Pain Education for Medical Professionals
Doctor: Do not mistake your Google searches for my 8 years of medical training.
Pain Patient: Do not mistake your 8 years of medical training for my 20 years of experience with chronic, debilitating pain.
The above exchange is one that many persons in pain have had with the medical professionals who are assisting in their care. However, it is important to realize that for many health professions, very little of their formal education is dedicated to an understanding of the pain systems. Most medical professionals do not know that you can have pain without significant tissue damage, which seems counterintuitive when you recognize that 80% of visits to medical professionals are caused by some kind of pain issue.
The average medical student is exposed fo very little with regards to education about pain, In my medical training, we had a one hour lecture on the somatosensory system, which included a minimal discussion on the nociceptive or pain systems. We also had a single one hour lecture on the primary medications used for pain - and bluntly, it focused primarily on opiates, steroids, and NSAIDs, not on other potential medications now commonly used for pain. We had more of a lecture on addiction risks, than we had with respect to pain perception and pain processing. We also had a session in our “doctoring” course on pain education - but the “pan” patient in that clinical scenario was actually not a pain patient at all, but a person faking lower back pain to get pain medications.
Nurses, on the other hand, often receive explicit training in pain management, both acute and chronic. This occurs because nurses are often the providers who assess pain on the front lines, in the hospital and in the clinic. While they do not have the extensive training in anatomy and physiology that physicians do, nurses do have courses sometimes explicitly dedicated to the assessment and management of pain, and often some of the best clinical researchers in pain throughout the world. Similarly, while nurses receive much better training in measurement tools for pain than physicians, they also do not get much education about the plasticity of the pain systems, or the abilities for the pain system to change after exposure to chronic stimulation.
Similarly, as many of the patients who seek chiropractic care do so explicitly for pain problems, such as joint pain and back pain, chiropractors have more coursework explicitly dedicated to pain. However, chiropractors do not receive specific courses dedicated to pain, but rather learn about the causes of pain when they learn about the syndromes that can bring a person to chiropractic care.
Pharmacists, of medical professionals, likely receive the most direct education with respect to pain, but again that centers on the medications that are appropriate for pain management, and the focus on potential addiction and abuse. Their training focuses on the mechanisms of those medications, rather than the pathways and pathology that can result in pain.
So why is this lack of education with respect to pain for medical professionals important when seeking medical care for pain? Without an understanding of the subjective nature of pain (pain is defined by the person experiencing it), you can have completely inappropriate conversations about odd concepts, like “appropriate pain.” There is no such thing as “appropriate pain,” or pain that can be expected based on what a medical professional finds through laboratory tests or imaging scans. Anyone with a basic understanding of how pain works knows that - pain is defined by the person experiencing it. Again, persons can have pain in the complete absence of tissue damage, and the pain systems can change significantly following chronic experience to stimuli approaching tissue damaging range
Why is this important for a person who is hurting?
Because of the limits of their education with respect to pain, when dealing with professionals in pain management, a person may have to show care in how they present themselves, and in how they describe their pain. Most pain physicians do not know that you can have pain without tissue damage - and other pain professionals, like nurses or pharmacists, may not understand how malleable the pain system is, and how acute pain can become chronic pain, even after tissue damage may have healed. An understanding of those biases can really help you in your interactions with medical professionals.
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