“PAIN TRAINING” seems to suggest two spheres of instruction, DIAGNOSIS & THERAPY. Didactic therapeutic instruction might be easier endeavor since the efficacious contemporary pharmacopoeia is limited & often includes convenient off-label medications that are CDC/BNDD benificent.
DIAGNOSIS of chronic pain disorders is another matter & seems a more primary skill since rational therapies rely on proper diagnosis; especially for specific therapies. Physical Therapy, favored therapy of Medical Insurances, is best applied to specifically defined disorders.
PROBLEM: chronic pain mostly manifests as radiolucent soft tissue disorders. In-depth histories of injury mechanisms, symptom constellations, & physical exams of soft tissues functioning in real time is skill requiring 1,000s of hours of to learn effective diagnostic methods.
Diagnostic precision of soft tissue disorders is best served by additional skills knowing when to use ultrasound & Pain Intervention blocks to refine diagnosis, & this skill set seems to rely on artfulness & tutoring more than classroom teaching.
Point I am making is diagnosis & therapy of chronic pain is a skill barely taught in 11, 22, or manifold these hours. A fast track to pain might be assertions that f(MRI) lit-up regions prove pain matched to VAS scale, & have PT, NSAID, Neurontin, & CBT cure all of it.
My discussion is in response to Dr. S. Mackey’s (Stanford) comment that US medical students receive 11 hours instruction “in pain”; 22 in Canada. My own impression of patients is that the most common reason patients come to see doctors is for chronic pain.
A good portion of medical education is spent in learning about exotic diseases that most primary medical doctors rarely if ever encounter. The absence of skill diagnosing chronic pain disorders is a glaring failure of modern medical education.
Fibromyalgia afflicts ~4% of population & good portion of physicians doubt reality of FM. TOS is a common disorder; many Neurologists doubt reality of TOS. Cannabinoid cellular receptors are most dense body receptor population & schools fail to teach endocannabinoid system.
In my mind these failing are, in major part, reason that we have a crisis in pain management in this country & why chronic pain patients are being treated inhumanely & sometimes driven to the street for illicit substances, and even to suicide.
Time for academic leadership in clinical medicine pain programs to develop Manhattan Program style approach to chronic pain management & treatment; based on firm science & proven results. We keep hearing stat that 30 million people in US suffer chronic pain. Seems a big market.
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