Academic Psychiatry

, Volume 43, Issue 5, pp 494–498 | Cite as

Difficult Conversations: Training Medical Students to Assess, Educate, and Treat the Patient with Chronic Pain

  • Alison M. VargovichEmail author
  • Matthew E. Schumann
  • Jun Xiang
  • Alexander D. Ginsberg
  • Brian A. Palmer
  • Jeannie A. Sperry
In Brief Report



Chronic pain, along with opioid abuse and misuse, continues to be a prevalent problem across the USA. Medical students have minimal training in biopsychosocial treatment of chronic pain and often lack the knowledge and skill necessary to address chronic pain with their patients. While there are a variety of treatment options available, research repeatedly has demonstrated that biopsychosocial treatment is the most effective option for chronic pain. Engaging patients in this type of treatment requires training and education.


The authors implemented a simulation workshop with standardized patients to educate medical students on the physical, psychological, and social aspects of chronic pain and also train students on the most effective ways to discuss chronic pain and educate their patients. Outcomes were measured by a pre- and post-test survey of knowledge, attitudes, and confidence in treating chronic pain, as well as satisfaction with the learning experience.


Test and survey results indicated improvements in knowledge, attitudes, and confidence in treating chronic pain. Additionally, students were satisfied with the experience as evidenced by high post-workshop ratings.


Chronic pain training during medical school is associated with students feeling more prepared to provide non-opioid biopsychosocial pain treatment. Additionally, training with standardized patients allows students to learn how to effectively educate their patients, reduce negative confrontations, and maintain a positive physician-patient relationship.


Chronic pain education Medical school Multidisciplinary Biopsychosocial treatment of pain 


Acknowledgements and Conflicts of Interest/Disclosure Summary

The authors have no conflict of interests or financial relationships to declare.


  1. 1.
    Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press; 2014.Google Scholar
  2. 2.
    Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville: National Center for Health Statistics; 2017.Google Scholar
  3. 3.
    Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319:872–82.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Baldini A, Von Korff M, Lin EHB. A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. Prim Care Companion CNS Disord. 2012;14(3).
  5. 5.
    Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624. Scholar
  6. 6.
    Scascighini L, Toma V, Dober-Spielmann S, Sprott H. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheum. 2008;47(5):670–8. Scholar
  7. 7.
    Reese C, Mittag O. Psychological interventions in the rehabilitation of patients with chronic low back pain: evidence and recommendations from systematic reviews and guidelines. Int J Rehabil Res. 2013;36:6–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Zgierska AE, Burzinski CA, Cox J, Kloke J, Stegner A, Cook DB, et al. Mindfulness meditation and cognitive behavioral therapy intervention reduces pain severity and sensitivity in opioid-treated chronic low back pain: pilot findings from a randomized controlled trial. Pain Med. 2016;17:1865–81.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Nijs J, Clark J, Malfliet A, Ickmans K, Voogt L, Don S, et al. In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain. Clin Exp Rheumatol. 2017;35(suppl 107):108–15.PubMedGoogle Scholar
  10. 10.
    Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol. 2014;69:119–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Mezei L, Murinson BB. Pain education in North American medical schools. J Pain. 2011;12:1199–208. Scholar
  12. 12.
    Shipton EE, Bate F, Garrick R, Steketee C, Shipton EA, Visser EJ. Systematic review of pain medicine content, teaching, and assessment in medical school curricula internationally. Pain Ther. 2018;7:139–61.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Corrigan C, Desnick L, Marshall S, Bentov N, Rosenblatt RA. What can we learn from first-year medical students’ perceptions of pain in the primary care setting? Pain Med. 2011;12:1216–22.CrossRefPubMedGoogle Scholar
  14. 14.
    Krisberg K. Medical schools confront opioid crisis with greater focus on pain, addiction education. AAMC News. 2018. Accessed July 2018.
  15. 15.
    Jamison RN, Scanlan E, Matthews ML, Jurcik DC, Ross EL. Attitudes of primary care practitioners in managing chronic pain patients prescribed opioids for pain: a prospective longitudinal controlled trial. Pain Med. 2015;17:99–113. Scholar
  16. 16.
    Pearson ACS, Eldrige JS, Moeschler SM, Hooten WM. Opioids for chronic pain: a knowledge assessment of nonpain specialty providers. J Pain Res. 2016;9:129–35.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Darnall BD, Ziadni MS, Stieg RL, Mackey IG, Kao MC, Flood P. Patient-centered prescription opioid tapering in community outpatients with chronic pain. JAMA Intern Med. 2018;178(5):707–8. Scholar
  18. 18.
    Accreditation Council for Graduate Medical Education (ACGME). ACGME Common Program Requirements. 2017; 9–12. PDF file.
  19. 19.
    SAS institute, Inc. Cary NC. 2013.Google Scholar

Copyright information

© Academic Psychiatry 2019

Authors and Affiliations

  1. 1.SUNY, Department of Medicine, Division of Behavioral MedicineUniversity at BuffaloBuffaloUSA
  2. 2.Mayo ClinicRochesterUSA
  3. 3.West Virginia UniversityMorgantownUSA
  4. 4.Allina HealthMinneapolisUSA

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