Future Doctors Unprepared to Manage Pain

Future Doctors Unprepared to Manage Pain

October 26, 2013 | 13,725 views

By Dr. Mercola

Chronic pain affects 100 million Americans – that’s more than the number impacted by diabetes, heart disease and cancer combined.1 Most suffering from pain turn to their family physician for help, but many leave the office with nothing more than a prescription for painkillers in hand.

The reason?

Many physicians simply do not know how to help their patients manage, or eliminate, chronic pain, and this trend is going to continue for the foreseeable future unless a radical change occurs.

As it stands, the APPEAL (Advancing the Provision of Pain Education And Learning) study revealed that new physicians are learning shockingly little about how to treat pain, despite it being one of the most common, and most debilitating, medical conditions around.

Just 12 Hours of Pain Education in Six Years of Medical School

The study, which surveyed undergraduate medical schools in Europe, found that even when compulsory pain courses are in place, they represent just 12 hours of the six-year program – or 0.2 percent.2

Further, most of the schools actually have no required courses on pain that all students must take. This means that 12 hours of pain study represents a best-case scenario; at 82 percent of medical schools without compulsory pain courses, the students may be receiving even less… or no pain training at all.

Even when the pain courses are compulsory, there is no consistency in what topics are covered, and most of the schools included only classroom-based teaching, not practical-based or placement-based teaching that could offer future physicians valuable hands-on experience.

The researchers called for a major overhaul to address the urgent public health need to adequately manage chronic pain, including:

• The establishment of a European framework for pain education to ensure consistency in pain teaching
• The introduction of compulsory pain teaching for all undergraduate medical students in Europe
• Improved documentation of pain teaching within the undergraduate medical curriculum

Pain Education in North American Medical Schools ‘Limited’ and ‘Fragmentary’

Though the featured study took place in Europe, it echoes a similar trend identified in the US and Canada by a separate study published in The Journal of Pain.3

Most of the schools offered pain education as only a part of general education courses. Less than 4 percent of the schools had a required course in pain and many offered no dedicated courses at all.

Even at those schools offering pain curriculum, the education amounted to less than five hours.4 Those researchers similarly concluded:

“Significant gaps between recommended pain curricula and documented educational content were identified. In short, pain education [in US and Canadian medical schools] was limited and fragmentary. Innovative and integrated pain education in primary medical education is needed.”

This is clearly out of sync with the needs of Americans. So many are suffering daily with pain that surveys show seven in 10 Americans believe pain research and management should be one of the medical community’s top priorities!5 Instead, it receives barely a passing mention…

What Happens When Physicians Don’t Know How to Treat Pain?

They resort to the only treatment they know: prescription drugs. And now we’re facing another epidemic on top of chronic pain: prescription drug abuse.

The latter has been called the fastest-growing drug problem in the US by the Centers for Disease Control and Prevention (CDC), as the number of deaths from opioid painkillers like hydrocodone and oxycodone rose nearly four-fold between 1999 and 2009.

The overdoses now kill more people than cocaine and heroin combined. As USA Today recently reported, more US states are now taking action to try and stop this growing problem:6

• Alabama has instituted three new laws that give more medical personnel access to the state’s prescription monitoring program database, as well as tighten regulations on pain management clinics and making ‘doctor shopping’ to get multiple prescriptions punishable by jail time
• Indiana instituted new oversight powers to the state attorney general on pain management clinics and is considering mandatory annual drug screening of people prescribed opioids
• Kentucky now requires pain clinics to be licensed and mandates that physicians check electronic prescription records before writing opioid prescriptions
• Washington state has set dosage limits for physicians who prescribe pain medications, and prescriptions over a certain amount must be approved by a pain specialist
• New York has a requirement that physicians and pharmacists check the state’s drug-monitoring program database before prescribing opioids

Prescription Painkillers are Addictive and Often Deadly

Painkillers (opioids) like morphine, codeine, oxycodone, hydrocodone and fentanyl are one of the most commonly abused drug classes. These drugs are not only addictive, they can lead to slowed breathing and death if too much is taken, and the risks are compounded if you add alcohol to the equation.

