Gary B. Rollman,
Emeritus Professor of Psychology,
University of Western Ontario
(In addition to links below, see weekly archives in the right column)
Thursday, March 21, 2013
Pain Training Pays Off for Physicians and Patients - National Pain Report - National Pain Report
Chronic pain patients who are treated by primary care providers will experience significant improvement in their symptoms if their physicians are trained in pain management, according to a new study published in the Clinical Journal of Pain.
The Primary Practice Physician Program for Chronic Pain (4PCP) helps doctors learn how to treat pain patients through educational classes taught by psychologists, occupational therapists, and physical therapists who specialize in pain management.
Even just a few hours of training provide "remarkable" benefits, with patients returning to work faster, and experiencing less pain, fatigue and depression. Physicians also reported more comfort in assessing and treating pain patients, and shorter visit times.
"We hope to avert chronic pain syndrome, and instead see improved return-to-work rates, fewer emergency room visits, and significantly improved emotional well-being in these patients," said Thomas C. Chelimsky, MD, professor and chairman of the department of neurology at the Medical College of Wisconsin. "From a physician perspective, we observed greater job satisfaction and more efficiency. Economically, the impact of 4PCP training could be significant as well in health care dollars saved."
Thirty-one primary care physicians participated in the pilot study, with about half having 4PCP training and the rest acting as a control group. Training was provided to the doctors through lectures, seminars, web-based information and personal interaction with the pain specialists.
Over one hundred patients being treated by the doctors also participated. The typical patient was a female in her 40's or 50's who suffered from back pain, fibromyalgia, arthritis or neck pain. Nearly all the patients used pain medicine and nearly a third had pain-related surgery. They had chronic pain for an average of 11 years.
"Patients with chronic pain experienced clinically significant benefit from this physician program including reduction in pain, fatigue, depression, and pain interference, resulting in improved function," said Chelimsky.
Doctors also reported greater satisfaction with how they were treating patients and more confidence in how they prescribed pain medications.
"For the physician, the return on investment is compelling, with time saved in visits and improved job satisfaction. 4PCP provides a promising framework for addressing recent calls to revamp approaches to chronic pain education and management," the study concluded.
The pilot study initially called for 16 hours of pain management training for physicians, but researchers found that just 10 hours a year was effective.
About 100 million Americans suffer from chronic pain, according to the Institute of Medicine, which has called for greatly expanded training for doctors in pain management. Fewer than 4,000 pain specialists are currently practicing in the U.S.
A recent survey of 117 medical schools by Johns Hopkins University found that most provided only a few core topics on pain; with cancer pain, pediatric pain and geriatric pain essentially ignored by most medical schools. Other studies have found that most primary care physicians feel "inadequately prepared" to counsel patients on pain.