The Continuing Need for Pain Education
In an editorial about “the distressed chronic pain practitioner (DCPP)” David C. Greenberg, MD, MPH1 writes that DCPPs were “physicians willing to sell prescriptions for controlled substances without bothering to obtain a history and work up the patient’s complaint, perform a physical exam, arrive at a proper diagnosis, utilize testing or consultation, choose a rational treatment plan or properly monitor their patients...” DCPPs are “self-declared experts in chronic pain medicine…with no formal training in chronic pain medicine or any history of studying under a qualified mentor in a prolonged clinical fashion…lacking any sort of comprehensive CME participation in recognized chronic pain educational programs…not belonging to professional pain treatment organizations and…not reading recognized current textbooks or journals regarding chronic pain.” Finally, for most DCPPs “it appears that...their main source of chronic pain diagnostic and treatment information is limited to what is supplied by pharmaceutical industry representatives and their patients.”
This chilling and rather disparaging editorial by Dr. Greenberg suggests that the failure to be properly trained in pain management, to only rely upon proprietary pharmaceutical information, and to not maintain basic currency in pain therapeutics endangers the public’s health, safety and welfare. Dr. Greenberg’s closing statement is simply that “…physicians and other stakeholders need to seriously deal with prescription abuse and diversion or the government will do it. The medical profession must better train and police itself...to avoid being forced to take many giant steps backward into a setting where chronic pain patients were undertreated, ignored, shamed, or labeled as hypochondriacs and malingerers.”
The remedy for the DCPP is appropriate pain-related education. After 30 years as a professional discipline, pain management/medicine has its own pain-related core curricula for healthcare practitioners, provides many learning opportunities for practitioners of all levels and backgrounds, and has several professional publications. The International Association for the Study of Pain has a standardized curriculum about pain for healthcare professionals. The American Pain Society, American Academy of Pain Medicine, and American Academy of Pain Management offer annual conferences providing up-to-date information about pain research, pain practice, and multidisciplinary pain management. The Society for Pain Practice Management, American Society of Interventional Pain Physicians, American Society of Region Anesthesia and Pain Medicine provide hands-on training for physicians wanting to learn specific techniques. The American Society of Pain Educators trains healthcare professionals to become professional educators. Numerous publications, including Practical Pain Management, disseminate information about pain-related diagnostics, therapeutics, evolving regulatory challenges, and more. Together, in the U.S. alone, there are annually more than a dozen major national learning opportunities, dozens of smaller regional meetings, hundreds of articles, thousands of “one off” programs, and ultimately no excuse for anyone to be a DCPP.
Collectively, those who provide frontline pain management services must challenge those who “casually” provide similar services to become more professional, more knowledgeable, and to do more to see pain practice as a serious endeavor, not just the prescribing of more medication for those requesting it. The development of any new area takes time, the presence of a few charismatic leaders, and then adoption by others. As members of a thirty-year old profession—with ABMS recognition as a distinct area of sub-specialization—those of us who are pain practitioners must now do our part to reach out to our colleagues in other areas of medicine and help them learn more about what we do, uphold the same standards of care (especially when prescribing controlled substances for the treatment of pain), and continue the professional development of pain management/medicine.
The remedy for most issues related to the practice of pain medicine will not be more governmental regulations and rules — or punitive action against the occasional “bad apple” — but, instead, will lie in the hands of those serving as pain educators. These include Deans of Curriculum at our medical schools, Program Directors for all residency programs, Directors of Education for pain and primary care organizations, and the commitment of the thousands of dedicated pain physicians and other pain practitioners who deliver care to those who suffer. Clearly, those providing appropriate pain-related therapeutics will become the best pain educators and sharing their expertise with others will be—rather than act of self-promotion—an act of mutual preservation and protection against all the challenges that we face today.
Since most healthcare providers were not formally trained to be healthcare educators, those planning to serve as pain educators in the future must now seek special learning opportunities to be effective. Pain Week 2007 will be the “first of its kind” meeting to blend teaching skills and techniques (the Pain Educators Forum) with primary care-tailored knowledge about pain and its management (the Fundamentals of Pain Medicine), along with other significant symposia to create “one stop” learning for those interested in being part of the solution. It is expected that by the end of Pain Week 2007 those who might be potentially “distressed” will be enlightened, while those already knowledgeable will be enthused about teaching what they know to others.
Collectively, we can seriously deal with prescription abuse and diversion, without the need for draconian measures. The medical profession must better train and police its members and never be forced to take many giant steps backward into a setting where chronic pain patients are under-treated, ignored, shamed or labeled as hypochondriacs and malingerers. The promise of pain education is to improve patient care across the board and to prepare a generation of leaders for the profession of pain management/medicine.