Evidence-Based Pain Management Alternatives for an Older Population

Welcome to the education module on Evidence-Based Pain Management Alternatives for an Older Population provided by TMF Health Quality Institute. For assistance, contact nhnetwork@tmf.org.

Click the "Start" button(s) below to listen to the podcast(s).

  • Overview
  • Accreditation
  • Disclosures
  • References

The purpose of this education activity is to enhance the knowledge and understanding of participating physicians and health care providers on the use of opioids and opioid alternatives in the Medicare and older patient population.

Learning objectives:

  • Podcast 1 - Discuss opioid and non-medication treatments for pain in the older population
  • Podcast 2 – Discuss short-term and long-term opioid use, pain measurements and side effects of opioid use
  • Podcast 3 – Discuss risk management evaluation tools for pain management
  • Podcast 4 – Discuss side effects of opioid use and substance use disorder

Release Date: 10/19/2020 Expiration Date: 10/19/2021

Target Audience

This enduring material is designed for physicians and health professionals who would like to increase their knowledge on the use of opioid and non-opioid treatment for pain in the older population.

Approval Statements

TMF Health Quality Institute is accredited by the Texas Medical Association to provide continuing medical education (CME) for physicians.

TMF Health Quality Institute designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

TMF Health Quality Institute designates this CME activity for a maximum of 0.5 2A credits for Osteopathic physicians (DOs).

This CME activity has been designated by TMF Health Quality Institute for 0.5 credits of education in medical ethics and/or professional responsibility.

Disclosure of Relevant Financial Relationships

Policies and standards of the Texas Medical Association, the Accreditation Council for Continuing Medical Education and the American Medical Association require that speakers/authors and planners for continuing medical education activities disclose any relevant financial relationships they may have with commercial interests whose products, devices or services may be discussed in the content of a CME activity.

The following planners have no relevant financial relationships to disclose:

Planners: Terri Watson, Tiffany Langham, Wendy Bradley

The following speaker have no relevant financial relationships to disclose:

Presenters: Clifford Moy, MD, and Lindsay Botsford, MD


Commercial Support TMF Health Quality Institute has received no commercial support.

Requirements for Successful Completion

To receive contact hours for this continuing education activity, the participant must:

  • Attend the session in its entirety to be eligible for continuing education credit for that session.
  • Complete the online claims process providing a unique identifier (birth day and month).
  • Complete and submit the online Educational Activity Evaluation Form for each session attended.

Once successful completion has been verified, a “Certificate of Successful Completion” will be awarded for 0.5 contact hours.

Glossary of Terms

Commercial Interest: Any entity producing, marketing, reselling or distributing health care goods or services consumed by, or used on, patients.

Conflict of Interest: The Accreditation Council for Continuing Medical Education considers financial relationships to create conflicts of interest in Continuing Medical Education (CME) when individuals have both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. The potential for maintaining or increasing the value of the financial relationship with the commercial interest creates an incentive to influence the content of the CME—an incentive to insert commercial bias.

Enduring Material: An activity that endures over a specified time and does not have a specific time or location designated for participation; rather, the participant determines whether and when to complete the activity. Examples: online interactive educational module, recorded presentation, podcast.

Relevant Financial Relationships: Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria for promotional speakers’ bureau, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds) or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership and other activities from which remuneration is received, or expected. See also “conflict of interest.” Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Estimated Time to Complete this Educational Activity: .5 hour


Centers for Disease Control and Prevention (2020, March). U.S. Opioid Prescribing Rate Maps. Retrieved from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html.

Agency for Healthcare Research and Quality (2019, September 18). New AHRQ Reports Highlight Seniors' Struggles with Opioids. Retrieved from https://www.ahrq.gov/news/newsroom/press-releases/seniors-struggles-with-opioids.html.

Texas Health and Human Services (2019, March). Opioids: An Epidemic Crisis. Retrieved from https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/QMP/opioids-epidemic-crisis.pdf (PDF).

U.S. Department of Health and Human Services (n.d.). Strategy to Combat Opioid Abuse, Misuse, and Overdose: A Framework Based on Five Point Strategy. Retrieved from https://www.hhs.gov/opioids/sites/default/files/2018-09/opioid-fivepoint-strategy-20180917-508compliant.pdf (PDF).

Weiss, A.J., Heslin, K.C., Barrett, M.L., Izar, R.I., & Bierman, A.S. (2018, September). Opioid-Related Inpatient Stays and Emergency Department Visits Among Patients Aged 65 and Older, 2010 and 2015. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb244-Opioid-Inpatient-Stays-ED-Visits-Older-Adults.jsp.