Hydrocodone, a prescription opiate, is synthetic heroin. It's indistinguishable from any other heroin as far as your brain and body is concerned. So, if you're hooked on hydrocodone, you are in fact a good-old-fashioned heroin addict.

Worse, pain-killing drugs like fentanyl are actually 100 times more potent than natural opioids like morphine, making the addictive potential and side effects associated with prescription drug use much higher.

Congressional testimony from the American Society of Interventional Pain Physicians stated that Americans consume 80 percent of the pain pills in the world,7 and once you start, they set off a cascade of reactions in your body that make it extremely difficult to stop. Dr. Sanjay Gupta, associate chief of neurosurgery at Grady Memorial Hospital and CNN's chief medical correspondent, reported:8

“ … after just a few months of taking the pills, something starts to change in the body. The effectiveness wears off, and patients typically report getting only about 30% pain relief, compared with when they started. Even more concerning, a subgroup of these patients develop a condition known as hyperalgesia, an increased sensitivity to pain.

As you might guess, all of this creates a situation where the person starts to take more and more pills. And even though they are no longer providing much pain relief, they can still diminish the body's drive to breathe.

If you are awake you may not notice it, but if you fall asleep with too many of these pills in your system, you never wake up. Add alcohol, and the problem is exponentially worse. People who take pain or sleeping pills and drink a couple glasses of wine are playing Russian roulette.”

Every Physician Should Have an Arsenal of Non-Toxic Options for Treating Chronic Pain

And at the top of this list should be an explanation of why dietary changes are so important for long-term pain relief. If you suffer from chronic pain, there’s a good chance your physician has neglected to tell you this:

• Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief.
• Reduce your intake of most processed foods as not only do they contain sugar and additives but most are loaded with omega-6 fats that upset your delicate omega-3:omega-6 ratio, which will contribute to inflammation, a key factor in most pain.
• Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
• Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.

Try These Natural Options Before Even Considering Painkillers for Chronic Pain

Once you’ve addressed the basics above, your physician should be able to suggest a number of non-harmful methods to give you pain relief now, while you wait for your body to become rebalanced and heal thanks to the foundational lifestyle changes you’re making. If your physician is not familiar with pain-relief techniques other than prescription drugs, it may be time to find one who is. Non-drug options may include:

• Emotional Freedom Technique (EFT): Few people want to be told that their pain is psychological or emotional in origin, but there's quite a bit of evidence that backs this up. Underlying emotional issues and unresolved trauma can have a massive influence on your health, particularly as it relates to physical pain. According to Dr. John Sarno, a psychiatrist who uses mind-body techniques to treat patients with severe low back pain, EFT has a greater than 80 percent success rate
• Chiropractic adjustments: According to a study published in the Annals of Internal Medicine9 and funded by the National Institutes of Health, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain free in 12 weeks compared to those who took medication.
• Massage: Massage releases endorphins, which help induce relaxation, relieve pain, and reduce levels of stress chemicals such as cortisol and noradrenaline – reversing the damaging effects of stress by slowing heart rate, respiration and metabolism and lowering raised blood pressure. It is a particularly effective therapy for stress-related tension, which experts believe accounts for as much as 80 to 90 percent of disease.
• Acupuncture: Researchers concluded that acupuncture has a definite effect in reducing chronic pain, such as back pain and headaches – more so than standard pain treatment.10
• Relearn proper posture: The Gokhale Method addresses the root cause of physical pain, which is typically caused by improper posture. The method teaches you to reclaim your primal posture, which is the way your body was designed to stand, sit and move. You can also try Foundation Training—an innovative method developed by Dr. Eric Goodman to treat his own chronic low back pain. The exercises are designed to help you strengthen your entire core and move the way nature intended.

Alternatives to Prescription Painkillers That Virtually Every Physician Should Know

If you have chronic pain of any kind, please understand that there are many safe and effective alternatives to prescription and over-the-counter painkillers. These are the types of pain remedies that medical students should be learning about, as they provide excellent pain relief without any of the health hazards that pain medications often carry.

• Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than prescription drugs like NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
• Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
• Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added only 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.
• Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
• Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.
• Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.
• Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
• Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.