Pain Education in North American Medical Schools

Knowledgeable and compassionate care regarding pain is a core responsibility of health professionals associated with better medical outcomes, improved quality of life, and lower healthcare costs. Education is an essential part of training healthcare providers to deliver conscientious pain care but little is known about whether medical school curricula meet educational needs. Using a novel systematic approach to assess educational content, we examined the curricula of Liaison Committee on Medical Education-accredited medical schools between August 2009 and February 2010. Our intent was to establish important benchmark values regarding pain education of future physicians during primary professional training. External validation was performed. Inclusion criteria required evidence of substantive participation in the curriculum management database of the Association of American Medical Colleges. A total of 117 U.S. and Canadian medical schools were included in the study. Approximately 80% of U.S. medical schools require 1 or more pain sessions. Among Canadian medical schools, 92% require pain sessions. Pain sessions are typically presented as part of general required courses. Median hours of instruction on pain topics for Canadian schools was twice the U.S. median. Many topics included in the International Association for the Study of Pain core curriculum received little or no coverage. There were no correlations between the types of pain education offered and school characteristics (eg, private versus public). We conclude that pain education for North American medical students is limited, variable, and often fragmentary. There is a need for innovative approaches and better integration of pain topics into medical school curricula.

Perspective

This study assessed the scope and scale of pain education programs in U.S. and Canadian medical schools. Significant gaps between recommended pain curricula and documented educational content were identified. In short, pain education was limited and fragmentary. Innovative and integrated pain education in primary medical education is needed.     

Interprofessional Pain Curriculum for an Academic Health Science Center

AIMThe aim of this project is to develop a comprehensive pain curriculum to educate a diverse group of students across health care disciplines who care for those in pain. The outcome goals for participants of this educational program are to have increased knowledge and skills associated with the management of pain. This poster will describe the process of team development, development of the grant proposal, conducting a gap analysis, designing and developing the content of the program, and finally the integration of technology as we prepare for program delivery.METHODSThe team developing the program include representatives from the disciplines of nursing, physical therapy, social work, and psychology. The curriculum is based on the Interprofessional Pain Curriculum developed by the International Association for the Study of Pain. Holographic technology will be used to optimize participant engagement and interest. Additional modes of content delivery include synchronous video meetings, asynchronous discussions, and the use of case studies in both modes, all completed in multidisciplinary teams.RESULTSContent has been developed and loaded into a Canvas course shell. Delivering parts of the program via hologram technology will be recorded within the next 3 months.CONCLUSIONSThis content will be delivered to student groups in the Spring 2023 semester during an Interprofessional Education (IPE) event focused on the management of pain. Health disciplines represented at the IPE event will include Medicine, Nursing, Physical Therapy, Psychology, Social Work, and Pharmacy. Outcome assessments related to knowledge, beliefs and attitudes about pain from IPE participants will be collected. Based on that data, further tweaking of the education program will be considered.ACKNOWLEDGEMENTThis project was made possible through funding from the Elizabeth Morse Genius Foundation, Grant number: AWD00001443     

Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom

BackgroundPain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering.Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management.DesignA three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool.ResultsThe word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes.ConclusionIn spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary patient suffering will continue. Undergraduate nurse education in the UK needs to review its current approach to content and ensure that pain is appropriately and prominently featured within pre-registration nurse education.     

Pain Prevalence,Pain Management,and the Need for Pain Education in Healthcare Undergraduates

