World Congress on Pain comes to you. 5: Innovative Approaches to Pain Education

Dr Eloise Carr (University of Calgary), Chair of the IASP Pain Education SIG coordinated the session “Innovative Approaches to Pain Education”. The goal of this session was to provide an update of the challenges and ongoing efforts of improving the consistency and accuracy of pain education in medical programs worldwide. Dr Carr, Dr Briggs, Dr Morinson and Dr Kopf defended the position that current pain education in medical programs is inadequate; it lacks consistency and is without a standard competency regarding the materials provided or the accuracy of the information.

Dr Andreas Kopf (Benjamin Franklin Pain Management Centre, Berlin) presented the “3 Sad Realities”: barriers to interprofessional and international pain research and education.

  • Poor pain management education in medical schools around the world
  • 90% of postgraduate physicians report no adequate training in pain
  • Essential medical deficits (inaccurate education)

Dr Kopf discussed the additional challenges of a lack of motivation by physicians and students, a lack of institutional priority for pain education and management, and a hierarchical resistance to change at an institutional level. The solution: dedicate more time to education at all levels, beginning with medical schools and provide mandatory pain education with support and access to quality materials [1].

Dr Beth Morrison (Center for Excellence in Pain Education, Baltimore) outlined the need for pain education to address both the affective and sensory components of pain, emphasizing that both understanding and providing pain education is challenging for medical students. How do we change the understanding and discussion around pain? We need motivated providers that are emotionally prepared to understand pain as it is experienced by their patients. This should lead to patients who feel they’ve been heard – an important component in developing the connection clinically with your patient. Dr Morrison stated, “Patients who feel they are understood are more likely to respond to education and comply with recommendations”.

Emotional development in the health care provider is likely to be an important part of becoming a successful pain sciences educator. But can empathy be taught? Dr Emma Briggs of Kings College London is working on it – “the whole purpose of education is to turn mirrors into windows to be able to see into others.” Dr Briggs aims to develop interprofessional education with an emphasis on “learning with, from and about each other”, with the patient remaining at the center. (Students get to spend some time understanding what pain is – she has them put chick peas in their shoes and walk around for a while).

The IASP Pain Education SIG is dedicated to establishing consistency and accuracy around pain education. It is an important goal and one that hopefully will help with the last challenge mentioned in the presentation – a challenge that faces the well educated health professional who leaves a program armed with current pain science, educational ideas and research, only to go into a setting with practitioners who practice in conflict with current pain education and have little to no interest to change. This is a recipe for frustration and burnout, and one that ultimately leaves the public lacking properly trained providers.

A quick poll of those around me following this session (N=3) revealed that in their experience (Australia, Canada and UK) there is awareness of the need to educate both professionals and the public about pain, but while they were aware of various models of pain education, they felt all models are challenging for health professionals to use. One health practitioner told me that in pelvic health particularly a model of pain education does not exist. I know better – it does, and I take that as a personal challenge to get better at the education of professionals and the public alike!

My favorite part of the talk? This quote:

“The way we do things is not the only way to do things, particularly as there is a lack of evidence”. Dr Emma Briggs

About Sandy Hilton

Sandy Hilton PhysiotherapistSandy is a physical therapist with a private practice in Lincoln Park – Chicago, USA.  She is incurably curious about how much of the latest pain research can be applied in the clinical treatment of people suffering from persistent pelvic pain.  In her spare time she hits the stand-up comedy open mics in Chicago, surprising audiences with tidbits about sex, pain and pelvic health.

Reference

  1. Guide to Pain Management in Low Resource Settings – free PDF

 

 

Comments

  1. Bronwyn, John and all the conference speakers: so great to see that human centred care is being brought in from all angles. I think that things are changing, even if empathy and sensitivity can be beaten out of young health practitioners once they are surrounded by the old ways.

    Promisingly (and curiously) a lot of health practitioners of all ages came to a workshop I ran for The School of Life called How to Make a Difference. They all saw limited potential to really contribute to people’s lives while working in mainstream care and were exploring different models of being of service. For some this is setting up their own clinic or teaming up with social health providers. Many were curious about models for social enterprise.

    So I think as health care providers look beyond traditional models of delivery, we’ll see innovation in the way we provide, receive and contribute to health care.

  2. Hi Sandy,

    Thanks for the summary.

    I feel like the much of the material presented has already been described in great detail by various authors/practitioners. For example, the 3 points Dr Briggs mentioned here – mirroring, empathy and emotional development…. these are very old concepts which have already been thoroughly researched. I’d like to see people give the proper credit to those who did the hard yards decades ago and not give the impression “we are just starting to understand..”, because the material is already published and freely available.

    The problem about ‘getting the news out’ on pain education is not just one of exposure, I’ve decided. Anyone who has presented such material to colleagues will know what I mean. There is a very powerful resistance to the idea that the mind is the primary process involved with pain. Dig down and you will see that this resistance has everything to do with feelings of personal power, control and wealth accumulation (on the part of the therapist).

    I think we could look at models of change with regard to religion and other belief systems. Religious beliefs can give us a feeling of safety and specialness – no wonder they are guarded so ferociously. The old biomedical model is the same. It can’t be fought directly. We need to be smarter than that.

    EG

  3. john Quintner says

    Sandy, this is a hugely important topic for discussion. In Western Australia we have been making what we hope will be a worthwhile contribution to health professional education. Funding has been an issue and but for the support of Arthritis and Osteoporosis WA, we would not have been able to offer these workshops. Our aim is to run two each year.

    Link: https://www.arthritiswa.org.au/news/view/making-sense-of-pain-workshop.html

  4. Go Sandy! I teach 5th year medical students, I’m fortunate to have two one hour sessions with them. They have an assignment where I ask them to use a semi-structured interview to help them understand the person’s perspective and to identify psychosocial risk factors. Many of them say it’s the first time they’ve had time to listen to the person’s pain story. Many of them are astonished to find that what they assumed to know about pain (and thought patients would have been told) is either wrong or the patient hasn’t been given/heard that message.
    It’s exciting listening to them talk about pain – but then I see them a few years later, when they’re now registrars and on their way to becoming consultants, and that sensitivity has gone.
    The point I want to make is that until their elders (the senior consultants) also learn pain science, and person-centred care, these young doctors will possibly not retain their awareness. It gets kind of beaten out of them when they enter the hustle of junior doctorhood.
    I’d love to see all of the medical faculties, especially the colleges, work together with educators to produce something that has emotional impact on clinical practice across all levels of seniority.
    Meantime, I’m really happy to have the time to spend with 5th year students, and hope some of the learning they get remains with them.