Some medical schools around the country have begun to change the conversation around pain management.
Medical schools are rethinking how they train doctors in pain management and addiction treatment, in hopes of graduating a generation of medical professionals that are better able to serve the needs of patients living amid the opioid epidemic.
In a recent role-play exercise at the Warren Alpert Medical School of Brown University, students talked to a patient about her back pain, and learned to ask an important question: “Have you ever taken any medications that weren’t prescribed to you?”
“To be perfectly honest I stopped buying the Percs because they were too expensive, and I started buying heroin, because it was cheaper. I’ve been doing the heroin for the past 5 months,” the woman playing the patient replied.
Dr. Paul George, associate dean of medical education at Brown, told WBUR that the exercise is a realistic representation of what pain doctors may face. “The point of that workshop is for the students to work together to show it really does take a team to care for folks who are using substances inappropriately,” he said.
Recently, Brown and the University of Massachusetts (UMass) were both recognized by the Association of American Medical Colleges for their proactive approaches to teaching medical students about pain management and addiction.
At UMass, Jill Terrien teaches graduate-level nursing students to talk to their patients about pain. Rather than treating pain as the fifth vital sign and aiming to mitigate it, Terrien encourages nurses to tell patients that they should expect some pain after undergoing major procedures like surgery.
“In our curriculum now, we’re more deliberate about [telling patients] ‘you’re going to have pain,’” she said. “That way patients don’t expect that a) they’re going to get opioids because that’s what they’ve always gotten, and b) that might not be the best treatment for them.”
In addition to changing the conversation around pain management, UMass and Brown both provide all medical students the training they will need to prescribe buprenorphine, a medication commonly used for medication-assisted treatment.
Currently, under 7% of doctors hold the waiver needed to prescribe buprenorphine, and the medical schools feel that needs to change.
“They can prescribe Oxycontin, they can prescribe morphine. It seems almost unfair they can’t prescribe a medication that is used to treat some of the consequences of prescribing opioids,” said Sarita Warrier, associate dean of medical education at Brown.
Paul Wallace, who recently graduated from medical school at Brown, agreed.
He said, “It helps dispel the notion that treating opioid use disorder is purely the domain of addiction specialists or primary care doctors, when truly all different types of physicians are going to encounter patients with opioid use disorder, whether it’s an emergency physician seeing a patient after an overdose or an obstetrician working with a patient with opioid use disorder.”