BackgroundPain is a common health problem in undergraduate students. Pain prevalence, pain management strategies and knowledge among healthcare groups has not been revealed yet.AimThis study explored pain prevalence, intensity, pain management strategies, knowledge, and education in undergraduate students specializing in healthcare science. The findings will highlight the necessity for increasing pain management education in the university setting.DesignA questionnaire-based, cross-sectional study was conducted.Settings/ ParticipantsData was collected from 1,490 university students in Tokyo between December 2015 and April 2016. A χ square test was performed to examine differences in pain status and management strategies according to gender. We compared medical knowledge scores among disciplines using one-way analysis of variance.ResultsIn total, 511 (79.2%) students had experienced bodily pain during the preceding 6 months. Pain prevalence differed by gender. More nursing students had used both pharmacological and nonpharmacological methods for pain management than had students from other disciplines (p = .011). Pain medication knowledge of students in other disciplines was low to moderate, with greater knowledge observed in medical students (p < .05).ConclusionsEducation regarding pain management should be developed that considers differences among disciplines. Additionally, poor pain management knowledge could affect the quality of care students provide to patients after graduation. Enhancing pain management knowledge by providing suitable pain management education in universities may contribute to better pain management for students, and this may translate to their work in clinical settings.     

League against pain: an experiment in extracurricular teaching

Although anatomical and physiological base of pain are subject of the basic sciences in health undergraduate curriculum, it is not usually to have pain concepts and therapy into undergraduate programs. Describing the League Against Pain objectives and organization and the students' opinions about their participation in this league were the aim of this study. The League Against Pain Statute was consulted to describe its objectives and organization. The opinions of all of the students that attended the League Against Pain program in 1995 and 1996 were investigated. The League Against Pain was organized at an university hospital in 1995. It is composed by nurses and medical students and professionals (physicians in varied specialties and nurses). All the activities are voluntary and the students are the managers of the League. The objectives of the League are: improving the quality of teaching of pain subjects in nursing and medical schools; developing research in epidemiological, clinical and therapeutics aspects of pain and to promote a model of multidisciplinary and multiprofessional assistance. The most frequent students' opinions about their participation in the League were: their abilities in pain control and in professional and client relationship were improved; they achieved their objectives; that pain should be included into undergraduate courses; and they would recommend the League for other students. The results are promising. The students' opinions about their experience in the League Against Pain have showed that the League Against Pain could be an usefull model to introduce pain subjects to undergraduate nursing and medical students.     

Development and Initial Evaluation of Psychometric Properties of a Pain Competence Assessment Tool (PCAT)

Competency-based education is now considered the best approach for pain educational programs provided for pre and postgraduate healthcare providers (HCPs). To demonstrate learners’ progression, an assessment tool that aligns with this educational approach and targets different HCPs is needed. A Pain Competence Assessment Tool (PCAT) was developed based on the pain management core competencies that align with the International Association for the Study of Pain interprofessional pain curriculum. The PCAT is an online competency-based assessment tool for HCPs that consists of 5 case scenarios followed by 17 key-feature questions. HCPs and trainees completed the PCAT through a series of studies to assess its psychometric properties. The preliminary evaluation suggested that the PCAT had adequate content validity. Apart from 6 questions, the PCAT questions demonstrated homogeneity and acceptable reliability, and substantial stability. No ceiling or floor effect was found. A significant difference was detected between the HCPs' and trainees’ scores. The PCAT scores strongly correlated with other variables reflecting different competence levels. The PCAT scores showed significant changes in the baseline scores compared to scores after attending an educational intervention. The PCAT offers a first-of-its-kind tool for assessing HCPs' competence (ie, knowledge and its application) in managing chronic pain. Future research is needed for further validation and adaptation of the PCAT.PerspectiveThe Pain Competence Assessment Tool (PCAT) offers a first-of-its-kind tool for assessing clinicians' core competencies that overlap between different professions and support the clinicians’ capacity to successfully manage chronic pain in the real world focusing on the patient-centered perspective rather than the profession-specific perspective.     

