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.