IASP Curriculum Outline on Pain for Medicine

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Task Force Members

Andreas Kopf (Chair), Rolf-Detlef Treede, Thomas Graven-Nielsen, Adriana Cadavid, James Rathmell

Outline Summary

Introduction
Principles
Objectives
Curriculum Content Outline
 I. Multidimensional Nature of Pain
 II. Pain Assessment and Measurement 
 III. Management of Pain
 IV. Clinical Conditions 
References

Introduction

The widespread prevalence of pain demonstrates the need for comprehensive pain education for all health-care professionals. Yet not all require the same type of pain-related knowledge and skills. IASP encourages all medical school programs to use the following curriculum outline to embed pain education and training. As with all health professions, an objective of the curriculum is to instill the knowledge and skills necessary to advance the science and management of pain as part of an interprofessional team. The desired outcomes of education emphasize critical competencies that support the humanistic aspects of health care and the learner’s capacity to successfully carry out tasks in the real world. The fundamental concepts and complexity of pain include how pain is observed and assessed, collaborative approaches to treatment options, and application of pain competencies across the lifespan in the context of various settings, populations, and care-team models.

Changing the curriculum of medical schools is challenging, and this curriculum outline will stimulate comments, criticisms, and suggestions. The hope is that those involved in planning medical school curricula will use the outline to draw the attention of their colleagues to the areas that ought to be covered if graduates are to be adequately prepared to manage pain.

Obviously, there are as many ways of covering the topics in the outline as there are medical schools. A general suggestion on the practical use of the outline is to address each item as part of basic, clinical, or social sciences early in the medical school curriculum followed by a comprehensive pain medicine course late in the curriculum. Examples that complement this outline are the medical school curriculum in Germany, which requires attention to pain medicine, as well as the European undergraduate pain medicine curriculum, both of which are cited in the References at the end of this document.

Principles

The following principles guide the pain curriculum for the entry-level physician:

  1. Pain is a multidimensional experience requiring comprehensive and ongoing assessment and effective management.
  2. Physicians play an essential role in the prevention, diagnosis and management of acute and persistent pain.

Objectives

Physicians upon completing this entry-level pain curriculum will be able to:

  1. Recognize pain medicine as a necessary field in clinical practice for acute and persistent (chronic) pain conditions
  2. Understand the basic science of pain-processing components such as anatomy, physiology, and pharmacology
  3. Identify clinical presentation of acute and persistent pain syndromes or conditions
  4. Recognize the multidimensional aspects of the pain experience and its related management
  5. Understand pain management options appropriate for individual patients according to medical condition, medicine availability, risk-benefit balance, cost-effectiveness, culture, mental status, and evidence of efficacy
  6. Know the indications, contraindications, and risks of the primary elements of multimodal pain management
  7. Learn effective interaction with multi-professional teams involved in practicing pain medicine
  8. Practice pain medicine according to ethical principles

Curriculum Content Outline

  1. Multidimensional Nature of Pain
    1. Definition of pain
      1. Biological significance of pain (survival value)
      2. Relationship between acute and chronic pain
      3. Distinction between nociceptive, nociplastic, and neuropathic pain
      4. Pain as a public health problem
      5. Epidemiology: Societal consequences
    2. Ethical issues
      1. The right to receive treatment for pain
      2. Pain disability and litigation
      3. Pain in children
      4. Pain and opiate dependence
      5. Pain research in humans and animals
    3. Basic sciences
      1. Neuroanatomy and Neurophysiology of Pain
        1. Peripheral receptors, afferent fibers, transduction and transformation, peripheral sensitization
        2. Spinal terminations and spinal processing of nociceptive information, spinal reflexes, ascending tracts, transmitters (peptides and amino acids)
        3. Brainstem mechanisms of pain (autonomic reflexes, ascending reticular activating system)
        4. Thalamic nuclei, nociceptive cortical network, cortical reorganization
        5. Descending control of nociceptive information and pain modulation
        6. Central sensitization
        7. Genetics in relation to pain mechanisms
      2. Pharmacology of Pain
        1. Basic pharmacology of local anesthetics
        2. Basic pharmacology of nonsteroidal anti-inflammatory agents
        3. Basic pharmacology of opioids
        4. Basic pharmacology of medicines licensed for neuropathic pain
        5. Basic pharmacology of other relevant analgesic medicines
      3. Psychology of Pain
        1. Affective, cognitive, behavioral, and developmental aspects
        2. Pain attribution., self-esteem, self-efficacy, and perceived self-control
        3. Interpersonal issues, sick role, illness behavior (normal and abnormal), the role of the family
        4. The influence of political, governmental, and social welfare programs
        5. Cultural differences in pain meanings and treatment approaches
        6. Illness behaviors associated with pain (denial and amplification)
        7. Pain as a coded message of psychosocial distress
  2. Pain Assessment and Measurement
    1. The validity, reliability, sensitivity, specificity, and clinical utility of methods for:
      1. The measurement of pain, disability, associated distress, and suffering
      2. Quantitative sensory testing in relation to specific mechanisms
      3. Assessment of pain relief and functional improvement (sleep, work, self-care, etc.)
  3. Management of Pain
    1. General principles
      1. The measurement, quantification, and recording of pain
      2. The multimodal approach (multidisciplinary pain clinics)
      3. The clinician-patient relationship
    2. Clinical pharmacology
      1. Nonsteroidal anti-inflammatory agents and antipyretics
      2. Systemic and spinal opioids, endorphins
      3. Local anesthetics
      4. Medicines indicated for neuropathic pain
      5. Other medicines active against neuropathic pain (e.g., anticonvulsants, antidepressants)
    3. Psychotherapeutic and behavioral approaches
      1. Individual, family, and group psychotherapy
      2. Cognitive-behavioral therapy
      3. Relaxation techniques (biofeedback, etc.)
      4. Hypnotherapy, operant approach, stress management
    4. Physical therapy
      1. Exercise and other active treatments
      2. Manual therapy and other physical medicine treatments
    5. Neuromodulation techniques
      1. Transcutaneous nerve stimulation
      2. Brain and spinal cord stimulation
      3. Acupuncture
      4. Pulsed radiofrequency
    6. Nerve blocks (image guided)
      1. Local anesthetics
      2. Neurolytic solutions
      3. Ablative Radiofrequency
    7. Surgical techniques
      1. Nerve decompression
      2. Neurosurgical techniques
      3. Orthopedic techniques
  4. Clinical Conditions
    1. Etiology, diagnosis, multidisciplinary management, economic impact, medico-legal, and compensation issues within:
      1. Emergency-service pain
      2. Postoperative pain
      3. Chronic primary pain syndromes
      4. Chronic pain related to cancer or its treatment
      5. Chronic postsurgical or posttraumatic pain
      6. Neuropathic pain
      7. Headache and facial pain syndromes
      8. Musculoskeletal pain
      9. Visceral pain
    2. Specific pain issues related to:
      1. Children and infants (signs of pain, evaluation and management, physiology, acute and chronic pain)
      2. Elderly
      3. Developmentally challenged
      4. Pregnancy, childbirth, and breastfeeding
      5. The opioid tolerant patient
      6. Substance use disorders

References

German Undergraduate Pain Curriculum (accessed Oct. 11, 2017)

Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Kosek E, Lavandʼhomme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JW, Wang SJ. A classification of chronic pain for ICD-11. Pain 2015;156:1003-7

Undergraduate Pain Curriculum, European Pain Federation (accessed Oct. 11, 2017)

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