Pain management in nursing procedures on premature babies

BACKGROUND: Pain can be caused to premature babies when nursing and other procedures are carried out. Procedural pain management for these babies raises challenging questions for health care professionals. Optimal pain management for premature babies can be reached by using and further developing existing pharmacological and non-pharmacological pain alleviation methods for procedural pain before, during, and after procedures. AIMS: The aims of this study were to describe the environment of pain management in nursing procedures and examinations with premature babies; to describe preparation of the baby for the procedure; to describe non-pharmacological pain alleviation methods during and after the procedures; and to develop a process describing procedural pain management in premature babies. METHOD: The material for this study consisted of journal articles on non-pharmacological procedural pain alleviation in infants published between 1994 and 2002. During this period knowledge of pain management in premature babies has improved considerably. The study was based on the method of content analysis. FINDINGS: Procedural pain management in premature babies was described by researchers as a process comprising: (1) an environment that is favourable to effective pain management, (2) safe preparation of the baby for the procedure, (3) pain alleviation during the procedure, and (4) restoring the baby's sense of security after the procedure. Pain management is recommended to be used alone or together with pharmacological interventions. Additionally, systematic pain management requires documentation of the whole pain management process. CONCLUSION: Pain management can be described as a process. It is important to test and assess this process and individual non-pharmacological pain management methods in practical nursing situations. The findings of this review can be used to improve pain management methods in premature babies.     

Research Agenda for the Prevention of Pain and Its Impact: Report of the Work Group on the Prevention of Acute and Chronic Pain of the Federal Pain Research Strategy

After the 2011 Institute of Medicine report on chronic pain, the Interagency Pain Research Coordinating Committee (IPRCC) was created to enhance research efforts among federal agencies. The IPRCC and Office of Pain Policy at the National Institutes of Health collaborated to identify gaps in knowledge and address them via a Federal Pain Research Strategy (FPRS). Interdisciplinary work groups (WGs) were established to make research recommendations in 5 areas: prevention of acute and chronic pain, acute pain and acute pain management, transition from acute to chronic pain, chronic pain and chronic pain management, and disparities in pain and pain care; cross-cutting issues were also considered. The objective was to provide guidance on current research and to make recommendations about addressing identified gaps. Findings from the Prevention of Acute and Chronic Pain WG are summarized in this article. The WG created subgroups to develop recommendations on specific aspects of prevention of acute and chronic pain, including: public education, primary prevention, secondary prevention, tertiary prevention, transition from acute to chronic pain, and cross-cutting mediators. No formal literature review was conducted; however, external advisors were available and consulted as needed. Seven key research priorities were identified. The one deemed “greatest near-term value” was to optimize public health strategies to educate patients on managing pain; that deemed “most impactful” was to determine an association between patient and intervention factors. Other recommendations were related to the epidemiology of acute pain from health care procedures, the epidemiology of acute pain from work-related injuries, safety and effectiveness of management of pain associated with health care procedures, optimizing approaches to acute postsurgical pain, and safety and effectiveness of early interventions for tertiary prevention. Stakeholders, including federally sponsored research programs, researchers, health care providers, policy makers, patients, and others should work together to implement recommendations and address important gaps.

Acute Pain in Undergraduate Medical Education: An Unfinished Chapter!

Inadequately treated acute pain is a global healthcare problem that causes significant patient suffering and disability, risk of chronicity, increased resource utilization, and escalating healthcare costs. Compounding the problem is the lack of adequate instruction in acute pain management available in medical schools worldwide. Incorporating acute pain diagnosis and management as an integral part of the medical school curriculum will allow physicians to develop a more comprehensive, compassionate approach to treating patients with acute pain syndromes and should be considered a healthcare imperative. In this article, we review the current status of pain education in educational institutions across the world, focusing on achievements, lacunae, and inadequacies. We appeal to all concerned—pain management specialists, health educators, and policymakers—to consider incorporating education on acute pain and its management at undergraduate medical levels in an integrated manner.     

Palliation of Pain in Advanced Oral Cancer

SYNOPSIS
Pain is a severe symptom in advanced oral cancer. Pain is often aggravated by the anxiety induced by visible oral cancer. Unless the primary and regional disease are controlled, nothing substantial in terms of pain relief can be achieved in advanced oral cancer by methods like radiotherapy, surgery or chemotherapy. However, additional treatments such as adequate medical and psychological management may result in considerable alleviation of pain. This article emphasizes the need for more organised education of health professionals, research and publications in cancer pain relief. It also underlines the importance of adequate medical and psychological management to alleviate pain from cancer.     