Centers for Medicare & Medicaid Services (n.d.). Medicare Part D Opioid Prescribing Mapping Tool. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/OpioidMap_Medicare_PartD.

American Psychiatric Association (2018, November). Opioid Use Disorder. Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder.

Substance Abuse and Mental Health Services Administration (2017, September 15). Screening, Brief Intervention, and Referral to Treatment (SBIRT). Retrieved from https://www.samhsa.gov/sbirt.

Substance Abuse and Mental Health Services Administration (2020). Medications for Opioid Use Disorder. Retrieved from https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-01-006_508.pdf (PDF).

Substance Abuse and Mental Health Services Administration (2018). SAMSA Opioid Overdose Prevention Toolkit. Retrieved from https://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA18-4742?referer=from_search_result.

Substance Abuse and Mental Health Services Administration (2017, November). Rx Pain Medications, Know the Options, Get the Facts: Safe Storage of Prescription Medications. Retrieved from https://store.samhsa.gov/product/Rx-Pain-Medications-Know-the-Options-Get-the-Facts-/SMA17-5053-11?referer=from_search_result.

U.S. Food & Drug Administration (n.d.) Approved Risk Evaluation and Mitigation Strategies (REMS). Retrieved from https://www.accessdata.fda.gov/Scripts/Cder/Rems/index.cfm.


Peer-reviewed Journals/Resources

Rao, V.L., Micic, D., & Davis, A.M. (2019, November 4). Medical Management of Opioid-Induced Constipation. JAMA, 322(22), 2241–2242. DOI:10.1001/jama.2019.15852.


Krebs et al (2018, March 6). Effect of Opioid vs Non-opioid Medications on Pain-Related Function in Patients with Chronic Back Pain or Hip or Knee Osteoarthritis Pain. JAMA, 319(9), 872. DOI:10.1001/jama.2018.0899.

Stern, E.H. (2018). Evaluating the Relationship Between Physician Characteristics and Opioid Knowledge and Use of Opioid and Non-opioid Chronic Pain Management Strategies. PCOM Psychology Dissertations, 522. Retrieved from https://digitalcommons.pcom.edu/psychology_dissertations/522.

Skelly et al (2018, June 11). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Comparative Effectiveness Review No. 209. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No 18-EHC013-EF. DOI:10.23970/AHRQEPCCER209.

Trotter Davis, M., Bateman, B., & Avorn, J. (2017). Educational Outreach to Opioid Prescribers: The Case for Academic Detailing. Pain Physician, 20(2S), S147–S151.

Tompkins, D.A., Hobelmann, J.G., & Compton, P. (2017). Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug and Alcohol Dependence, 173 Suppl 1(Suppl 1), S11–S21. DOI:10.1016/j.drugalcdep.2016.12.002.

Berna, C., Kulich, R.J., & Rathmell, J.P. (2015, June). Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice. Mayo Clinic Proceedings, 90(6), 828–842. DOI:10.1016/j.mayocp.2015.04.003.

Jamison, R.N., Sheehan, K.A., Scanlan, E., Matthews, M., & Ross, E.L. (2014). Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers. Journal of Opioid Management, 10(6), 375-382. DOI:10.5055/jom.2014.0234.


Clinical Guidelines

Rao et al (2020, March 1). Association of Formulary Exclusions and Restrictions for Opioid Alternatives with Opioid Prescribing Among Medicare Beneficiaries. JAMA Network Open, 3(3), e200274. DOI:10.1001/jamanetworkopen.2020.0274.


U.S. Department of Health and Human Services Working Group on Patient-Centered Reduction or Discontinuation of Long-term Opioid Analgesics (2019, October). HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics. Retrieved from https://www.hhs.gov/opioids/sites/default/files/2019-10/Dosage_Reduction_Discontinuation.pdf (PDF).

Centers for Disease Control and Prevention (n.d.). CDC Guideline for Prescribing Opioids for Chronic Pain. Retrieved from http://www.cdc.gov/drugoverdose/prescribing/guideline.html.

Institute for Healthcare Improvement (n.d.). Reducing Inappropriate Medication Use by Implementing Deprescribing Guidelines. Retrieved from http://www.ihi.org/resources/Pages/Publications/Evidence-Based-Medication-Deprescribing-Innovation-Case-Study.aspx.

Dowell, D., Haegerich, T.M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 [Abstract]. MMWR Recomm Rep 2016;65(No. RR-1), 1-49. DOI:10.15585/mmwr.rr6501e1.

Mccarthy, M. (2015). Opioids should be last resort to treat chronic pain, says draft CDC guideline. BMJ, 351. DOI:10.1136/bmj.h6905.