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Pain Management for the Outpatient

Course Description | Faculty | Accreditation | General Information

Course Description

Acknowledgement: This module is supported by a grant from the Donald Reynolds Foundation.

This activity meets the criteria of the Massachusetts Board of Registration in Medicine for 2 credits of Risk Management Study. This includes:

2 Credits of Opioid Education and Pain Management Training and
2 Credits of End-of-Life Care Studies

Please check your individual state licensing board requirements before claiming these credits.

Pain is a common problem among elderly individuals with persons over age 60 having a twofold increase in painful conditions as compared to younger individuals. Among the geriatric population, pain results in serious negative impacts including direct suffering, decreased physical function, decreased socialization, depression, sleep disturbances, increased health utilization costs, increased postoperative pulmonary and cardiac morbidity, and increased length of hospitalization. Despite the high prevalence and associated negative outcomes, pain is often poorly assessed and undertreated among elders. Patients with cognitive impairment are particularly vulnerable. Among these individuals, vague complaints are less likely to result in an evaluation for pain compared to similar complaints among cognitively intact elders. In addition, elders with cognitive impairment are prescribed and receive less analgesic medication than cognitively intact individuals.

This web-based, interactive virtual patient program aims to educate clinicians regarding some of the most common issues associated with pain assessment and management in the outpatient setting. The first case focuses on differentiating between neuropathic, somatic, and visceral pain. It also explores various treatment options for neuropathic pain in geriatric patients. The second case reviews possible atypical presentations of pain symptoms in elders with cognitive impairment, presents pain assessment tools appropriate for use in these individuals, and discusses the use of opioid analgesics in this population. In the third case, pain assessment and management issues in elders with severe cognitive impairment are reviewed including use of observational pain assessment scales such as the PAINAD scale. Questions are interspersed within the text of each case and video feedback is provided to reinforce main concepts. At the completion of each case, an expert provides a teaching summary. References are provided with links to PubMed.

Original Release: 12/9/2008
Most Recent Update: 7/16/2013
Termination Date: 7/16/2016

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

COST: $40.00 for the average learner. Participants living in emerging nations receive a 50% discount or can register for free. See our International Pricing Page for details.


  1. The learner will understand the different types of pain.
  2. The learner will understand who to apply World Health Organization (WHO) pain management principles to cognitively impaired individuals.
  3. The learner will understand that pain symptoms often present in an atypical manner in cognitively impaired individuals.


  1. The learner will understand and be able to select an appropriate treatment option for neuropathic pain.
  2. The learner will be able to provide a differential diagnosis of pain symptoms in cognitively impaired individuals.
  3. The learner will be able to utilize alternative pain scales to assess pain in cognitively impaired individuals.
  4. The learner will be able to select appropriate pain medications for cognitively impaired individuals.


Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.


This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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Course Director
Dr. Angela Catic, a geriatric clinician educator at Beth Israel Deaconess Medical School and Harvard Medical School, is the recipient of a Hartford Center for Excellence Research Fellowship Award and two Geriatric Academic Career Awards. She utilized these awards to develop multidisciplinary educational programs regarding the safety of elders during acute hospitalization. Particular areas of focus include pain management; delirium prevention and management; successful care transitions; and appropriate care of elders with advanced dementia.

Dr. Catic also co-directs ECHO-AGE, a tele-medicine educational program which trains long term care providers in the management of elders with dementia and associated behavioral issues. She holds a number of leadership roles including directing the Harvard Geriatric Medicine Fellowship program, leading the fourth year Harvard Medical School geriatric elective, and directing the educational component of the geriatric elective for internal medicine residents at Beth Israel Deaconess Medical Center.

The commercial entities which which we have relationships do not produce, market, re-sell, or distribute health care goods or services relevant to the content I am planning, developing, presenting, or evaluating for the activity.

Course Contributor
Dr. Janet L. Abrahm trained and practiced for many years as a Hematologist/Oncologist and has been a full-time Palliative Medicine specialist for over 10 years. She is an Associate Professor of Medicine at Harvard Medical School and the Director of the Pain and Palliative Care Program at the Dana Farber Cancer Institute and the Brigham and Women’s Hospital, where she directs the inpatient intensive palliative care unit, and the inpatient and outpatient consultation services. The second edition of Dr.Abrahm’s book, A Physician’s Guide to Pain and Symptom Management in Cancer Patients, was published in 2005 by Johns Hopkins University Press.

Company: Merck & Co., Perdue Pharma LP, Janssen Ortho Inc.

