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Chronic nonmalignant pain (CNMP) is pain caused by injury or disease that persists longer than 3 to 6 months or longer than expected. In its report “Relieving Pain in America,” the Institute of Medicine notes that, “Chronic pain has a distinct pathology, causing changes throughout the nervous system that often worsen over time. It has significant psychological and cognitive correlates and can constitute a serious, separate disease entity.” CNMP is particularly common in primary care settings, with prevalence estimated anywhere from 5% to 50%, depending on the source. In alignment with the patient centered medical home (PCMH) and Chronic Care Model, many experts and clinicians agree that CNMP requires a multimodal, interdisciplinary approach to achieve maximum benefit for patients. CNMP, however, differs from many other chronic diseases cared for by primary care providers (PCPs) because of the availability of chronic opioids as a treatment option. PCPs must consider addiction, drug diversion, overdose, and legal and regulatory factors in their patient assessment and treatment decision making. For many providers, decisions about the use and management of chronic opioids remain one of the most difficult aspects of caring for patients with CNMP… READ MORE

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