Pain Medicine: Avoid Teaching to the Test

PALM SPRINGS, Calif. — With pain affecting several aspects of life, the way pain medication is being taught in medical school is of upmost importance for both clinicians and patients. 

Speaking at the American Academy of Pain Medicine (AAPM)’s annual meeting, David J. Tauben, MD, chief of pain medicine at the University of Washington (UW) as well as a UW clinical associate professor in a joint appointment with the Department of Anesthesia and Pain Medicine and Department of Medicine in the Division of General Internal Medicine, reviewed how medical school curriculum needs to evolve, particularly with regard to pain management.

“The current state is we are teaching to the exam,” he said, “and this needs to change.”

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Starting his presentation with “pain is really at a point of equilibrium,” Dr Taubin outlined an abundance of opportunity in pain: an evolving medical school curriculum, a paradigm shift regarding opioid use and misuse, the national attention focused on evidence and outcomes, and how health systems are focused on outcomes and costs.

He also discussed a variety of threats facing the field: pain is still an “orphan” topic; negotiating adequate pain training in an already overly crowded curriculum; focusing on the “fifth vital,” not on MDPC; poor quality evidence and outcomes; and the ROI of pain medicine.

Today there’s a focus redirect from episodic hospital-based care to a biopsychosocial model, he noted. This curriculum renewal highlights longitudinal experiences, interprofessional and team-based care, and chronic pain. 

Based upon the chronic disease model and team care approach, collaborative care should include embedded specialists in the PCMH, patient registries for selected conditions, team care with RN or MSW care manager, and patient education and self-management programs. 

Enhanced service and economics provide greater inpatient and outpatient service coverage. Expected improvements include: reduced LOS, reduced ED visits, reduced readamissions, and expanded services. Improved patient, staff, and provider satisfaction is also a result. 

There are several benefits to care planning guided by multidimensional assessment: improving the patient experience, improving health care outcomes and controlling costs. 

There are various actions to take in education: build IPE pain curriculum during “curriculum renewal,” expand dialogue with licensing and credentialing, promote access via telementoring, and extend curriculum to residencies and postgraduate CME. 

For care, Dr Tauben believes the industry should transform pain care across the continuum, measure and track treatment outcomes, and assess risks and then match to care pathways. 

Systems should demonstrate “triple aim” by focusing on patient and family communication, increasing assessment evidence-based care and treatment outcomes in all settings, and expanding value-based pain care performance.