Pain Education Improves Opioid Prescribing

By Pat Anson, Editor

A safe opioid prescribing course --- aimed at filling in gaps in pain education at many medical schools -- can help reduce the abuse and misuse of opioids, according to a new study published in the journal Pain Medicine.

Boston University School of Medicine launched its Safe and Competent Opioid Prescribing Education (SCOPE) program in 2013, offering live or online courses in chronic pain and safe opioid prescribing practices.

A survey of over 10,000 doctors who took the SCOPE program found that two months after the training about two-thirds of participants reported greater confidence in their prescribing practices, and 86 percent improved how they prescribed opioids and monitored patients.

"Our program improved knowledge, attitudes, confidence and clinical practice in safe opioid prescribing," said corresponding author Daniel Alford, MD, associate professor of medicine at Boston University School of Medicine and course director of the SCOPE of Pain program.

SCOPE was the first program to receive funding from the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy (REMS), which requires opioid manufacturers to fund continuing education programs in pain management.

"While education cannot be the only strategy to combat this national crisis, it can help improve clinician behaviors and be a major part of the solution,” said Alford.

An earlier survey of physicians by Boston University found that many lacked confidence in managing patients on opioids. Over a quarter (28%) said they had not completed certified medical education (CME) in safe opioid prescribing. Many also said they lacked the time or staff to implement an opioid monitoring system for patients, such as drug testing and pill counts.

Only a quarter of the doctors surveyed said they were very confident about their ability to safely manage chronic pain with opioids.

Pain education for doctors – or the lack of it – is such a concern that the National Pain Strategy considers it a top priority.

“Many health professionals, especially physicians, are not adequately prepared and require greater knowledge and skills to contribute to the cultural transformation in the perception and treatment of people with pain,” a draft version of the report states. “Core competencies in pain care are not fully developed and generally do not inform undergraduate curricula in health professions schools or graduate training programs, even those in pain medicine.”

A 2012 study published in the Journal of Pain  called pain education in the U.S. and Canada “lackluster” and warned that unless steps were taken to improve the training of pain physicians, “the crisis in pain care and resultant deaths from opioid abuse will only spiral upwards.”

The study of 117 U.S. and Canadian medical schools found that less than 4% required a course in pain education and only one in six schools offered a pain elective. A large number of U.S. medical schools do not have any pain courses and many of those that do have less than five hours of classes.