CPMP Exam Content Outline

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Certified Pain Management Pharmacist (CPMP)

Official Examination Content Outline

This document provides the official content outline for the Certified Pain Management Pharmacist (CPMP) examination. The exam certifies that a pharmacist possesses the specialized, advanced knowledge and clinical skills required to provide safe, effective, and evidence-based pain management, including complex pharmacotherapy, opioid stewardship, and multimodal treatment strategies.

Examination Specifications

Name of Credential Certified Pain Management Pharmacist (CPMP)
Certification-Issuing Body The Council on Pharmacy Standards (CPS)
Designation Awarded CPMP
Target Population Clinical pharmacists specializing in pain management, palliative care, and ambulatory care.
Examination Length 120 multiple-choice items
Administration Time 3.0 hours

Examination Content Outline

The CPMP examination is weighted according to the six domains listed below, which cover the comprehensive scope of pain management, from foundational patient assessment to complex pharmacotherapy and risk mitigation.

Domain 1: Pathophysiology and Patient Assessment 20%
Domain 2: Pharmacotherapy for Pain 30%
Domain 3: Opioid Stewardship and Risk Mitigation 20%
Domain 4: Special Populations 15%
Domain 5: Interdisciplinary and Non-Pharmacologic Pain Management 10%
Domain 6: Healthcare Systems, Policy, and Innovation in Pain Care 5%

Domain 1: Pathophysiology and Patient Assessment (20%)

Task 1: Evaluate the pathophysiology and classification of pain.
  • Differentiate between nociceptive, neuropathic, and nociplastic pain mechanisms.
  • Describe the neurobiology of pain signaling and the role of central sensitization.
  • Differentiate between acute pain, chronic pain, and acute-on-chronic pain.
  • Classify common pain syndromes.
Task 2: Implement a comprehensive pain and functional assessment.
  • Use a multidimensional approach to assess pain, including location, intensity, and quality.
  • Utilize validated pain assessment scales (e.g., Numeric Rating Scale, PEG Scale).
  • Assess the impact of pain on the patient's physical function, sleep, mood, and quality of life (QOL).
  • Establish patient-centered functional goals for pain management.
Task 3: Assess psychosocial factors and health disparities.
  • Apply the biopsychosocial model to the assessment of a patient with chronic pain.
  • Screen for common psychological comorbidities, such as depression, anxiety, and PTSD.
  • Apply principles of trauma-informed and culturally competent care to the patient assessment.
  • Assess for social determinants of health that impact pain reporting and access to care.
Task 4: Implement a risk assessment for opioid misuse and substance use disorders.
  • Utilize validated screening tools to assess a patient's risk for opioid misuse before initiation.
  • Conduct a thorough personal and family history of substance use disorders.
  • Interpret data from Prescription Drug Monitoring Programs (PDMPs).
  • Conduct and interpret urine drug tests to monitor for adherence and non-prescribed substances.
Task 5: Evaluate pain-related diagnostic tests and imaging.
  • Understand the appropriate use and limitations of diagnostic imaging in the evaluation of pain.
  • Interpret basic laboratory values that may be relevant to pain management.
  • Understand the principles of electrodiagnostic studies.
  • Interpret genetic testing results that may influence analgesic selection or metabolism (e.g., CYP2D6).
Task 6: Differentiate common pain syndromes.
  • Differentiate the clinical presentation of common neuropathic pain conditions.
  • Differentiate the clinical presentation of common musculoskeletal and inflammatory pain conditions.
  • Differentiate the clinical presentation of common visceral pain conditions.
  • Recognize headache syndromes and their appropriate management.

Domain 2: Pharmacotherapy for Pain (30%)

Task 1: Manage non-opioid pharmacologics.
  • Optimize the use of acetaminophen and NSAIDs, implementing strategies to mitigate their risks.
  • Select appropriate topical analgesics to minimize systemic exposure.
  • Manage skeletal muscle relaxants, considering their risks and benefits.
  • Counsel patients on the appropriate use of over-the-counter analgesic products.
Task 2: Manage opioid pharmacotherapy.
  • Select appropriate opioid agents based on their pharmacokinetic and pharmacodynamic properties.
  • Perform accurate equianalgesic dose calculations and apply appropriate dose reductions for incomplete cross-tolerance.
  • Manage common and serious opioid-induced side effects.
  • Differentiate between immediate-release, extended-release, and abuse-deterrent formulations.
Task 3: Manage adjuvant and emerging therapies.
  • Select and manage antidepressant and anticonvulsant medications for neuropathic pain.
  • Evaluate the evidence for cannabinoids in the management of chronic pain.
  • Understand the role of NMDA receptor antagonists like ketamine for refractory pain.
  • Stay current with emerging therapies, including long-acting injectables and psychedelics under investigation.
Task 4: Design multimodal analgesic regimens.
  • Design evidence-based, multimodal analgesic plans for acute and chronic pain.
  • Develop combination therapy regimens using drugs with different mechanisms of action.
  • Utilize scheduled non-opioid analgesics to minimize opioid requirements.
  • Manage transitions between different analgesic agents and routes of administration.
Task 5: Monitor treatment response.
  • Establish a plan for regular follow-up to assess the efficacy and safety of the pain regimen.
  • Use functional goals as the primary metric for assessing the success of a pain management plan.
  • Monitor for and manage adverse effects of all analgesic medications.
  • Adjust the therapeutic plan based on the patient's response and any changes in their clinical status.
Task 6: Implement deprescribing strategies.
  • Identify appropriate candidates for analgesic deprescribing, particularly for opioids and sedative-hypnotics.
  • Engage the patient in a shared decision-making process to initiate a voluntary taper.
  • Develop a slow, patient-centered tapering schedule to minimize withdrawal symptoms.
  • Incorporate non-opioid and non-pharmacologic strategies to manage pain during and after the taper.

