Web-based virtual textbook on pain management deals with problem of untreated pain

Washington 08 September 2003An estimated 50 million Americans suffer from persistent pain, yet most medical school students do not take a single course focused on treating pain, research shows. That's why the American Academy of Pain Medicine, former Health and Human Services Secretary Dr. Louis Sullivan, former Surgeon General Dr. David Satcher, and representatives of several leading medical schools have launched a bold new initiative to fill this troubling gap in the education of new doctors.


The initiative, named TOP MED or Topics on Pain Medicine, is a comprehensive "virtual textbook" on treating patients of all ages suffering from different types of pain. It will be made available free of charge to medical students across the country. "Untreated pain, tragically, is an epidemic in the United States", stated Dr. Sullivan, former Secretary of Health and Human Services and chairman of the TOP MED advisory board.

A new poll released this month by Research!America found that three out of every four surveyed say they are either suffering from pain themselves or have a close family member or friend who is suffering. Dr. Satcher, who also serves on the TOP MED advisory board, noted that the cost of pain reaches $100 billion annually from, among other causes, lost workdays and unnecessary hospitalisations.

"Untreated pain turns otherwise productive lives into an endless succession of agonizing days and sleepless nights", stated Dr. Satcher, who now serves as director of the National Center for Primary Care, Morehouse School of Medicine. Yet too few medical students are receiving adequate instruction on pain management. As a rule, education about pain management is embedded in general medical school courses, rather than being presented in a coherent, comprehensive fashion.

Only 3 percent of medical schools have a separate required course on pain management and just 4 percent require a course in end of life care, according to 2000-2001 survey results from 125 medical schools compiled by the Association of American Medical Colleges (AAMC).

Less than a third of schools offer elective courses in pain management, and only a quarter of schools provide electives in end of life care, the survey results show. "If we are to effectively treat a future generation of pain patients, we first must educate that next generation of doctors who will care for them", stated Dr. Jordan Cohen, president of the Association of American Medical Colleges.

A distinguished team of physicians, including the deans of two prestigious medical schools, the past president of the American Academy of Pain Medicine, and the president of the American Pain Society, drew on thousands of hours of instructional and clinical experience to develop the virtual textbook. TOP MED's content is based on best practices in pain diagnosis and treatment.

The virtual textbook comprises 9 modules, plus a self-test section. The subjects are: human and social costs of pain; neurobiology; evaluating a patient; analgesics; acute pain; cancer pain and palliative care; chronic (persistent) non-cancer pain (neuropathic and back pain); paediatric pain; and culture, race and ethnicity.

Because TOP MED is Web-based and self-directed, medical students will be able to learn when and where it is convenient in their crowded schedules. Self-testing allows students to measure their understanding of topics and to repeat modules until they have mastered the material.

"TOP MED will put the best information on pain medicine right at students' fingertips", stated Dr. Daniel Carr, executive editor of the TOP MED project, professor of pain research in the Departments of Anaesthesia and Medicine at New England Medical Center in Boston and secretary of the American Academy of Pain Medicine. TOP MED is sponsored by an educational grant from the Purdue Pharma Fund.

Physicians and educators already unveiled highlights of the first 2 modules to be completed in the virtual textbook, namely on Cancer Pain and Palliative Care, and Neurobiology. These modules will be tested in the field in the coming months at Morehouse School of Medicine, the University of Connecticut School of Medicine and the Texas College of Osteopathic Medicine. The completed virtual textbook should be available to students across the country in the fall of 2004.

In addition to Drs. Sullivan, Satcher, Carr and Cohen, those supporting the new initiative are Dr. Marc Hahn, dean of the Texas College of Osteopathic Medicine at the University of North Texas Health Sciences Center and immediate past President of the American Academy of Pain Medicine; and Dr. Douglas Wood, D.O., Ph.D., president of the American Association of Colleges of Osteopathic Medicine.

Leslie Versweyveld

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