Good adverse effect management is a necessary skill for delivering good analgesia. These specialists were asked to identify barriers to good pain management in their own practice settings. In both studies, inadequate assessment was identified as the major barrier to good pain control. These physicians also saw lack of staff knowledge about pain management as a barrier. Both samples felt that their training in pain management in medical school was inadequate and not much better in postgraduate training.
Most medical schools devote little or no time to pain assessment and management.
Studies of physicians in training confirm the impressions of cancer specialists that they were also poorly prepared to manage pain by postgraduate education. There is no lack of consensus that cancer pain should be aggressively managed and that more severe pain should be matched with analgesics strong enough to control it. It certainly should not prove difficult for those used to managing cancer, AIDS, or other chronic diseases that require combined therapies that have multiple adverse effects. As the cancer specialists in the studies cited above recognized, lack of proper pain assessment is a priority issue. At a minimum, patients with aggressive disease need to be asked to rate the severity of their pain on a scale from 0 to 10 at every visit and encouraged to call between visits if pain becomes a problem.