Future Doctors Unprepared to Manage Pain

The lack of adequate training in pain management has long been an issue in U.S. and Canadian medical schools – a problem that also exists in Europe.

A new survey of 242 undergraduate medical schools in 15 European countries found that medical students only receive an average of 12 hours of training in pain management during their entire six-year degree program. That translates to just 0.2 percent of the teaching medical students receive during their undergraduate studies.


The APPEAL (Advancing the Provision of Pain Education and Learning) study also found that 82% of the medical schools have no dedicated courses on pain that are compulsory for students.  The study was presented at the annual Congress of the European Pain Federation, in Florence, Italy.

“With the exception of France and a handful of schools in other countries, which have made headway in the provision of pain teaching, there is a striking lack of dedicated teaching on pain across Europe,” said Dr. Emma Briggs, a lecturer at King’s College London and Chair of the British Pain Society Pain Education Special Interest Group.

“This raises the question as to whether the provision of pain education in undergraduate medical studies is fit for purpose to address the current and growing unmet public health need.”

Researchers say that almost two-thirds (62%) of undergraduate medical schools offer pain teaching only within other subjects, and that those subjects vary across schools.

Moreover, nearly one out of four of medical schools that offer compulsory courses on pain don’t even document pain topics on the curriculum, making it difficult to assess where and how pain teaching is included in other subjects.

“A lack of knowledge about pain among physicians has long been recognized as a key barrier to effective pain treatment and management,” said Professor Hans G. Kress, President of the European Pain Federation.

“This study shows us that, at best, we are educating our medical students for only 0.2 percent of their studies on how to deal with one of the most frequent problems they will encounter in medical practice.”

That lack of knowledge has a financial consequence for patients, healthcare systems, and national economies. The cost of under diagnosed and under-treated chronic pain accounts for between 3 and 10 percent of a country’s Gross Domestic Product.

Based on those findings, members of the APPEAL task force are calling on medical schools, pain specialists, medical students and policymakers to ensure that pain education for undergraduate medical students sufficiently addresses the need to manage and treat pain.

Among their recommendations:

  • The establishment of a European framework for pain education, developed jointly by pain specialists and educators to ensure consistency in pain teaching in medical schools.
  • The introduction of compulsory pain teaching for all undergraduate medical students to enable them to acquire a defined minimum level of competency in pain management.
  • Improved documentation of pain teaching within the undergraduate medical curriculum, with clearly stated teaching content and defined student competencies in pain.

A 2012 study published in the Journal of Pain found pain education in the U.S. and Canada “lackluster” and unaddressed by the vast majority of medical schools. It warned that unless steps are taken to improve the training of physicians who treat pain, “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. Most provided only a few core topics on pain; with cancer pain, pediatric pain and geriatric pain essentially ignored by most medical schools.

Surveys have found that most primary care physicians feel “inadequately prepared” to counsel patients on pain. Fewer than 4,000 pain specialists are currently practicing in the U.S.