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The Complexities of Pain Management in the Extended Care Setting

neuroscienceCME Multimedia Snack

Premiere Date: Tuesday, November 13, 2012

This activity offers CE credit for:

  1. Physicians (CME)
  2. Pharmacists (ACPE)
  3. Other

All other clinicians will receive a Certificate of Attendance stating this activity was certified for AMA PRA Category 1 Credit™

Credit Expiration Date:
Sunday, November 13, 2016
Note: Credit Is No Longer Available


Amy L. Mestemaker, MDAmy L. Mestemaker, MD (Moderator)
Medical Director
HomeReach Hospice/Kobacker House
Clinical Instructor for Pain and Palliative Medicine
The Ohio State University Department of Internal Medicine
Columbus, OH

Phyllis A. Grauer, RPh, PharmD, CGP, CPEPhyllis A. Grauer, RPh, PharmD, CGP, CPE 
Clinical Consultant
HospiScript Services, LLC
Clinical Assistant Professor
The Ohio State University College of Pharmacy
Columbus, OH

Charles W. Mason, DO, CMDCharles W. Mason, DO, CMD 
Geriatric Medicine
Riverside Methodist Hospital
HomeReach Hospice
Clinical Associate Professor of Family Medicine
The Ohio University College of Osteopathic Medicine
Clinical Associate Professor of Family Medicine
Ohio State University
Columbus, OH

Statement of Need

Pain is a common challenge in nursing homes and other long-term care facilities. Often unrecognized and under-treated, pain is a major source of distress and compromised activities of daily living, which lead to increased functional impairments. Patients in long-term care often present specific and substantial barriers to pain assessment and management. Multiple concurrent disease processes and possible cognitive impairment and communication difficulties—along with limited access to diagnostic technologies—make assessment of pain more difficult in this population. Multiple medications, altered physiology and pharmacology, and limited access to a variety of drug and non-drug interventions make treatment strategies more difficult to implement.(1)

This neuroscienceCME Snack introduces you to Robert, a patient in long-term care who has stage IV rectal cancer, mild dementia, and a reasonably good quality of life. A multidisciplinary faculty panel will take you through Robert’s case, looking into pain assessment and treatment-planning options to ease Robert’s pain while considering management issues in the setting of long-term care facilities.

  1. Ferrell BA. The management of pain in long-term care. Clin J Pain. 2004;20(4):240-243. PMID: 15218408.

Activity Goal

To offer a unique window into pain management in extended-care facilities, from the perspectives of two pain experts and a pharmacist, who review a case and detail the salient and often overlooked aspects of pain assessment and management in patients with mild cognitive impairment who live in a long-term care setting.

Learning Objectives

At the end of this CE activity, participants should be able to:

  • Describe the salient issues and implement a treatment plan for management of pain in long-term care facilities.
  • Identify appropriate assessment scales to measure pain intensity for patients in extended care facilities.
  • Recognize the factors that affect pain expression and measurement of pain intensity in patients in extended care facilities and use information gathered from better recognition of these factors to improve symptomatic management of chronic pain in these patients.

Financial Support

CME Outfitters, LLC, gratefully acknowledges an educational grant from Endo Pharmaceuticals and Pfizer Inc. in support of this CE activity.

Target Audience

Physicians and health care professionals who care for patients in long-term care who have pain.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME Outfitters, LLC, designates this enduring material for a maximum of .5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CPE Credit (Pharmacists):
ACPE CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. .5 contact hours (0.05 CEUs)
Universal Activity Number: 0376-0000-12-025-H01-P
Type: knowledge-based

Post-tests, credit request forms, and activity evaluations must be completed online at (requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit

Disclosure Declaration

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Mestemaker has no disclosures to report

Dr. Grauer has no disclosures to report.

Dr. Mason has no disclosures to report.

Tony Graham, MD (peer review) has no disclosures to report.

Robert Kennedy, MA (planning committee) has no disclosures to report.

Joy Bartnett Leffler, MLA, NASW, CSE (planning committee) has no disclosures to report.

Sandra Haas Binford, MAEd (planning committee) has no disclosures to report.

Sharon Tordoff, CCMEP (planning committee) has no disclosures to report.

Unlabeled Use Disclosure

Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.

CME Outfitters, LLC, the faculty, Endo Pharmaceuticals, and Pfizer Inc. do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).


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