P-094 - Pain and Substance Abuse Integration into Medical School Education: A Case Report

Abstract Title: Pain and Substance Abuse Integration into Medical School Education: A Case Report

Background: Pain represents up to 78% of emergency department visits, with around 16% of those patients experiencing chronic pain. In the outpatient setting, up to 20% of visits are related to pain. The preceding data reflects a need for practitioners to be up-to-date on pain syndromes and clinical guidelines for the treatment of pain. Pain education begins in the medical school curriculum, but unfortunately most medical schools do not meet the standards of our society and public health needs.

Purpose/Objectives: The purpose of this case report is to describe a unique model of incorporating adequate pain and substance abuse education into the medical curriculum at the University of Houston Tilman J. Fertitta Family College of Medicine (COM).

Methods: The authors examined three courses for content on the topic of pain during the preclinical curriculum phase by reviewing the course objectives and session materials. Topics searched for include pain and physiology, pharmacology, alternative treatments, public health, palliative care, biopsychosocial factors, substance abuse, interdisciplinary healthcare roles and contemporary research. As both students and authors, we provided opinions on both the quality and applicability of pain education within the curriculum.

Results: At the COM, three one-week sessions are conducted during the preclinical phase of medical school education with significant content on the topic of pain; The courses include “Coping with Pain”, “Substance Use to Thriving Life”, and “Living and Dying with Dignity”. Topics taught in “Coping with Pain” include: 1) comprehensive biopsychosocial and functional approach to chronic low back pain 2) pharmacologic and non-pharmacologic treatment of chronic low back pain 3) epidemiology and public health aspects of chronic low back pain and 4) neurological and physiological aspects of chronic low back pain. Topics taught in “Substance Use to Thriving Life” include: 1) neurobiology of addiction 2) harm reduction in substance use disorder (SUD) 3) barriers to care in SUD 4) criminal justice and race equity in recovery services 5) early intervention, treatment, and management of substance use disorders 8) epidemiology of substance use 9) public health interventions that seek to address SUDs and 10) the societal impact of accidental drug overdoses. In this course, a panel of individuals from the community in various stages of recovery came to share their stories and how healthcare professionals played a role in their journey. Topics taught in “Living and Dying with Dignity” include medical aid in palliative and hospice care, as well as an on-site visit to a hospice facility. Pain measurement methodology, sex disparities in pain, and contemporary research findings were not found in the curriculum. These three weeks are interactive, encouraging medical students to think through real-world situations and meet their patients through a compassionate lens using evidence-based practices. At the end of each course, teams of students present a twenty minute presentation to a panel of experts.

Conclusions/Implications for future research and/or clinical care:
Through analysis of the curriculum, we found sufficient pain education. In these sessions, students are able to have a space to learn about one of the most common complaints that they will see throughout their career in medicine: pain. We found a lack of emphasis on pain measurement methodology, sex disparities in pain, and contemporary research findings. Although the authors note opportunities for improvement, the curriculum continues to evolve, incorporating feedback from students every year. The mission remains the same throughout: to provide a dedicated space for thought-provoking pain-related discussions. The authors’ opinion is that pain education should be included in every organ system block, with the addition of separate courses dedicated to pain included throughout the preclinical phase of medical education. Research in medical education should focus on the correlation of pain education in medical school curriculum to clinical competence and patient satisfaction in the treatment of pain.






References:
American Medical Association. (2018, August 30). Essentials of Good Pain Care: A Team-Based Approach, Safely Manage Acute and Chronic Pain. AMA EdHub. https://edhub.ama-assn.org/steps-forward/module/2702759#:~:text=Quiz%20Ref%20IDPain%2Drelated,visits%20in%20the%20United%20States

Felix, F., Oliveira, E., Silva, S. C., & Agualusa, L. (2023). The Overuse of the Emergency Department at a Multidisciplinary Pain Clinic by Patients with Chronic Pain: A Cross-Sectional Study. Cureus, 15(1), e33757. https://doi.org/10.7759/cureus.33757





Shipton, E. E., Bate, F., Garrick, R., Steketee, C., Shipton, E. A., & Visser, E. J. (2018). Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain and therapy, 7(2), 139–161. https://doi.org/10.1007/s40122-018-0103-z