By Will Boggs MD
NEW YORK—Psychiatry residents typically receive little or no education and training in pain medicine, according to a survey of psychiatry residency program directors in the U.S.
"Chronic pain and psychiatric illnesses are frequently comorbid," Dr. Muhammad Hassan Majeed from Natchaug Hospital, in Mansfield Center, Connecticut, told Reuters Health by email. "There is also a significant overlap between psychiatric and pain-management pharmacological and psychotherapeutic interventions. With some education and training in pain management, psychiatrists may be well positioned to treat many patients with chronic pain disorders."
A 2012 survey found that two-thirds of psychiatry residency programs offered formal didactics in pain and that 87% of program directors were interested in expanding education in pain management (https://bit.ly/2IU1GJa).
Dr. Majeed and colleagues created an 11-item questionnaire to assess whether the education, training and practice of pain management have changed since then. They received 107 responses from psychiatry residency program directors (about half of those contacted).
Seventy percent of program directors agreed with the statement "Psychiatry residents should have didactic and clinical experience in the management of patients with chronic pain disorders"; 16% of program directors disagreed.
Even among program directors who agreed with the statement, 16% had programs with no didactic clinical exposure or pain-management supervision. Overall, 21% of programs offered no such experience.
Most programs (69/107) offered an elective in pain management (compared with less than half of the programs in the earlier survey), and 45 programs had at least one resident who elected this experience.
About a quarter (22%) of programs required mandatory rotation in pain medicine, compared with 7% in the earlier survey.
About a third of programs reported participation in a multidisciplinary pain-management program, and 14 programs reported a total of 21 residents selecting a career in pain management.
Sixty program directors indicated an intention to increase education and training about pain management in their programs in the next two years, the researchers report in Pain Medicine, online May 16.
The most frequently cited barriers to education and training in pain management were the lack of trained faculty for education and supervision (73%) and the lack of time (37%).
"Program directors not favoring the need for pain management education for psychiatry residents provide insight into some of the larger issues," the authors note. "These include liability for treating conditions that are generally outside the scope of psychiatry, lack of experience on the part of the psychiatry resident in dealing with heterogenous etiologies of pain, and overall lack of interest of psychiatry residents in pain management. Greater participation of psychiatrists in pain management would require a cultural shift within and outside of psychiatry."
Currently, they add, there are fewer than 100 pain-medicine board-certified psychiatrists in the country, from a pool of approximately 4,000 pain specialists.
"Expanding the active participation of psychiatrists should bring a new perspective to the field of pain management, increase human capital to treat more patients, and particularly help patients with comorbid mental illnesses by fostering compliance, decreasing stigma, and improving mental health while administering effective pain-management services," said Dr. Majeed, who is about to begin a pain-management fellowship at Johns Hopkins Hospital.
"Pain is a public-health concern, and if psychiatrists take an active role in chronic pain management, the goal of effective pain treatment as a basic human right for everyone could be fulfilled," he added.
Pain Med 2019.
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