5.2 Training and education for healthcare providers
The significance of interprofessional education on pain assessment cannot be overstated. Particularly as assessing pain in individuals with OUD requires not only efficient, validated tools, but also professionals knowledgeable in the nuanced interactions between the two conditions. For a comprehensive review, it would be impossible to discuss assessments without considering the education of those doing the assessment,
Despite calls for action within undergraduate medical education to address pain as a multidimensional construct and to address biases in pain assessment191, along with a strong desire to acquire pain-management and addiction-management skills, as indicated in stakeholder analyses192, there have been limited formal evaluations of the effectiveness of these interventions in improving pain outcomes. Moreover, there is a scarcity of studies specifically designed to investigate the intersection between pain and OUD. From a students’ perspective, clinical skill simulation laboratories have illuminated that medical students find cases involving these two interconnected diagnoses intricate and demanding193.
A recurrent criticism against numerous interprofessional continuing education initiatives is the dearth of assessments measuring tangible improvements in patient outcomes194. It is evident that medical students, for example, frequently receive inadequate instruction on pain and addiction management during their medical schooling195, 196, although there exist several published model curricula that can be employed for both pain and OUD education197-201. For example, Stevens and colleagues developed a pain assessment and management curriculum for second-year medical students and compared them with the previous class which did not have access to the curriculum202. At the end of third year, both cohorts underwent a clinical skills examination considering different types of pain cases (acute, chronic, and terminal). More intervention students obtained basic (87.2% vs. 76.0%, p=.028) and comprehensive (75.2% vs. 60.9%, p=.051) descriptions of acute pain than control students. Students exposed to the curriculum more often asked about the impact of pain on functioning (40.7% vs. 25.8%, p=.027), advised changes of medication (97.3% vs. 38.7%, p<.001), and provided additional medication counseling (55.0% vs. 27.0%, p<.001). However, the authors did not comment on their curricula applications to OUD, exemplifying the scarcity of integrating the two issues.
Educational interventions such as the one described generally lead to enhancements in pain documentation, improvements in patient self-reported pain scores, and pain satisfaction levels203. Regrettably, while individual studies and resources exist for addressing pain and OUD separately, few have delved into the co-occurrence of these two conditions. To our knowledge, the scarcity of curricula considering both pain and OUD is pervasive throughout health-care professions beyond medicine, as we also could not find published examples in nursing, psychology, or social work literature.
A significant obstacle to effective pain management in persons with OUD is the prevailing stigma within healthcare systems and among individual providers towards this patient population, impacting patient encounters and treatment outcomes for chronic pain and OUD204, 205. Concerning in the previously referenced study by Sobel and colleagues is the early emergence of certain forms of stigma towards patients with OUD at an early stage of medical training193. Brief educational interventions hold the potential to significantly reduce stigmatizing beliefs, particularly regarding OUD, among medical professionals201, 206. By addressing stigma through education, healthcare providers may adopt an inclusive, patient-centered approach to evaluating and managing pain and OUD, enhancing patient engagement and outcomes.