Chronic pain is among the most prevalent and challenging health conditions in the nation and people suffering from it outnumber those with cancer, diabetes and heart disease combined. Pain is the most common problem that physicians are asked to treat, but clinicians have not been adequately trained in managing pain. Treatment involving prescription opioids has often been inappropriate and even unsafe, contributing to a national emergency involving tens of thousands of overdose deaths each year and an ever-rising number of people with substance-use disorders.
Prescription drug abuse and unintended overdose deaths have become a serious and ongoing public health problem in the U.S. The epidemic of substance abuse disorders and addiction cannot be overstated say experts like Scott Fishman, a pain medicine specialist at UC Davis Medical Center and director of the university’s Center for Advancing Pain Relief. The center, which grew out of collaboration with the School of Medicine and the Betty Irene Moore School of Nursing at UC Davis, aims to meet the need for more clinician education and training.
Providing more education and training to health care providers
Part of the problem, says Fishman, is that the vast majority of physicians and other opioid prescribers are still not well trained in pain management and have never been fully educated on safe and effective prescribing of these controlled substances. That’s why Fishman and his UC Davis colleagues are working to strengthen the knowledge base and skills of the health care workforce so they understand the wide array of options for and approaches to pain relief, most of which do not involve opioids, as well as carefully balancing risks and benefits in the much less frequent situations when opioids may be necessary to responsibly address an individual’s pain.
Fishman has a long history of advising physicians about the inherent risks in prescribing opioids for pain, having authored or co-authored dozens of articles, studies and other publications over more than 20 years.
“There has been a lot of work focused on raising awareness about the risks associated with opioids and the need for appropriate comprehensive pain management, including many non-opioid options” says Fishman, who also serves as chief of the Division of Pain Medicine at UC Davis Medical Center and laments that the field has not done a better job of educating health care professionals.
Fishman suggests the nation finds itself in a crisis that has been driven in part by a rising awareness about pain and its chronic, debilitating consequences, but without much of the essential education, research and resources that are necessary for safe and effective pain relief.
Reaching out to primary care providers
“One of the top priorities at UC Davis is our new Center for Advancing Pain Relief, where we recently launched three educational programs designed for primary care providers. We established the nation’s first primary-care Pain Management Fellowship, offered our first training for office-based treatment of opioid addiction, as well as recently hosted a rigorous continuing medical education (CME) conference to introduce providers to the essentials of pain management.”
Each of the programs, adds Fishman, is designed to help primary care clinicians address pain in its most comprehensive form, which he believes can also address the public health crisis in prescription drug abuse.
The CME conference, for example, focused on the essentials of primary care pain management, integrating the latest scientific data and current clinical practices to help providers gain a better sense of the broad options possible for pain control as well as addiction dangers and emerging guidelines for responsible opioid prescribing practices. Attendees included physicians, nurses, physician assistants, pharmacists and other health professionals.
This short video features interviews with Dr. Fishman and other UC Davis pain experts, who are expanding training and education so more health care providers can learn about best practices in pain management.
“Practitioners face enormous challenges in trying to provide pain management for their patients, largely because they have inadequate tools and options needed to help people in pain. We find that primary care clinicians are often surprised to find that there are additional approaches and options for their patients.”
The two-day conference, included comprehensive discussions about chronic pain management and provided a framework for helping clinicians understand how to more thoughtfully work with persons in pain as well as their families and communities that have been impacted by prescription drug abuse and overdose deaths. Coursework covered how to evaluate pain; improving risk management associated with prescribing opioids for chronic pain; developing awareness of other treatment modalities besides medications; and identifying the connection between chronic pain and depression or anxiety, both of which can lead prescription drug abuse.
'Training the trainers’ in pain management
In addition to the CME conference, the year-long fellowship was established as a “train-the-trainer” initiative, giving primary care clinicians, including physicians, nurses, pharmacists and others, the tools and materials they need to serve as resource experts for best practices in pain management in their own clinics, including responsible opioid prescribing.
The primary care pain-fellowship program follows the ECHO Telementoring program, a four-year-old collaborative via weekly teleconferences that enables local primary care providers throughout California to discuss challenging cases and best practices with pain specialists at UC Davis Medical Center. Like the ECHO program, the fellowship utilizes UC Davis’ expertise in health technologies by offering participants distance-learning opportunities, as well as one-on-one mentoring, consultation and weekly trainings.
“We’re being aggressive about clinical education and skills-building because this public health problem demands a vigorous, multifaceted approach,” says Fishman, adding that the goal is to create the infrastructure at UC Davis that provides more community providers with the expertise and resources they need to address this national problem at the local level.
“In addition to our commitment to reforming the education and training of future providers, we must address the very serious education gap among currently practicing clinicians. Our aim is to create programs that can be scaled to a national level to help reverse the epidemic of prescription drug abuse and improve the safety and effectiveness of pain management.”
For more information, visit the Center for Advancing Pain Relief.