Pain Management in Current Combat Operations

Pain management in the U.S. Military, particularly in combat, shares many of the same principles found in civilian heath care organizations andinstitutions. Pain is one of the most common reasons for which soldiers seek medical attention in the combat environment, which mirrors the civilian experience. However, the combat environment exacerbates the typical challenges found in treating acute pain andhas the additional obstacles of a lack of supplies andequipment, delayed or prolonged evacuation times anddistances, devastating injuries, provider inexperience, anddangerous tactical situations. These factors contribute to the difficulty in controlling a soldier's pain in combat. Furthermore, civilian health care providers have also learned the importance of practicing pain management principles in austere andtactical environments because of recent natural andman-made domestic disasters. Pain management research, education, andtreatment strategies have been created to try to achieve adequate battlefield analgesia, andthese lessons learned may aid civilian health care providers if the circumstances arise. This article presents a brief history andcurrent overview of pain management for combat casualties on today's battlefield. Recent natural disasters andincreased threats for terrorist acts have proven the need for civilian health care providers to be properly trained in pain management principles in an austere or tactical environment     

Developing Effective Cancer Pain Education Programs

Pain is prevalent, burdensome, and undertreated in individuals with cancer across the disease trajectory. Providing patients and family caregivers with psychosocial support and education to manage cancer pain is a core component of quality care that can result in significant clinical benefit. In this review, we: (1) outline an approach for developing and assessing the effectiveness of education programs for adults with cancer pain; (2) discuss considerations for tailoring programs to the needs of diverse populations and those with limited health literacy skills; (3) describe the resource needs and costs of developing a program; (4) highlight innovative approaches to cancer pain education. We conclude with recommendations for future research and the next generation of educational interventions.     

Examination of Knowledge About and Nursing Interventions for the Care of Patients in Pain of Nurses Who Work at Çukurova University Medical Faculty Balcali Hospital

Pain is a concept that goes back into distant history and is something that is faced by every person in different degrees and at different times in their lives. A definition of pain, adopted by the International Association for the Study of Pain and the American Pain Society, is: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Although pain is one of the most common reasons for needing health care, it is not well understood and continues to be one of the most important health problems today. The pain experience is dynamic, and the nurse is responsible for understanding this. Nurses need to cooperate with the patient and other members of the health care team to be able to control pain. Nurses are ethically responsible for the management and easing of pain. This study was conducted to investigate what nurses know about the care of patients in pain and what nursing actions are used. There were 198 nurses working day shift at Çukurova University Balcali Hospital who were included. The data were collected using a questionnaire that described the nurses and measured the nurses' knowledge about care. The mean age of the nurses was 30.89 years, they had a mean 12.0 years of experience in the profession, 52.0% did not have experience with chronic pain, 42.4% stated that they frequently encountered patients in pain, 70.2% had received education about pain in school, 88.4% had not received education about pain outside of school and did not read about pain in journals, 88.9% used pharmacologic management, 85.4% evaluated patients' pain based on verbal statements, 96.5% knew the important points in the use of opioid analgesics, and 3% knew pain theory. As a result of this study, it is seen that nurses have inadequate knowledge about care of patients in pain and pain control methods. After evaluation of the conclusions, they will be used in education to increase the quality of the nursing care.     

