Sunday, January 1, 2012

Pain Education in Medical Schools Lacking

Pain-Pourri Knowledgeable and compassionate care regarding pain is a core responsibility of health professionals, and this also is associated with better medical outcomes, improved quality of life, and lower healthcare costs. However, according to a new study published in the December edition of the Journal of Pain, even though pain is a most common reason that people seek medical care, education on pain at North American medical schools is relatively minimal, variable, and often fragmentary.

Investigators from the Johns Hopkins University Pain Curriculum Development Team examined curricula at 117 medical schools in the United States and Canada during 2009 and 2010. The authors performed a systematic review analyzing curricular emphasis on topics such as pediatric and geriatric pain, neuropathic pain, cancer pain, pain neurobiology. and pharmacological pain management.

Results showed that a majority of medical schools, 80%, claim they are teaching one or more core topics in pain, but many schools are not reporting any pain teaching at all and a surprisingly large number of schools devote less than 10 hours to pain education. Among Canadian medical schools, 92% require some pain education, and the median hours of instruction on pain topics at Canadian schools was twice the U.S. median.

Still, many topics included in the International Association for the Study of Pain (IASP) core curriculum received little or no coverage. The authors found that cancer pain, pediatric pain, and geriatric pain are essentially unaddressed by the vast majority of medical schools. Furthermore, the benefits/risks of opioid treatment and the medico-legal implications of pain treatment were distinctly underrepresented in medical curricula. There were no correlations between the types of pain education offered and school characteristics (eg, private vs public).

The authors conclude:

“Taken as a whole, these data bring to light glaring discrepancies between the prevalence of pain in society and the time dedicated to educating future physicians about pain in medical school. Given that the twin dangers of pain undertreatment and the abuse of pain-active medications are among our society’s deepest public health concerns, pain medicine does not receive the attention that it deserves in medical education. There are inarguable links between the undertreatment and the maltreatment of pain and the lackluster state of pain education in medicine. It is likely that unless opinion leaders and the next generation of physicians become aware both of the importance of conscientious pain management and the dangerous deficits in pain education, the crisis in pain care and resultant deaths from opioid abuse will only spiral upwards. A more organized and formal delivery of pain education is likely to be a principal catalyst in the sea change required to rectify the current shortcomings of pain care.”

COMMENTARY: This was a comprehensive, well-conducted survey and the authors’ conclusions speak to the dire need for better education on pain management among healthcare professionals. Since only U.S. and Canadian schools were included, the results cannot be generalized outside of North America; although, it would be surprising if education on pain management is vastly superior in other parts of the world.

In background information provided by the authors, they note that the development of recommended standards for pain education dates back to 1983 when the IASP published a consensus curriculum. Since that time, additional or updated standards for pain education have been published, such as the European Federation of IASP Chapters curriculum and pain medicine exam guidelines. The various experts concur that major topics should include: pain neurobiology, clinical assessment, and pharmacological pain management, as well as special focuses on geriatric pain, pediatric pain, cancer pain, acute pain, neuropathic pain, and substance abuse.

However, little is known about the extent to which these topics are covered in medical schools worldwide, and this present study suggests that education on pain management is severely deficient. Of special importance, as the researchers conclude, unless there are significant improvements in medical education on pain, current problems surrounding analgesic-related overdoses and deaths may not be brought under effective control in the future.

REFERENCE: Mezei L, Murinson BB. Pain Education in North American Medical Schools. J Pain. 2011(Dec);12(12):1199-1208 [abstract here].