Domain 3: Opioid Stewardship and Risk Mitigation (20%)

Task 1: Implement principles of opioid stewardship.
  • Promote a culture of safety and judicious use of opioids across the health system.
  • Develop and implement institutional policies and guidelines for safe opioid prescribing, aligning with state and federal guidelines (e.g., CDC).
  • Use data analytics to monitor opioid prescribing patterns and identify opportunities for improvement.
  • Provide education to providers on evidence-based pain management and safe opioid prescribing.
Task 2: Implement overdose prevention and naloxone distribution.
  • Identify patients at high risk for opioid overdose and co-prescribe naloxone.
  • Provide education to patients and caregivers on how to recognize an overdose and administer naloxone.
  • Understand and apply state-specific laws, such as standing orders, related to naloxone.
  • Develop workflows to proactively offer and dispense naloxone in various practice settings.
Task 3: Manage Prescription Drug Monitoring Programs (PDMPs).
  • Understand the state-specific requirements for checking the PDMP before prescribing or dispensing.
  • Routinely review PDMP data for all patients on chronic opioid therapy.
  • Identify high-risk patterns in PDMP data, such as multiple prescribers or pharmacies.
  • Address concerning PDMP findings with the patient and prescriber in a non-judgmental manner.
Task 4: Implement strategies to prevent diversion.
  • Recognize common diversion tactics used by patients.
  • Implement policies and procedures to prevent internal diversion of controlled substances.
  • Counsel patients on the safe storage and proper disposal of unused opioids.
  • Collaborate with law enforcement and regulatory agencies when diversion is suspected.
Task 5: Evaluate and manage Opioid Use Disorder (OUD) in patients with pain.
  • Regularly screen patients on chronic opioid therapy for the development of OUD using DSM-5 criteria.
  • Differentiate between physical dependence, tolerance, and opioid use disorder.
  • Facilitate a "warm handoff" or referral to a substance use disorder treatment specialist.
  • Understand the pharmacist's role in initiating and managing medications for OUD (e.g., buprenorphine, methadone).
Task 6: Manage opioid tapering and discontinuation.
  • Identify appropriate candidates for an opioid taper.
  • Engage the patient in a shared decision-making process to initiate a voluntary taper.
  • Develop a slow, patient-centered tapering schedule to minimize withdrawal symptoms.
  • Incorporate non-opioid and non-pharmacologic strategies to manage pain during and after the taper.

Domain 4: Special Populations (15%)

Task 1: Manage pain in pediatric and adolescent patients.
  • Use age-appropriate pain assessment tools for infants, children, and adolescents.
  • Calculate weight-based doses for analgesics and adjust for age-related pharmacokinetic differences.
  • Understand the risks and developmental considerations of using certain analgesics in children.
  • Develop multimodal analgesic plans for pediatric postoperative pain.
Task 2: Manage pain in geriatric patients.
  • Apply the principles of geriatric pharmacotherapy, including age-related changes in pharmacokinetics and pharmacodynamics.
  • Use the AGS Beers Criteria® to avoid potentially inappropriate analgesics in older adults.
  • Assess for and manage the impact of analgesics on cognition and fall risk.
  • Address the challenges of managing pain in patients with frailty and polypharmacy.
Task 3: Manage pain in pregnant and lactating patients.
  • Assess the risks and benefits of analgesic use during pregnancy and lactation.
  • Select appropriate analgesics, prioritizing those with the best safety data.
  • Manage neonatal abstinence syndrome (NAS) in infants exposed to opioids in utero.
  • Counsel on non-pharmacologic strategies for pain management during pregnancy.
Task 4: Manage pain in patients with renal and hepatic dysfunction.
  • Adjust analgesic doses based on the degree of renal or hepatic impairment.
  • Identify analgesics that are contraindicated in patients with severe organ dysfunction.
  • Monitor for the accumulation of toxic metabolites.
  • Utilize alternative agents or routes of administration to minimize risk.
Task 5: Manage pain in patients with co-occurring psychiatric and substance use disorders.
  • Develop an integrated treatment plan that addresses both pain and the co-occurring disorder.
  • Collaborate closely with mental health and addiction specialists.
  • Implement strategies to mitigate the risk of misuse and diversion in this population.
  • Utilize non-opioid and non-addictive therapies as the foundation of the pain plan.
Task 6: Manage pain in palliative and end-of-life care.
  • Apply the principles of palliative care to relieve suffering and improve quality of life.
  • Manage complex pain syndromes and other symptoms associated with advanced illness.
  • Apply the principle of double effect in the context of providing analgesia at the end of life.
  • Use alternative routes of administration when the oral route is no longer feasible.