Pain related undergraduate teaching in medical faculties in Finland

The present questionnaire study was conducted to examine how teachers in all Finnish medical faculties have included pain teaching in their courses for undergraduate medical students. The study was planned to compare the existing education in Finland with the IASP curriculum on pain for medical schools. In 1991 and 1995 the questionnaire was sent to a total of 135 and 130 university teachers, respectively. The teachers were asked about the quantity and quality of their pain teaching. Teachers' attitudes on pain related teaching were also examined. A Finnish translation of the IASP curriculum was provided, and university teachers were asked to evaluate it and compare it with their current teaching. The educational programs of all universities were also analyzed. After completion of these surveys, representatives of teachers responsible for teaching of pain, and of medical students from all Finnish medical faculties were invited to a meeting to discuss methods for improving and developing education. Completed questionnaires were received from 107 university teachers (78%) in 1991 and from 74 (60%) in 1995. No printed curricula for pain education were found in any university and in all universities pain teaching was provided in an inconsistent way. There were differences, yet statistically non-significant, between the faculties in the pain teaching. No major differences were observed between the two questionnaires. A serious lack of teaching in psychology of pain was a general finding. University teachers were found to have positive attitudes towards developing their teaching of pain. The IASP curriculum has not been fully followed but was considered a valuable tool in planning the educational programs. The curriculum should be distributed directly to the governmental bodies of the universities, since individual university teachers are not necessarily familiar with it. Local associations may have an important role in this distribution as we have shown. This report shows the necessity of changing the attitudes of university teachers providing concrete teaching programs for pain. A multimedia package of pain containing references, video tapes and cd-discs produced by a workshop of IASP would certainly be welcome.     

App-Based Pain Management and Opioid Education Program for Patients in Clinic Waiting Rooms

BackgroundBest approaches to delivering patient education related to pain management and opioid safety are understudied.AimsThis study assessed the feasibility, acceptability, and preliminary patient-reported impact of an app-based patient pain education program.DesignPilot study with data collection occurring on 43 weekdays between August 2019-February 2020.SettingWaiting rooms at the pain clinic and a primary care medical home within two military treatment facilities.ParticipantsMilitary health system beneficiaries seeking general care at the primary care medical home or pain-specific care at the pain clinic.MethodsThe Joint Pain Education and Project curriculum includes patient-focused videos describing the biopsychosocial aspects of pain and pain management, medication take-back and safe disposal, and multidimensional pain assessments. The app-based videos were available on tablets in the waiting rooms for patients to view and complete surveys on after.ResultsOverall, 152 patients viewed the videos and completed surveys. Most viewers were interested in receiving other tablet-based health education while in the waiting room (62%). Most viewers found videos to be moderately or very helpful (73%) and were satisfied or very satisfied with the information provided (85%). Participants at the primary care medical home were more likely to find videos helpful compared to participants at the pain clinic (OR = 2.11; 95% CI: 1.07, 4.20; p = .03).ConclusionImplementing app-based pain management education is feasible across clinic settings and is well received by patients. Clinics should consider providing pain education across care setting, rather than just pain specialty clinics, to help foster discussions between clinicians and patients regarding pain management and opioid safety.     

Key Learning Statements for Persistent Pain Education: An Iterative Analysis of Consumer,Clinician and Researcher Perspectives and Development of Public Messaging

Over the last decade, the content, delivery and media of pain education have been adjusted in line with scientific discovery in pain and educational sciences, and in line with consumer perspectives. This paper describes a decade-long process of exploring consumer perspectives on pain science education concepts to inform clinician-derived educational updates (undertaken by the authors). Data were collected as part of a quality audit via a series of online surveys in which consent (non-specific) was obtained from consumers for their data to be used in published research. Consumers who presented for care for a persistent pain condition and were treated with a pain science education informed approach were invited to provide anonymous feedback about their current health status and pain journey experience 6, 12 or 18 months after initial assessment. Two-hundred eighteen consumers reported improvement in health status at follow-up. Results of the surveys from 3 cohorts of consumers that reported improvement were used to generate iterative versions of ‘Key Learning Statements’. Early iteration of these Key Learning Statements was used to inform the development of Target Concepts and associated community-targeted pain education resources for use in public health and health professional workforce capacity building initiatives.PerspectiveThis paper reflects an explicit interest in the insights of people who have been challenged by persistent pain and then recovered, to improve pain care. Identifying pain science concepts that consumers valued learning provided valuable information to inform resources for clinical interactions and community-targeted pain education campaigns.