Course Contributor
Dr. Gillick received her B.A. degree from Swarthmore College and her MD degree from Harvard Medical School. She completed a residency in internal medicine at Boston City Hospital and a geriatrics fellowship at Boston Medical Center. Her area of interest is ethical issues near the end of life, a field in which she has published widely, including 4 books for a general audience, the most recent of which was The Denial of Aging: Perpetual Life, Eternal Youth, and Other Dangerous Fantasies (Harvard University Press, 2006). Dr. Gillick is a geriatrician and palliative care specialist with Harvard Vanguard Medical Associates and a Clinical Professor in the Department of Ambulatory Care and Prevention of Harvard Medical School.

Reported no relevant financial relationships with commercial entities

Course Contributor
Winnie Suen, M.D., MSc is a geriatrician and palliative care physician in the Division of Geriatrics at the Cambridge Health Alliance. She is an Instructor of Medicine at Harvard Medical School. She received her medical degree from the University of Hawaii John A. Burns School of Medicine, completed her Internal Medicine residency and Geriatrics fellowship at Boston Medical Center, and her Palliative Care fellowship at the Massachusetts General Hospital and Dana Farber/Brigham and Women’s Hospital. Dr. Suen is active in medical student, resident, and fellow teaching. Her practice focuses on providing home care for frail homebound elderly and on improving the quality of life of those living with life-limiting illnesses.

Reported no relevant financial relationships with commercial entities

Course Contributor
Dr. Tsai is an Instructor in Medicine at the Beth Israel Deaconess Medical Center in Boston, MA.

Reported no relevant financial relationships with commercial entities

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Dr. Janfaza is an Instructor in Anaesthesia at Brigham and Women's Hospital in Boston, MA.

Reported no relevant financial relationships with commercial entities

A native of Watertown, Massachusetts, Dr Warfield worked her way through Jackson College, Tufts University College of Engineering and Tufts Medical School, training in anesthesiology and pain medicine at Massachusetts General Hospital and Beth Israel Hospital at Harvard Medical School. She has been on the faculty at Harvard for over 30 years where she is currently the Lowenstein Professor of Anesthesia and former Chief of the Arnold Pain Management Center and Chair of the Department of Anesthesia, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center.

With an international reputation as one of the leading experts in the field of pain medicine, Dr Warfield has lectured worldwide and has authored almost two hundred articles and four textbooks on pain management which have been widely used for training in pain medicine and have been translated into Spanish, Chinese and Italian. Her clinical practice has focused on the treatment of cancer pain and low back pain and her academic practice has focused on teaching optimal methods to relieve pain and suffering from Boston to underserved countries throughout the world and in research relating to new therapies for pain relief.

The recipient of many awards and distinctions, Dr Warfield is active in a number of national and international organizations. She was a founding member of the New England Pain Association and has served as an officer, on the board of trustees and/or on committees of numerous organizations including the American Pain Society, the American Society of Anesthesiologists, the American Academy of Pain Medicine, the American Board of Anesthesiology, the International Association for the Study of Pain, the American Society of Regional Anesthesia and the Anesthesia Foundation. She has also served on several editorial boards and as a consultant to the FDA.

The first woman to hold an endowed professorship at Beth Israel Deaconess Medical Center and Harvard Medica

Reported no relevant financial relationships with commercial entities

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Course Planners
Dr. Sanjiv Chopra is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. In his role as Faculty Dean for Continuing Education, Dr. Chopra provides oversight and leadership of the Department and oversees the academic development of our programs. Dr. Chopra is an experienced clinician, researcher, and educator. In his research roles, he has served both as a principal investigator as well as co-investigator. He has more than 120 publications and five books to his credit, addressing topics in disease states, patient care, and leadership. Dr. Chopra’s teaching experience is extensive, and he has won numerous teaching awards for his work with medical students, residents and physicians. Currently, he directs and speaks at 10 multiday CME courses, nine of which are through HMS. For his full bio, please click here.

Reported no relevant financial relationships with commercial entities

Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development.

Reported no relevant financial relationships with commercial entities

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The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate

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General Information


Any computer running Windows, Mac OS, or Unix machines are supported.

Internet Connection
Your computer should be configured to access the Internet. A high speed internet connection may be required to view some of the large multimedia files.

Firefox or Internet Explorer 5.5 or higher are recommended. JavaScript and cookies must be enabled.

Some of the multimedia resources in this course require Apple Quicktime, RealMedia, or a Flash player. You will be prompted to download the appropriate plugin when necessary. No plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.


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