Domain 5: Interdisciplinary and Non-Pharmacologic Pain Management (10%)

Task 1: Implement interdisciplinary collaboration.
  • Serve as the medication expert on a multidisciplinary pain management team.
  • Communicate effectively with physicians, nurses, physical therapists, psychologists, and other providers.
  • Participate in interdisciplinary case conferences to develop comprehensive care plans.
  • Advocate for the integration of pharmacy services into pain clinics and palliative care teams.
Task 2: Evaluate physical and rehabilitative therapies.
  • Describe the role of physical therapy and occupational therapy in improving function and reducing pain.
  • Recommend appropriate referrals to rehabilitation specialists.
  • Encourage patient engagement in an active, exercise-based therapy program.
  • Understand the evidence for modalities such as heat, cold, and electrical stimulation.
Task 3: Evaluate psychological and behavioral therapies.
  • Describe the role of psychological approaches, including Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT).
  • Recommend mind-body therapies like yoga, tai chi, and mindfulness meditation.
  • Refer patients to pain psychologists or other mental health professionals.
  • Promote a self-management approach that empowers the patient to use these strategies.
Task 4: Evaluate integrative and complementary therapies.
  • Evaluate the evidence for integrative therapies such as acupuncture, chiropractic, and massage.
  • Critically appraise the evidence for common dietary supplements and herbal therapies used for pain.
  • Counsel patients on the potential risks, benefits, and drug interactions of these therapies.
  • Maintain an open and respectful dialogue with patients about their use of complementary therapies.
Task 5: Evaluate interventional pain procedures.
  • Describe the principles and indications for common interventional procedures (e.g., nerve blocks, epidural steroid injections).
  • Understand the indications for implantable devices, such as spinal cord stimulators and intrathecal pumps.
  • Recognize the potential complications of interventional procedures.
  • Manage medications (e.g., anticoagulants) before and after procedures.
Task 6: Implement a multimodal, patient-centered care plan.
  • Design a comprehensive pain management plan that integrates pharmacologic, non-pharmacologic, and interventional therapies.
  • Use shared decision-making to develop a plan that aligns with the patient's goals and preferences.
  • Coordinate care among all providers involved in the patient's treatment.
  • Regularly reassess and adjust the multimodal plan based on the patient's response.

Domain 6: Healthcare Systems, Policy, and Innovation in Pain Care (5%)

Task 1: Evaluate federal and state controlled substance regulations.
  • Apply all relevant DEA and state regulations to the prescribing and dispensing of controlled substances.
  • Understand the legal requirements for a valid controlled substance prescription.
  • Ensure compliance with all record-keeping and inventory requirements.
  • Stay current with changes to federal and state laws governing controlled substances.
Task 2: Manage reimbursement and payer considerations.
  • Navigate prior authorization processes for pain medications and procedures.
  • Understand how formulary restrictions and step-therapy policies can impact the selection of analgesics.
  • Advocate for coverage of evidence-based non-pharmacologic therapies.
  • Understand the billing and coding framework for pharmacist-led pain management services.
Task 3: Implement telehealth and digital health technologies.
  • Utilize telehealth platforms to provide remote pain management consultations.
  • Understand the regulations governing the teleprescribing of controlled substances.
  • Incorporate data from digital health tools, such as wearables and ePROs, into patient care.
  • Evaluate the role of digital therapeutics and AI-enabled safeguards in pain management.
Task 4: Implement quality and safety improvement in pain care.
  • Develop and track key quality metrics for pain management services (e.g., HEDIS measures).
  • Participate in the analysis of adverse drug events related to analgesics.
  • Ensure compliance with accreditation standards (e.g., The Joint Commission) related to pain management.
  • Use quality improvement methodologies to improve the safety and effectiveness of pain care.
Task 5: Manage interprofessional communication and care coordination.
  • Document all clinical assessments, interventions, and care plans in the EHR.
  • Communicate effectively with all members of the interdisciplinary team.
  • Facilitate smooth transitions of care for patients with complex pain regimens.
  • Provide education to other healthcare professionals on best practices in pain management.
Task 6: Advocate for rational pain policy and patient care.
  • Advocate for policies that balance the need for access to effective pain management with the need to prevent misuse and diversion.
  • Work to reduce the stigma associated with chronic pain and substance use disorders.
  • Participate in professional organizations to advance the practice of pain management pharmacy.
  • Promote a patient-centered, compassionate, and evidence-based approach to pain care.

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