The Problem of Pain Education

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Chronic pain is the most common reason for doctor’s visits in the US. Despite that, most doctors do not get proficient training in chronic pain care. Our CEO Mika Marjalaakso wrote about how chronic pain care is broken. However, the problem runs deeper. It starts already in the medical schools. Because of this, we’ll use this post to take a look at the problem of pain education in US medical schools.

The state of pain education today

According to a study of 104 medical schools in the US, only 4 had a required pain course (https://www.jpain.org/article/S1526-5900(11)00646-8/fulltext). Most medical schools teach pain as a subsection of a general required course, not as an independent topic. In total, the average number of hours of pain education in US medical schools is 11 (the median being 9 and the mode 4).

Not only do most medical schools address pain as subsections of general required courses, they also focus mainly on biomedical approaches. In other words with medication as the main mode of care. Chronic pain is much more than a physical experience that can be cured with a biomedical approach.

The shortcomings of the biomedical approach

I was lucky enough to get a chance to sit down with Dr. Michael Schatman. He shared his thoughts on pain education in US medical schools with me. Dr. Schatman is a trained clinical psychologist who’s been working with pain medicine for the last 35 years. He is also the Editor-in Chief of the Journal of Pain Research.

The one topic our conversation kept coming back to was that of the short comings of a biomedical approach to chronic pain care. In other words, medications alone do not cut it. Dr. Schatman noted insightfully that nowadays many things have become polarized, including chronic pain care. He says it seems you have to be either pro-opioids or anti-opioids. He is neither, instead he is pro-patients, meaning he thinks opioids have a role to play in chronic pain care but shouldn’t necessarily be the first line of treatment.

I inquired what he sees as the answer, if a purely biomedical approach doesn’t cut it. What needs to change? Dr. Schatman did not hesitate on this. He explains we need interdisciplinary teams that can treat each patient with a biopsychosocial approach.

Dr. Schatman on some of the problems of pain education today.

An interdisciplinary approach to pain education

To say that chronic pain is complex is definitely to state the obvious. Chronic pain affects every single aspect of a person’s life. It affects not only what they can or cannot do, but also how they feel about themselves, how they relate to others, and how they see the world around them. Prescribing medications only targets a small section of the chronic pain experience. Other approaches are needed as well, and for this reason an interdisciplinary approach is the answer.

Most medical schools address pain as a subsection of general required courses. Because of this students come out with a fragmented view of what pain is. Dr. Schatman says students lack a big-picture understanding of the complexities of pain. To improve pain education he suggests pain should be taught as an entity of its own. That way students could learn about the continuum of pain from acute to chronic. They should also bring in experts from different fields help students build a 360 degree understanding of pain and how it should be treated. Dr. Schatman himself has developed programs like this in for instance Harrisburg, Pennsylvania. While heavily educational, the program was also physical. The staff included physicians, psychologists, nurses, physical and occupational therapists, biofeedback therapists, and a vocational counselor.

Luckily there are some US medical schools that have programs that teach chronic pain care with an interdisciplinary approach. Namely at the Mayo Clinic, Cleveland Clinic, and the Haley Veteran’s Administration (VA) hospital in Tampa, Florida. Unfortunately the number of programs such as these have been decreasing since the 1990s. Dr. Schatman says that a study published in 1999 indicated that there were over 1000 programs in the country. Now, it is down to fewer than 30. Curiously, this decrease of programs coincides with the increase of opioid prescriptions.

How to effectively distribute care to those who need it

While interdisciplinary pain clinics are certainly needed they might not always be accessible enough. People living in remote or small towns face obstacles accessing this kind of treatment. The Aivo Program is one solution to this. Our program operates from the kind of interdisciplinary approach Dr. Schatman argues for. In addition it is accessible regardless of physical location as it is delivered over a mobile app. Our team evaluates the data of each participant and personalizes the program to fit their needs. This is the future of chronic pain care.

My warmest gratitude goes to Dr. Schatman for taking the time to talk to me. To learn more about his work you can follow him on Twitter under @headdock.

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