Pain education in the United States and Canada is “lackluster” and unaddressed by the vast majority of medical schools, according to a Journal of Pain study. And unless steps are taken to improve the training of physicians who treat pain, researchers warn “the crisis in pain care and resultant deaths from opioid abuse will only spiral upwards.”
The study of 117 U.S. and Canadian medical schools found that less than 4% had a required course in pain and only one in six schools offered a pain elective. A large number of U.S. medical schools do not have any pain courses and many of those that do have less than five hours of classes. What’s more, many topics in the International Association for the Study of Pain’s core curriculum receive little or no coverage.
“Pain takes a very backseat course,” says Dr. Daniel Bennett, a Denver pain physician who is the Chief Medical Officer of American News Report. “Most discussions in medical school are about internal medicine or surgery or some other structural component with very little attention paid to pain. Universities don’t have the funds to fund it. Outside sources have not come in to say we’re willing to fund this. It’s a very short term view from both industry and universities.”
Pain affects more Americans than diabetes, coronary heart disease and cancer combined. The Institute for Medicine estimates that 100 million Americans suffer from chronic pain.
“In this country, for the largest reason that people seek medical care, which is pain, there is no residency available. There is no formal training for it outside of a year of fellowship. Compounding this, the population is aging. People have more and more pain issues. And there is less and less trained physicians available to meet those needs,” said Bennett.
“So care is not uniform. The public has no idea what they’re getting when they see a spine physician, when they see a pain physician. This is a huge problem. What you have in this country are a lot of physicians who are being forced to manage pain but doing it incorrectly.”
Bennett says the lack of pain education in medical schools makes physicians even more reliant on information and research funded by the pharmaceutical industry.
“But that’s not real training. That’s marketing. The majority of physicians understand pain drugs based on what the pharmaceutical rep tells them,” says Bennett. “So you have over prescription of opioids. You have overutilization of surgical devices. You have missed diagnoses.”
The Journal of Pain study concludes that a “sea change” is needed in the curriculum of medical schools to rectify the “lackluster state of pain education.”
“The more we come to know about what’s being taught in pain, the more glaringly obvious the gap between theory and practice becomes,” said study co-author Beth B. Murinson, MD, PhD, a director of pain education in the Department of Neurology at John Hopkins School of Medicine.
Studies related to pediatric pain, cancer pain, geriatric pain and opioid painkillers are particularly lacking, according to the study. “There’s literally almost nothing on these topics. Kids should not suffer needless pain. And, clearly, cancer patients should not endure untreated pain,” Murinson told Pain Medicine News.