Chronic Pain in Primary Care: Focus on Low Back Pain

David M. Simpson, MD, FAAN; Cynthia P. Koh-Knox, PharmD, RPh
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Jointly sponsored by Purdue University College of Pharmacy and Asante Communications, LLC

This activity is supported by an educational grant from Lilly USA, LLC. For further information concerning Lilly grant funding visit

Activity Goal

This continuing medical education (CME) activity features discussions on best practices in the assessment and treatment of patients with chronic low back pain.          


Intended Audience

This CME activity is intended for primary care physicians and allied healthcare professionals interested in the management of patients with chronic pain. 

There are no prerequisites for this educational activity.

Learning Objectives

At the conclusion of this educational activity, participants should be better prepared to:

  • Characterize disease mechanisms underlying the transition from acute to chronic pain and the need for tight clinical management of all patients presenting with pain
  • Evaluate patient-specific biopsychosocial factors that shape the presentation of low back pain
  • Formulate realistic treatment goals through transparent and ongoing dialogue with patients 
  • Individualize pharmacotherapy for patients with low back pain based in part on differential diagnosis, prior medical history, comorbidities, level of function, and treatment goals   
  • Integrate behavioral therapies tailored to the biopsychosocial and functional needs of patients with low back pain


Statement of Need

The prevalence and deleterious consequences of chronic pain have prompted the US Institute of Medicine to declare pain a major health crisis.1 Chronic pain is a multifaceted disorder of the peripheral and central nervous systems that reduces patient function and quality of life, including affective, cognitive, physical, and occupational domains.2 At least 116 million adult Americans suffer from chronic pain, with estimated costs related to medical expenses and lost productivity ranging from $560 billion to $630 billion each year.1 In fact, chronic pain is the most common reason for clinician visits.1 As basic and clinical research continues to elucidate the complicated mechanisms underlying chronic pain syndromes, clinicians are better able to assess and treat their patients based on relevant neurologic and biochemical changes in the nervous system.3 And although timely diagnosis is critical, the subjective and dynamic character of chronic pain complicates assessment, particularly because of time constraints during a typical office visit. Moreover, the patient-specific biologic, psychological, and social factors that shape the pain experience require clinicians to be familiar with the full landscape of analgesic therapies, referring to specialists and coordinating care, when necessary.4 This monograph focuses on chronic low back pain—among the most frequent patient complaints5—to highlight the pathophysiologic changes that occur in chronic pain and provide practical approaches to comprehensive pain evaluation, physical examination, and multimodal treatment strategies.


  1. Institute of Medicine of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.
  2. McCarberg BH, Nicholson BD, Todd KH, Palmer T, Penles L. The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey. Am J Ther. 2008;15(4):312-320.
  3. Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med. 2004;140(6):441-451.
  4. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
  5. Tsang A, Von Korff M, Lee S, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883-891.

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 Purdue University College of Pharmacy and Asante Communications. Purdue University College of Pharmacy, an equal access/equal opportunity institution, is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

Purdue University College of Pharmacy designates this enduring educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Participation

There are no fees for participating in and receiving credit for this activity. Participants will have two opportunities to obtain a score of at least 70% to successfully complete this activity. Credit for participation can be obtained online at through February 20, 2013.

Conflict of Interest Statement

All faculty and staff involved in the planning or presentation of continuing education activities sponsored/provided by Purdue University College of Pharmacy are required to disclose to the audience any real or apparent commercial financial affiliations related to the content of the presentation or enduring material. Full disclosure of all commercial relationships must be made in writing to the audience prior to the activity.

Faculty and Planning Committee Disclosures

David M. Simpson, MD, FRCP, FAAN–Astellas Pharma US Inc. (Consultant,
Speakers Bureau); Forest Laboratories, Inc. (Consultant); Lilly USA, LLC (Consultant,
Speakers Bureau); NeurogesX (Consultant, Speakers Bureau); Pfizer Inc. (Consultant,

Cynthia P. Koh-Knox, PharmD, RPh–Has no relevant financial relationships
to disclose.

James A. Kappler, PhD, of Asante Communications–Has no relevant financial relationships to disclose.

All additional planning committee members, including Purdue University College of Pharmacy and Asante Communications staff, have no relevant financial relationships to disclose.


The opinions, ideas, recommendations, and perspectives expressed in the accompanying materials are those of the authors and faculty only and do not necessarily reflect the opinions, ideas, recommendations, or perspectives of their affiliated institutions, Purdue University College of Pharmacy, Asante Communications, LLC, or the activity’s commercial supporter.

Copyright Information

© 2012 Purdue University College of Pharmacy and Asante Communications, LLC. All rights reserved. No part of this report 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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