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“The more we come to know about what’s being taught in pain, the more glaringly obvious the gap between theory and practice becomes,” said co-author Beth B. Murinson, MD, PhD, associate professor and director of pain education at Johns Hopkins School of Medicine, in Baltimore.

Chronic pain affects at least 116 million U.S. adults, many of whom receive inadequate assessment and treatment, according to the Institute of Medicine.

The researchers discovered that pain is most often taught in the context of a more general required course that is not focused on pain—an approach the researchers called fragmentary. Among U.S. medical schools, only 3.8% reported having a required pain course. An additional 16.3% of U.S. medical schools offered a designated pain elective. The total number of pain sessions taught at a single school ranged from one to 28, with a mean of nine and a median of seven. A large number of U.S. medical schools did not report teaching any pain courses and an equally large number commit fewer than five hours to pain education over four years.

Steven D. Passik, PhD, professor of psychiatry and anesthesiology at Vanderbilt University Medical Center, in Nashville, Tenn., said, “It is lacking in almost every respect—not enough time spent, not enough breadth of the psychological and other complications of pain, not nearly enough case-based understanding. Given that pain is the most common reason people go to the doctor, it is a travesty that more time is not spent on it.”

Areas particularly underserved, said Dr. Murinson, are pediatric pain, cancer pain and medicolegal issues pertaining to opioids. “There’s literally almost nothing on these topics,” she added. “Kids should not suffer needless pain. And, clearly, cancer patients should not endure untreated pain.” Geriatric pain also is not addressed sufficiently, according to the study.

Pain education currently focuses on basic science, but more pragmatic education is needed, according to Dr. Murinson. “There’s a groundswell for more clinically focused education,” she said.

The authors recommend that the number of required, integrated, pain-focused courses be increased, as part of a more organized, formal delivery of pain education. Dr. Murinson has developed a curriculum for pain, an 18-hour course at Johns Hopkins. Her personal mission is “to understand better how medical students grow and develop as clinicians.” Emotional as well as intellectual skills are important. “We’re asking how to facilitate students’ progress toward becoming highly compassionate physicians,” she said.

Carol Aschenbrener, MD, chief medical education officer at the Association of American Medical Colleges (AAMC), said the new study was limited by the great variability in the extent of data reported by medical schools. (Data from AAMC were used in the study.) “There are many areas where we can improve, and [pain education] is one of them, but we shouldn’t focus just on medical school,” she said.

The Journal of Pain study is important, said Dr. Passik, because “it documents just how bad the problem is and gives a recent perspective, i.e., that this problem has been known for a long time. If anyone was laboring under the misconception that it had improved with all the attention to pain that has characterized recent years, this [study] demonstrates that it has not.”