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      Acute and Chronic Pain Learning and Teaching in Medical School—An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students

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          Abstract

          Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group ( p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.

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          Most cited references32

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          The prevalence of chronic pain with an analysis of countries with a Human Development Index less than 0.9: a systematic review without meta-analysis.

          To date, there are no systematic reviews of epidemiological studies of chronic pain in the developing world. To estimate the prevalence of chronic pain worldwide paying particular attention to data from countries with a Human Development Index (HDI) of less than 0.9. A literature search was conducted for cross-sectional surveys of chronic pain (≥3 months) in the adult general population using Medline, Embase, CINAHL, SportDiscus, Sciencedirect, CAS ILLUMINA, Academic search complete, PsycINFO and AMED. Forty-eight studies were identified and 29 of these were excluded because they surveyed children, the elderly or were longitudinal studies. Weighted mean ± SD prevalence of chronic pain worldwide was 30.3% ± 11.7% (19 studies, 65 surveys, 34 countries, 182,019 respondents). There was no correlation between HDI and prevalence. In countries with a HDI < 0.9 prevalence was 33.9% ± 14.5% and significantly higher than prevalence in countries with a HDI of ≥0.9 (29.9% ± 12.7%), although removal of a large study that may have included a sample of individuals with comorbidities reduced the worldwide estimate to 28.0% ± 11.8% (47 surveys, 33 countries, 139,770 participants). Interestingly, the estimate of countries with a HDI < 0.9 to 24.8% ± 8.9% (7 surveys, 7 countries, 6122 participants) became significantly lower than the estimate of countries with a HDI ≥ 0.9 which was 28.1% ± 11.6% (40 surveys, 21 countries, 133,648 participants). The review provides further evidence that the prevalence of chronic pain in the general population is high. However, there was insufficient reliable data to estimate with any certainty the prevalence of chronic pain in countries with an HDI < 0.9 with variability in estimates between surveys being of concern. Subtle differences in review and survey methodology appeared to impact markedly on estimates. There is a need for epidemiological studies that estimate the prevalence of chronic pain in developing countries to determine the scale of the problem.
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            Pain as a reason to visit the doctor: a study in Finnish primary health care

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              Identification and Management of Chronic Pain in Primary Care: a Review

              Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and re-assessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Primary care management should be holistic and evidence-based (where possible) and incorporates both pharmacological and non-pharmacological approaches, including psychology, self-management, physiotherapy, peripheral nervous system stimulation, complementary therapies and comprehensive pain-management programmes. These may either be based wholly in primary care or supported by appropriate specialist referral.
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                Author and article information

                Journal
                Medicina (Kaunas)
                medicina
                Medicina
                MDPI
                1010-660X
                1648-9144
                26 August 2019
                September 2019
                : 55
                : 9
                : 533
                Affiliations
                [1 ]Student Science Club at the Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
                [2 ]Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland
                [3 ]Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland
                [4 ]Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, 70-111 Szczecin, Poland
                Author notes
                [* ]Correspondence: aleksandra.szylinska@ 123456gmail.com ; Tel./Fax: +48-91-48-00-914
                Author information
                https://orcid.org/0000-0001-6105-5329
                https://orcid.org/0000-0002-4337-6476
                https://orcid.org/0000-0001-8430-1369
                Article
                medicina-55-00533
                10.3390/medicina55090533
                6780207
                31454932
                a852debb-800f-4559-9852-54b482aeff48
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 30 June 2019
                : 21 August 2019
                Categories
                Article

                pain,medical education,student,pain scales,bps,cpot,delirium
                pain, medical education, student, pain scales, bps, cpot, delirium

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