Conflicting Guidelines Lead to Significant Differences in How Chronic Pain Is Treated

Conflicting Guidelines Lead to Significant Differences in How Chronic Pain Is Treated

Chronic pain treatment guidelines are “unclear and conflicting,” according to authors of a new research published in BMC Medical Education.  

The study looked at 35 medical students and 50 physicians, and their treatment decisions for 16 computer-simulated patients with chronic pain. The purpose of this study was to examine factors that reportedly influence providers’ chronic pain treatment decisions. A secondary aim was to examine differences across participant training level.

Frequency analyses indicated that most participants reported using patients’ pain histories (97.6 %) and pain description (95.3 %) when making treatment decisions, and they would have used information about patients’ previous treatments (97.6 %) and average and current pain ratings (96.5 %) had this information been available. Compared to physicians, medical students endorsed more frequently that they would have used patients’ employment and/or disability status (p < 0.05).   

A greater proportion of medical students wanted information on patients’ use of illicit drugs, alcohol and employment / disability status to make treatment decisions, while a greater proportion of physicians reported using personal experience to inform their decisions.

“These results highlight the complexity of chronic pain care and suggest a need for more chronic pain education aimed at medical students and practicing providers,” the authors reported.

They found that the conflicting treatment guidelines contributes to inconsistent pain care.

“In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions,” the authors stated.

This was one of the first investigations to examine the factors that medical students and physicians report using to make chronic pain treatment decisions.

This study highlights the complexity of chronic pain management and suggests a need for medical and continuing education efforts to more strongly focus on systematic, evidence-based clinical decision-making in this context.

The study, Examining influential factors in providers’ chronic pain treatment decisions: a comparison of physicians and medical students, was authored by Nicole A. Hollingshead, Samantha Meints, Stephanie K. Middleton, Charnelle A. Free and Adam T. Hirsh.

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Authored by: Staff

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My thoughts are, what are medical students actually learning about all of these “new” issues during their medical training! Unfortunately, chronic pain is not new for those of us who have been suffering for years trying to find the right combination of meds to at least “dull” the pain a bit so you can live a little in this big world of ours! I never go to the ER for pain because they either look at me with a blank stare or they just don’t understand that we use higher dosages for pain and all they can give is like 1mg of Dilaudid per hour. That’s just not enough to control our pain. I was on 4mg Dilaudid pills that I took and that wasn’t even enough and I didn’t like it so we switched to another combo. And it’s a bit hard to get a full physical/verbal exam from a chronic pain patient because we just want relief! But we are looked at like drug seekers, so no ER for me. I will only go to Dr.s that know at least a little bit about my genetic disease, but it looks like I’m going to have to head out East to get the real help I need and I can’t afford it!

Diane Succio

Yes after 6 surgeries and going to pain Dr. I finally had enough and had to go off on his PA just to listen to me. I am more than a file number. I am a human being who listened to every Surgeon and now have little to no feeling in my leg and constant pain in my lower back. I am so over all of them, I submit to random drug testing that I must pay for our of pocket.


That certainly explains why a person must dump a number of clueless doctors, before finding the one who knows what he’s doing. It’s not all in your head–they really are that ignorant.