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4 Education Challenges
Pages 179-216

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From page 179...
... Many members of the public, people with pain themselves, and many health professionals are not adequately prepared to take preventive action, recognize warning signs, initiate timely and appropriate treatment, or seek specialty consultation when necessary with respect to pain. The avoidable negative consequences are that more people than necessary experience pain, acute pain often is not optimally treated and progresses unnecessarily to chronic pain, 1 Quotation from response to committee survey.
From page 180...
... In addition, educa tion programs need to be high quality and evidence based, and in their planning draw on such sources as the successful examples highlighted in this chapter, inasmuch as the history of both patient and public education efforts is littered with failed, ineffective, and poorly implemented programs. PATIENT EDUCATION I had to relearn how to live.
From page 181...
... While the table addresses strictly patient education, families, too, should be seen as an appropriate target for educational efforts. Education for people with chronic pain should not be a onetime effort; as pain progresses, as treatments have greater or dwindling effects, as new treatments become available, the educational process should continue.
From page 182...
... and pain that is not protective should be treated (maladaptive) Reasons why the need for relief is important, To persuade people to obtain early treatment especially the possibility that poorly managed when necessary acute pain will progress to chronic pain When and how emergency or urgent care To encourage seeking immediate intervention, should be obtained which sometimes can prevent pain from severely worsening Treatment-related pain (such as postoperative To enable patients to be informed consumers pain)
From page 183...
... Various types of education programs evaluated or in use by voluntary health organizations have benefited people with pain, including • information on ways to control and cope with pain (American Chronic Pain Association, 2011; American Pain Foundation, 2011; PainKnowledge.org, 2011) ; • psychosocial supports for people with pain and their personal caregivers, with a strong patient education component (Porter et al., 2010)
From page 184...
... The committee identified five reasons why public education about pain could be highly beneficial: • People who have received such education can take steps to avoid pain, such as practicing proper stretching and lifting techniques, and can en gage in timely and useful self-management when pain strikes. • Educated people can give appropriate advice and assistance to family members, friends, and colleagues of people with pain, especially by advising them to refrain from telling injured individuals to simply "bear with it" or "suck it up." • In interactions with health care providers, educated people can advocate for and accept appropriate treatment of acute and chronic pain they or family members experience.
From page 185...
... Some existing campaigns, described in Box 4-1, illustrate how public education on pain might take place. Some public health education campaigns outside the pain field illustrate the potential for producing change in pain-related behavior.
From page 186...
... The effort further included leaflets, as well as information packets distributed to health professionals and employers. The campaign produced a positive effect on public and profes sional attitudes, as most people became aware of the benefits of staying active for those with back pain.
From page 187...
... . Local combinations of a well-designed public education campaign, community and school-based programs, strong enforcement efforts, and smoking cessation programs have reduced smoking among youth by as much as 40 percent (Campaign for Tobacco-free Kids, 2011)
From page 188...
... , or third-party payers and others who influence the course of pain care. An additional advantage of public education overall is that it can draw people into public decision-making processes, for example, by encouraging them to ask their employer to make sure that their health insurance plan sufficiently covers pain management or advocate that their local public schools have an injury prevention policy, especially in sports programs.
From page 189...
... Some organizations, such as the American Pain Foundation and the Mayday Fund, certainly promote public awareness. Several patient-oriented groups focused on single pain conditions or issues -- such as the National Fibromyalgia Association, Women with Pain Coalition, and American Chronic Pain Association -- take strong advocacy positions.
From page 190...
... Patient and public education, the two topics addressed in the first part of this chapter, help shape the demand for pain care. The following sections turn to the supply of health professionals adequately prepared to provide pain care, begin ning with physicians.
From page 191...
... People have sought out physicians for pain care for centuries. Pain treatment is an essential component of clinical practice, as recognized in state medical practice acts and by the Federation of State Medical Boards in its model Medical and Osteopathic Practice Act: Practice of medicine means .
From page 192...
... The results included "negative generalizations about patients with chronic pain" and "further alienation and misunderstanding of the patient and chronic pain." Moreover, this first work group observed that pain management is spread out over many clinical specialties, creating confusion about "who is in charge" of developing, documenting, and reporting best practices and pain care guidelines. As a result, there are "no standards for measuring the effectiveness of treating pain in clinical practice." The work group also noted the paucity of information about treating pain in children.
From page 193...
... and the National Board of Medical Examiners took steps to require pain training of most residents and include questions about pain on physician licensure examinations, respectively. Finally, the competencies work group determined that "competing, overlap ping, and sometimes conflicting efforts of the various organizations involved" mean there is no "single-party" ownership of the pain medicine specialty.
