Finding the cause of a patient’s pain complaint can be a real struggle for both the patient and the healthcare provider, especially when the pain is chronic (i.e., lasts longer than three months (1)) and widespread. This struggle often leads to frustration in many patients, as the messages they receive about the cause and treatment of their pain are often contradictory, depending on their healthcare providers (2). Unfortunately, this problem is very common in daily clinical practice.

Back to the roots

How is it possible that patients receive contradictory messages about their pain? This brings us back to the healthcare providers. A couple of decades ago, a shift towards a biopsychosocial approach to pain was made. Pain does not equal tissue damage and can be a disease in its own right (3). Despite the extensive work in clinical research on approaching pain as a biopsychosocial concept, this knowledge is often too limited in clinical practice and therefore not adequately applied by all healthcare professionals (4,5). For this reason, we should go back to the roots, to the curricula that healthcare providers receive.

A systematic review from 2018 concluded that pain education was mostly included in medical curricula such as anesthesia or pharmacology, rather than given as a stand-alone course (6). Moreover, 96% of the medical curricula in the USA and UK, and 80% of the medical curricula in Europe had no specific curricula on pain. Another scoping review from 2018 also identified that students’ knowledge, skills, attitudes, and beliefs about pain are poorly understood due to the lack of attention to pain in health curricula (4). Both studies concluded that current health curricula do not adequately respond to current society’s needs regarding the approach of (chronic) pain. Remarkably, a more recent study also showed that only physiotherapy students improved their pain-related knowledge and attitudes from the first to the last year, compared to occupational therapy, paramedics, diagnostic radiography, midwifery, and nursing students (7).

What about now?

A reorganization and implementation of pain-related courses should be included in all medical schools. This implementation should occur early in the curricula so that students can improve their pain knowledge and approach pain as a biopsychosocial concept from the start of their education. A recent Delphi study proposed the most important components to include in pain-related curricula (8). These components were related to the taxonomy and definition of pain, pain assessment and measurement, different pain models and theories, the multidimensional nature of pain, pain management, communication, beliefs and attitudes of patients and healthcare providers, health policy, and pain subgroups/special pain populations. Detailed information can be found in the study itself.

Sophie Vervullens

Physiotherapist and PhD student at the University of Antwerp (MOVANT) and the University of Maastricht (CAPHRI).

2024Pain in Motion

References and further reading:

1. 1.Perrot S, Cohen M, Barke A, Korwisi B, Rief W, Treede RD, et al. The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain. Pain. 2019 Jan;160(1):77–82.
2. 2.Dow CM, Roche PA, Ziebland S. Talk of frustration in the narratives of people with chronic pain. Chronic Illness. 2012 Sep 1;8(3):176–91.
3. 3.Nicholas M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019 Jan;160(1):28–37.
4. 4.Thompson K, Johnson MI, Milligan J, Briggs M. Twenty-five years of pain education research—what have we learned? Findings from a comprehensive scoping review of research into pre-registration pain education for health professionals. PAIN. 2018 Nov;159(11):2146.
5. 5.Ram A, Booth J, Thom JM, Jones MD. Exercise physiologists use of pain neuroscience education for treating knee osteoarthritis: A qualitative interview study. Musculoskeletal Care. 2022 Dec;20(4):821–30.
6. 6.Shipton EE, Bate F, Garrick R, Steketee C, Shipton EA, Visser EJ. Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain Ther. 2018 Dec;7(2):139–61.
7. 7.Mankelow J, Ryan CG, Taylor PC, Casey MB, Naisby J, Thompson K, et al. International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students. BMC Med Educ. 2022 Jul 15;22:547.
8. 8.Reezigt R, Beetsma A, Köke A, Hobbelen H, Reneman M. Toward consensus on pain-related content in the pre-registration, undergraduate physical therapy curriculum: a Delphi-study. Physiother Theory Pract. 2024 May;40(5):1040–53.