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The education of pain physicians.

It has been my good fortune to have played a variety of roles both in medical education and in the evolution of the pain movement; I feel qualified to talk about how we should educate physicians who wish to focus their careers on chronic pain management. The plans for education and certification in chronic pain medicine that have been proposed and often implemented by various professional organizations do not adequately address the most pressing issues. I am acutely discomforted by the increasing prices chronic pain medicine and our patients have paid to be included in the domain of anesthesiology. Radical restructuring of the education and training of all physicians for the management of chronic pain patients is required if we are to effectively alleviate the burden of chronic pain and its accompanying excessive health care costs. I urge that chronic pain medicine should be considered an aspect of primary care, with specialist consultants available when needed, roughly analogous to subspecialties in internal medicine.

The recent Institute of Medicine report on pain makes it abundantly clear that chronic pain is a prevalent and expensive problem in our country, to say nothing of the human suffering that it causes [1]. Addressing the education of pain medicine physicians is not only an academic debate; it is an issue for the practicing community and the public as well. Although we live in the era of evidence-based medicine, there are few controlled trials on how to educate pain providers, nor are there likely to be many in the future. Asking those who are involved in interdisciplinary struggles for turf is not the optimal source of information on these issues. All that one can do is look carefully at the past, assess what is happening now, and attempt to design systems that will improve things …