The Importance of Pain-Control Education

The pain management concept is evolving, and medical professionals in the Texas Medical Center institutions are seeing to it that up-and-coming physicians and other health professionals are properly trained in this all-important subject.

Last year, American Pain Foundation figures estimated that 50 million Americans suffered from chronic pain. Out of this population, approximately 60 percent of cancer patients and 50 percent of post-surgery patients received inadequate pain relief. In January 2001, U.S. hospitals were required to implement new Joint Commission on Accreditation of Healthcare Organizations standards, which include requiring hospitals to regularly measure patients’ pain and provide proper pain relief, or risk losing their accreditation. Therefore, future physicians must be prepared for these workforce challenges awaiting them.

Dr. Martin Grabois, professor and chairman of the department of physical medicine and rehabilitation at Baylor College of Medicine, and Dr. Hui Ming Chang, associate professor and director of education in the department of palliative care and rehabilitation at The University of Texas M.D. Anderson Cancer Center, and associate vice president for international programs and special advisor to the president at The University of Texas Health Science Center at Houston, were the panel for the May 23 TMC Pain and Palliative Care Grand Rounds, where the topic was pain curriculum and courses for medical students. Both panelists are experts in the pain-control field, and serve on a statewide committee that has been working on a pain-control curriculum outline.

In 1995, the Texas legislature passed a bill which requires that each medical school in the state determine the extent to which pain treatment medical education course work meets specific instructional elements listed in the legislation, and determine the extent to which this course work is offered to all enrolled medical students. Results of a 1996 pain treatment survey led to complete documentation of pain learning opportunities for students at all eight Texas medical schools. It was estimated that pain treatment education comprised 7.5 percent of the medical schools’ four-year curriculum hours, which Dr. Grabois estimates as "a little high."

Conceptual curriculum topics include an introduction and overview; the definition of pain; ethical issues; medical, legal, and regulatory policy; biological sciences; social and behavioral sciences; classification of pain syndromes (adult and pediatric); clinical evaluation; management; and outcome measures.

The format for each topic is the same, and includes the goal, content and concepts, learning format, instructional resources and faculty needs. The goals of each topic are straightforward, and include detailed objectives; likewise for content and concepts. Learning formats range from lectures to panels, audio-visual mediums, case studies, and in some cases, mentored clinical evaluation. Instructional resources are mainly comprised of reading materials originating from papers, journals, and Web sites. Faculty needs vary from topic to topic, and require experienced professionals with training in each topic.

This model comprehensive curriculum outlines what pain management topics should be taught, but doesn’t dictate how to teach them, Dr. Grabois said.

Dr. Chang, who teaches elective courses on the effects of end-of-life palliative care and pain management, added that in addition to the proposed topics and format, it is important for students to have mentors and time to reflect on what they’ve seen, heard and learned.

"One of the problems in dealing with medical education," Dr. Grabois said, "is that most of the time, medical schools deal with pain as a symptom of a disease, instead of concentrating on pain treatment or evaluation."

This is due partly to senior physicians with their own ideas of how to manage pain – ideas that are continually passed down through the ranks, he said.

Dr. Chang concurred. In the past, she said, physicians were not educated on pain management, so it’s often hard for students to learn from today’s "seasoned" professionals.

"It is clear that pain training curriculum is inadequate," she said. "Pain terminology is not well defined, and people use ‘pain management,’ ‘symptom management,’ and ‘palliative care’ without knowledge of a clear definition."

Although it is not required that every medical student learn about pain and palliative care, Dr. Grabois said, the curriculum committee, made up of representatives from every medical and osteopathic school in Texas, concluded that pain curriculum should be required, versus elective.

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©2006 Texas Medical Center

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