Non-Pharmacologic Pain Management for Family Physicians Performance Improvement Project

The Illinois Academy of Family Physicians (IAFP) oversees and manages the Non-Pharmacologic Pain Management for Family Physicians Performance Improvement Project. This initiative aligns with the American Board of Family Medicine (ABFM) Performance Improvement standards and fulfills Meaningful Participation requirements.

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Registration and participation are free. 
Funding for this project was made possible by a grant from the American Board of Family Medicine.


ABOUT
Chronic pain remains a leading cause of disability and opioid use and is among the most challenging conditions encountered in primary care. When chronic pain is not effectively managed, patients often experience diminished function, reduced quality of life, and inappropriate reliance on opioid medications. Primary care physicians play a central role in ensuring that treatment plans support safe, sustainable, and patient-centered outcomes.

This Performance Improvement activity is designed to strengthen chronic pain management by emphasizing functional improvement, increased use of nonpharmacologic therapies, and reduced reliance on opioid medications among adults with chronic noncancer pain. Over a ninety-day period, participating physicians will apply evidence-based strategies that promote a multimodal approach to care. This includes appropriate use of nonopioid and nonpharmacologic interventions such as physical therapy, mindfulness practices, movement-based therapies, and behavioral health support. The project also reinforces safe and thoughtful opioid prescribing, guided by ongoing monitoring, risk mitigation, and clear documentation.

Physicians who complete this activity will enhance their ability to integrate practical, evidence-informed methods into routine practice. The overarching goal is to balance symptom relief with improved daily functioning while maintaining the highest standards of patient safety.

Objectives include the following.

1. Enhancing safe opioid prescribing practices through appropriate dosing, duration, and monitoring.
2. Increasing the use of nonpharmacologic pain management interventions.
3. Improving documentation of functional goals and pain assessments.
4. Expanding patient engagement in self-management strategies that support long-term well-being.

COLLECTING DATA AND SUBMISSION PROCESS
Submitting Performance Improvement:
Submit your completed Performance Improvement cycle using the online IAFP PI PDSA Form.

You must complete all sections of the Performance Improvement activity in order to receive credit. For your convenience, you may use the fillable PDF or Word worksheet to record and save your work before submitting the final online form.
IAFP Pain Management PDSA PI Submission form
Fillable PDF worksheet
Word document worksheet

Please note that the activity end date is 03/19/2028. All Performance Improvement cycles must be submitted by that date.

CME Credit: The AAFP has reviewed Non-Pharmacologic Pain Management for Family Physicians Performance Improvement and deemed it acceptable for up to 20.00 Performance Improvement AAFP Prescribed credit(s). Term of Approval is from 03/20/2026 to 03/19/2028. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn twenty (20) Performance Improvement points in the American Board of Family Medicine (ABFM) Family Medicine Certification program.
A link to claim credit (up to 20 credits) will be emailed to those participants who have completed the PI cycle and submitted the online form.


PDSA CYCLE

AIM
Chronic pain is a leading cause of disability and opioid use and is a challenging condition seen in primary care. Inadequate pain management can lead to poor function, decreased quality of life, and overuse of opioid medications.

The aim of this Performance Improvement activity is to improve chronic pain management by improving functional outcomes, increasing use of nonpharmacologic interventions, and reducing opioid reliance among patients with chronic non-cancer pain within 90 days.

Note: Physicians may adjust or narrow the AIM to fit their practice needs, provided the revised AIM remains within the scope of improving function, increasing use of nonpharmacologic treatments, and supporting safe opioid practices for patients with chronic non‑cancer pain.

Narrative / Objective: This PI project helps physicians implement practical, evidence‑based strategies to manage chronic non‑cancer pain more effectively. The focus is on balancing pain relief, functional improvement, and patient safety using multimodal, evidence-based approaches.  Integrating nonpharmacologic and nonopioid therapies (e.g., physical therapy, mindfulness, movement, behavioral therapy) and optimizing opioid prescribing can improve patient outcomes.

Objectives:

1. Enhancing safe opioid prescribing practices (dose, duration, monitoring).
2. Increase use of nonpharmacologic pain management interventions.
3. Improve documentation of functional goals and pain assessments.
4. Increase patient engagement in self‑management strategies.

Sample Project Strategy: PDSA Cycle
PLAN
Implement a structured, evidence-based pain management protocol that includes:
Assessment and Documentation

• Use a functional assessment tool such as the PEG Scale or Oswestry Disability Index.
• Document patient‑identified functional goals.

Safety and Monitoring

• Ensure an opioid treatment agreement is signed and on file for all patients receiving chronic opioid therapy.
• Review the state Prescription Drug Monitoring Program (PDMP) at each prescribing encounter.

Nonpharmacologic Interventions Incorporate at least one nonpharmacologic treatment option, such as:

• Physical therapy or movement‑based programs.
• Cognitive‑behavioral therapy or mindfulness‑based strategies.
• Lifestyle counseling focused on sleep, activity, ergonomics, and nutrition.
• Stress management education.
• Behavioral health referral as appropriate.

DO
During the 90‑day project period, clinicians will:

1. Identify all patients receiving chronic opioid therapy for ≥3 months.
2. Review and update individualized pain management plans.
3. Educate patients on nonopioid and nonpharmacologic treatment options.
4. Set or revise functional goals using a simple SMART framework (e.g., walk 10 minutes 5 days/week, practice relaxation 3 times/week).
5. Ensure all opioid agreements are completed and documented.
6. Adjust opioid prescriptions to the lowest effective dose and document functional improvement goals.
7. Initiate nonpharmacologic referrals or provide direct interventions as appropriate.

STUDY
Evaluate the following measures to assess improvement:

• Changes in patient pain and functional scores using validated tools (PEG or Oswestry).
• Number or percentage of patients participating in nonpharmacologic interventions.
• Opioid prescribing patterns, including MME per day, duration, and whether tapering was initiated when appropriate.
• Adherence and documentation of opioid treatment agreements.

Physicians will analyze whether the interventions improved patient function, reduced opioid reliance, or increased patient engagement in self‑management activities.

ACT
Based on findings from the Study phase, physicians will:

1. Identify barriers limiting improvement (access issues, workflow challenges, patient engagement).
2. Adjust clinic workflows (for example, adding EHR templates or reminders).
3. Strengthen collaboration with physical therapy, behavioral health, or pain specialists.
4. Enhance patient education materials and revisit goal‑setting as needed.
5. Sustain successful changes by embedding new workflows or templates into the EHR.

Outcome Measure Examples (Choose 2–3)
≥20% of patients with chronic pain participate in at least one nonpharmacologic intervention.
≥15% improvement in functional or pain‑interference scores using a validated tool.
≥10%  percent reduction in average daily MME among chronic opioid users.
100% documentation of opioid agreements.

RESOURCES
Opioid Treatment Agreement
FDA Opioid Patient‑Prescriber Agreement

Clinical Toolkits and Guidance
AAFP Chronic Pain Management Toolkit
CDC Clinical Practice Guideline for Prescribing Opioids for Pain
HHS Guide for Dosage Reduction or Discontinuation of Long‑Term Opioid Therapy

Functional Tools
PEG Scale
Oswestry Disability Index

Articles
Altug Z. Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach. Am J Lifestyle Med. 2021;15(4):425-433. Published 2021 Jul 21. doi:10.1177/1559827620971547