The importance of safe and effective pain management is an increasingly pressing issue for all frontline clinicians. A recent New England Journal of Medicine Perspective article, “Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education” calls for a change in prescriber education on the management of chronic pain and describes how appropriate education can help address the epidemic of prescription-opioid misuse. The article states:

“Prescriber education is a more finely tuned approach to addressing the opioid-misuse epidemic, allowing us to individualize care on the basis of a patient’s needs after a careful benefit–risk assessment. That, after all, is the way we manage all chronic diseases. Education can empower clinicians to make appropriate, well-informed decisions about whether to initiate, continue, modify, or discontinue opioid treatment for each individual patient at each clinical encounter.”

CAPC’s Pain Management curriculum offers 14 online courses to help clinicians learn how to safely and effectively manage pain for seriously ill patients. The curriculum concentrates heavily on opioid prescribing because, despite risks and concerns surrounding their use, opioids are both safe and effective when used properly in patients with serious medical illness and palliative care needs.  The courses teach through interactive Q+A case studies of typical pain patients with challenging needs:

  • An 87 year old woman with dementia and severe low back pain leading to repeated readmissions. Her clinician believes opioids should never be used in people with cognitive impairment.
  • A 42 year old schoolteacher and father of two diagnosed with curable head and neck cancer who has a history of alcoholism and smoking that place him at risk for substance use disorder.
  • A 75 year old Spanish-speaking man with COPD presenting with steroid associated necrosis of the femoral head and compression fractures causing severe pain and repeated hospitalizations. His doctor is afraid of respiratory depression from opioid analgesics.
  • A 35 year old woman with treated stage 3B breast cancer and no current evidence of disease. She is experiencing disabling post-mastectomy syndrome that is unresponsive to a range of other treatments.


Course Demo_Converting from Short-Acting to Long-Acting Opioids

Take a CAPC Course Demo: Converting from
Short-Acting to Long-Acting Opioids

This course focuses on patients with persistent pain as it takes
learners through the process of converting from short-acting to long-acting opioids.


As the article above mentions, clinical training on the safe and effective use of opioids has been largely absent from most medical and nursing education. Opiophobia, an unintended consequence of opioid misuse and the regulations in place to combat it, is prevalent among providers. Concerns are warranted as opioid analgesics carry risks if prescribers fail to follow best prescribing practices and regulatory requirements. However, the growing misuse of prescription opioids is leading to undertreatment of pain in ALL patient populations – including cancer patients and the seriously ill. It doesn’t have to be this way.

Members, take the CAPC Pain Management curriculum to gain the knowledge and skills needed to manage pain for seriously ill patients, beginning with a course on comprehensive pain assessment. As palliative care specialist Lynn Hallarman, MD points out in this video, “you’re much more likely to make an error in the patient’s pain management if you haven’t taken the time to do this kind of pain assessment”.

Not a member? Learn more about all CAPC courses here.


  1. Misuse of opioids’ analgesic especially among chronic pain patients is a growing public health problem worldwide. Studies show that opioids misuse occurred more frequently among patients with chronic pain especially among those patients who are smoking, and with history of alcohol or drugs use. For example, studies found that opioid misusers were more likely than non-misusers to have a past history of cocaine, have previous driving under influence (DUI) conviction, be younger, have past history of alcohol use or be a male.
    Therefore, individuals with chronic pain and opioid analgesic users should be carefully evaluated and followed up by the prescribers, including the primary health care doctors and other health care providers, for any signs of opioid misuse. Also, urine toxicological screening should be performed for those suspected patients with chronic pain.

  2. Andrew Esch says:

    Obviously this is a very timely topic. I cannot go a day without reading, watching or hearing about the opioid epidemic and the number of deaths from misuse of prescription opioids. In response to Dr. Subhi Bajis, I agree that “misuse of opioid analgesics, especially among chronic pain patients, is a growing public health problem worldwide”. It is in fact epidemic. Since 1999, prescription painkiller overdoses as a proportion of all deaths have risen by 265% in men and 400% in women and prescribers are now scared of hurting patients and regulators. This has resulted in “opiophobia” (fear of prescribing opioids) among many providers – an unintended consequence of opioid misuse and regulations intended to combat it- which has led to an epidemic of massive under treatment of pain and suffering in patients with serious illness.

    Regulations are complex and intimidating and the result is that many prescribers are concerned about criminal prosecution and scrutiny so they just avoid dealing with their seriously ill patient that may be suffering and in pain. It doesn’t need to be this way.

    The responsibility of all clinicians taking care of the seriously ill is to provide safe and effective treatment of pain. How the clinician accomplishes this is by thorough

    #1 the assessment and treatment of pain and its impact on function
    #2 prevention of opioid diversion and substance use disorder.

    There are regulations and policies in place that attempt to insure adequate treatment of pain while at the same time protect both the patient AND provider. If a clinician follows the The Federation of State Medical Boards “Model Policy” for the treatment of chronic pain, and applies these rules to all patients in pain, including the seriously ill, we would see a decline in misuse and death, and improvement in pain control for our patients that need it most.

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