identification of a commercial product/device that is unlabeled for use or an investigational use of a product/device not yet approved.

Peer Review Statement

In order to help ensure content objectivity, independence, and fair balance, and to ensure that the content is aligned with the interest of the public, UMDNJ-CCOE has resolved all potential and real conflicts of interest through content review by a non-conflicted, qualified reviewer. This activity was peer-reviewed for relevance, accuracy of content and balance of presentation by Deanna Janora, MD, FAAPMR, FABEM.

Field Test Statement

This activity was pilot tested for time required for participation by Amy Maley DO, Tara Pellegrino DO and Sue Yang-Novellino DO.

Faculty/CME Reviewer and Planner Disclosures

Charles E. Argoff, MD

Ameritox (Advisory Board); Cephalon, Inc. (Advisory Board); Depomed Inc. (Advisory Board); Endo Pharmaceuticals (Consultant, Research Grants, Speakers Bureau): Forest Laboratories, Inc. (Advisory Board, Research Grants, Speakers
Bureau); Inflexxion, Inc. (Advisory Board); Iroko Pharmaceuticals (Advisory Board); Johnson & Johnson/PriCara (Speakers Bureau); King Pharmaceuticals, Inc. (Advisory Board, Speakers Bureau); Lilly USA, LLC (Advisory Board, Research Grants, Speakers Bureau); Pfizer Inc. (Advisory Board, Research Grants, Speakers Bureau)

Michael J. Brennan, MD

Cephalon, Inc. (Advisory Board, Consultant, Speakers Bureau); Covidien (Advisory Board, Consultant, Speakers Bureau); Eli Lilly and Company (Speakers Bureau); Forest Laboratories, Inc. (Speakers Bureau); Pfizer Inc. (Speakers Bureau); ProStrakan, Inc. (Advisory Board); Purdue Pharma L.P. (Advisory Board, Consultant, Speakers Bureau)

Paul P. Doghramji, MD

Cephalon, Inc. (Speakers Bureau)

Mark S. Wallace, MD

Has no relevant financial relationships to disclose.

Deanna M. Janora, MD, FAAPMR, FABEM

Has no relevant financial relationships to disclose.

Field Testers: Amy Maley DO, Tara Pellegrino DO and Sue Yang-Novellino DO, have no relevant financial relationships to disclose.

Planners: UMDNJ-Center for Continuing and Outreach Education staff members—Patrick Dwyer, Director, Continuing Medical Education; Elizabeth S. Ward, Director, CME Compliance and Administration; and Felicia James, Program Manager—have no relevant financial relationships to disclose.

Asante Communications, LLC, staff members—Jim Kappler, PhD, Vice President, Scientific Services; Poshala Aluwihare, PhD, Senior Scientific Associate; Chris Blagden, PhD, Account Supervisor; and Christina Santiago, Account Executive—have no relevant financial relationships to disclose.

Off-label/Investigational Use Disclosure

This activity contains information of commercial product/devices that are unlabled for use or investigational uses of products not yet approved. Gabapentin is not included in the labeling approved by the US FDA for the treatment of chronic pain.

Method of Participation

There are no fees for participating in and receiving credit for this activity. Study the educational content, complete the evaluation and choose the best answer to each test question. The participant will have two opportunities to a score of at least 70% to successfully complete this activity. Credit is available through December 6, 2012.

Provider Contact

Please direct content or CE related questions or concerns to UMDNJ at 973-972-4267 or email

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Content Disclaimer

The views expressed in this activity are those of the faculty. It should not be inferred or assumed that they are expressing the views of Janssen Scientific Affairs, LLC, Lilly USA, LLC, any other manufacturer of pharmaceuticals or devices, UMDNJ, or Asante Communications, LLC. It should be noted that the recommendations made herein with regard to the use of therapeutic agents, varying disease states, and assessments of risk are based upon a combination of clinical trials, current guidelines, and the clinical practice experience of the participating presenters. The drug selection and dosage information presented in this activity are believed to be accurate. However, participants are urged to consult all available data on products or procedures before using them in clinical practice. UMDNJ and Asante Communications, LLC, reserve the right to modify the activity content and faculty if necessary.

© 2011 UMDNJ-Center for Continuing and Outreach Education and Asante Communications, LLC. All rights reserved. No part of this program content may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.

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