From page 194...
... 3) The Mayday panel recommended that every health professional be taught "the skills to assess and treat pain effectively, including chronic pain" (Mayday Fund, 2009, p.
From page 195...
... . Likewise, in a survey of 1,236 practicing physicians, more than half said they felt poorly prepared to manage end-of-life or chronic pain care (Darer et al., 2004)
From page 196...
... at community clinics found that most felt inadequately prepared to treat pain and had low satisfaction with providing pain care, even though nearly 40 percent of adult appointments involved people with chronic pain complaints (Upshur et al., 2006)
From page 197...
... . Another way to improve primary care physicians' ability to manage pain would be to expand interdisciplinary education in pain so that more pain care can be delivered competently and efficiently by a primary care team instead of having to be handled by an individual physician (see Chapter 3)
From page 198...
... Many who did obtain certification in pain medicine are believed to have allowed their certification to lapse because of retirement, difficulties in obtaining desired reimbursement for specialty pain care, or other factors. The American Board of Pain Medicine (ABPM)
From page 199...
... . The very existence of the UCNS certification effort may reflect the lack of sufficient attention to pain care in the overall scope of graduate medical education.
From page 200...
... While anesthesiology has a key position in the delivery of pain care, other specialties have strong reasons to engage in pain medicine. One reason is the po tentially broad range of applications of pain medicine's rapidly evolving knowl
From page 201...
... who prescribe these agents to treat pain." The white paper recommends providing outcome-oriented continuing education and making pain education available to all members of health care teams, including those who are not health professionals. NURSE EDUCATION Every patient is an individual pharmacological experiment; one size does not fit all.
From page 202...
... More specifically, nurses with baccalaureate degrees are charged with responsibility for providing care that incorporates many components of high-quality pain care. A recent report of the American Association of Colleges of Nursing states: Baccalaureate-prepared nurses provide patient-centered care that identifies, respects, and addresses patients' differences, values, preferences, and expressed needs (IOM, 2003)
From page 203...
... . Numerous actions demonstrate the nursing profession's commitment to highquality pain care.
From page 204...
... . Given that responsibility for most pain care falls heavily on primary care practitioners, and too few primary care physicians exist to shoulder that burden, nurse practitioners are likely to play an increasingly important role.
From page 205...
... . As is true with other health professions, it would be useful to encourage more psychologists to provide pain care and to conduct pain-relevant research.
From page 206...
... However, only recently has the American Psychological Association begun to accredit specialty training in clinical health psychology at the postdoctoral level. Even so, pain psychology remains a subspecialty within the broader field of clinical health psychology, and there are no explicit criteria for credentialing psychologists with specific expertise in pain management.
From page 207...
... In a survey of 119 physical therapists who belonged to the American Physical Therapy Association's Section on Orthopaedics, all but 4 percent said they preferred not to work with patients likely to have chronic pain, 72 percent said their entry-level education in pain management was very inadequate or less than adequate to handle orthopedic patients, and pain knowledge scores were found to be low (Wolff et al., 1991)
From page 208...
... Complementary and Alternative Medicine (CAM) Because complementary and alternative therapies are widely used in pain care (see Chapter 3)
From page 209...
... Programs should • b e endorsed by expert pain health professions organizations; • s trive to increase awareness of the significance of pain, its preven tion, the need to address acute and chronic pain in timely and ef fective ways, the biological and psychosocial aspects of pain, and the need for comprehensive assessment of pain, as well as to instill a balanced understanding of available treatments; • i ncorporate materials such as fact sheets and information that can be made widely available, including on the Internet; and • b e specifically and appropriately targeted to patients, the public, and providers to ensure understanding of the concepts being imparted.
From page 210...
... • U ndergraduate and graduate health professions training in programs whose graduates will participate in pain care should include pain education. • R elevant accrediting organizations (such as residency review com mittees and the Accreditation Council for Graduate Medical Edu cation)
From page 211...
... 2007. ACGME program require ments for graduate medical education in pain medicine.
From page 212...
... Workgroup report. The first national pain medicine summit -- final summary report.
From page 213...
... Workgroup report. The first national pain medicine summit -- final summary report.
From page 214...
... 2009. A call to revolutionize chronic pain care in America: An opportunity in health care reform.
From page 215...
... 2011. A new program in pain medicine for medical students: Integrat ing core curriculum knowledge with emotional and reflective development.
From page 216...
... 2006. Primary care provider concerns about management of chronic pain in community clinic populations.


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