American Society of Regional Anesthesia and Pain Medicine August 2017 - 30

is not feasible to delegate all treatment of pain to pain specialists.
There are reported fewer than 4,000 pain specialists in the country,
which is an insufficient number to treat all patients with acute,
subacute, chronic, or persistent pain in inpatient wards and in the
outpatient setting.4
Based on these facts, perhaps we should all agree that pain
management needs better emphasis in trainee's education across
the medical school, internship, residency, and fellowship.
This is especially important in the current opioid epidemic crisis.
As opioid usage has been increasingly scrutinized and highly
publicized and critiqued, we cannot help wondering if physicians'
roles in this opioid epidemic, while controversial, have certainly
been affected by our training or lack thereof on this complex topic.
In a recent survey, over 50% of primary care physicians felt only
"somewhat prepared" to educate patients about their pain, while
27% felt "somewhat unprepared" or "very unprepared."4 This
leaves less than 25% of primary care physicians feeling prepared to
treat pain. It is unfair, however, to criticize these physicians without
providing proper tools and education to counteract the issue.
A nationwide call to address the opioid epidemic was recently
laid forth by former President Barack Obama in March 2016. This
prompted a pledge from nearly 75 United States medical schools
to incorporate the prescribing guidelines at the Centers for Disease
Control and Prevention (CDC) safe into requisite coursework. The
International Association for the Study of Pain, in collaboration with
various pain management societies, including ASRA, has drafted
a comprehensive recommended pain medicine curriculum that
lays the groundwork for improved pain education. Pain-related
proficiencies are increasingly being incorporated into resident
evaluations for progression and graduation. Overall increased
awareness regarding risks of opioids and bolstered training
paradigms, while well intended, are not set up for success without
up-to-date, unbiased evidence-based resources. Building on those
points, through the Resident and Medical Student Pain Education

30

Special Interest Group (SIG), we are attempting to put training and
teaching of our trainees into the hands of those that may be best fit
for it. Thus, even highly specialized pain subspecialty practitioners,
while mastering their own realm of pain and staying abreast of
new research developments in a field like headache, may be called
upon to give in-depth lectures on peripheral neuropathies or other
aspects of pain outside of their wheelhouse. This is part of the
motivation for our creation of the Resident and Medical Student
Pain Education SIG: to distill down the immense pain medicine
knowledge and treatment experience in the members of ASRA.
Optimal pain management of patients, superimposed on the
current opioid epidemic, requires a new approach. Perhaps in this
subspecialized era of medicine "Teach one. See one. Do One" is
more appropriate when initiated by expert guidance and supported
with significant evidence-based research and novel ways of
teaching such as simulation and virtual reality. By utilizing the
teaching prowess of this society and our members, we can help
facilitate this transition by creating teaching tools and mentoring
opportunities to educate our future colleagues, striving to ultimately
teach everyone.
REFERENCES
1.

Global Industry Analysts, Inc. Global pain management market to reach US$60
billion by 2015, according to a new report by Global Industry Analysts, Inc.
[press release]. January 10, 2011. Available at: http://www.prweb.com/
pdfdownload/8052240.pdf. Accessed June 2017.

2.

Friessem C, Willweber-Strumpf A, Zenz MW. Chronic pain in primary care.
German figures from 1991 and 2006. BMC Public Health. 2009;9:299.

3.

Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain.
2012;13:715-724.

4.

Pizzo P, Clark N. Alleviating suffering 101 - pain relief in the United States. N
Engl J Med. 2012;366:197-199.

5.

Mezei L, Murinson B, Johns Hopkins Pain Curriculum Development Team. Pain
education in North American medical schools. J Pain. 2011;12(12):1199-1208.

6.

Briggs EV, Battelli D, Gordon D, et al. Current pain education within
undergraduate medical studies across Europe: Advancing the Provision of Pain
Education and Learning (APPEAL) study. BMJ. 2015;5(8):e006984.

American Society of Regional Anesthesia and Pain Medicine
2017
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