Teaching Pain Management in Serious Illness in the Era of the Opioid Epidemic: A Team-Based Intervention

Abstract

Introduction Despite the prevalence of pain in patients with serious illness, recent guidelines for opioid prescribing practices have largely excluded palliative care patients. In lieu of such guidelines, many have recommended adapting risk mitigation strategies from the chronic pain arena for palliative care and oncology populations. Teaching interventions are needed to demonstrate how these methods can be applied to patients with serious illness. Methods We developed a teaching intervention for fourth-year medical students to improve knowledge about safe opioid prescribing practices in palliative care patients and emphasized both effective and safe pain management. A secondary aim of the intervention was to demonstrate how a palliative care interdisciplinary team works together to care for a complex patient near the end of life. The intervention lasted 1 hour and consisted of an interdisciplinary case presentation as well as a slide presentation. Results Twenty-two medical students attended the session over 2 years. After the intervention, medical students better understood risk mitigation strategies and felt more strongly that opioids can be a useful tool in treating pain for patients with serious illness. Students' familiarity with palliative care interdisciplinary roles also improved after the intervention. Discussion This session was a useful part of a palliative care 2-week classroom elective and was well received by students. The development of a survey tool that assesses student attitudes around effective and safe pain management in patients with serious illness may be of use to others who teach pain management in palliative care populations.

Demystifying Acute Pain Management in the Emergency Department: A Case-Based Approach

“… 2 – 5 The seminar was well received by our learners while significantly enhancing both their confidence and their knowledge. As physicians continue to address ongoing public health crises related to pain care (e.g., the opioid epidemic or SUD) through medical education, 12 it remains necessary to bolster trainees’ basic understanding of acute pain management. 5 Our seminar not only increases the availability of acute pain educational interventions but also provides ample resources to enhance future facilitators’ comfort with pain education.…”

“…Over the past decade, the number of pain education curricula and resources in MedEdPORTAL and elsewhere has surged in response to the overall limited scope of pain management, though most target learners in GME, emphasizing inpatient pain management 10 or opioid use disorder/withdrawal management. 11 Current UME-targeted publications emphasize pain management in palliative care 12 and family medicine. 13 These interventions highlight pain assessment and management specific to critically ill or dying patients and patients managing chronic pain, without focusing on assessment of acute pain in the undifferentiated patient.…”

Opioid Use Disorder Curriculum: Preclerkship Pharmacology Case-Based Learning Session

“… 18 , 19 The published work from that clerkship curriculum did not evaluate medical student readiness to prescribe MOUD. Other preclerkship curricula in the literature focus on various areas surrounding OUD, from opioid use in pain management 20 , 21 to opioid risk-mitigation strategies (e.g., using naloxone to treat opioid overdose). 22 MedEdPORTAL even hosts a collection of publications on opioids, addiction, and pain medicine.…”

Methadone for Palliative Care Providers: A Case-Based Flipped Classroom Module for Faculty and Fellows

“…Because of the complexity of prescribing methadone for pain with regard to the pharmacologic properties and safety concerns discussed above, we hope this resource will be a useful tool for educators and learners at multiple institutions. This publication builds on multiple existing MedEdPORTAL resources that teach safe opioid prescribing through interactive cases, such as the road map for opioid use by Lester, Remolana, Sandhu, and Scott 7 and recent work by Sagin and colleauges 8 teaching an interdisciplinary approach to pain management to students. Our workshop was created in response to learners’ self-identified need for training on this topic, similar to the session by Vettese, Thati, and Roxas on outpatient opioid prescribing that was developed in response to residents’ reported learning needs.…”