There are two significant patient groups which are not emphasized in the higher curriculum: inpatients with exacerbations of chronic pain and patients with drug abuse or addiction problems.
The ability to manage patients with exacerbations of chronic pain in the inpatient setting is a core skill. This patient group forms a significant proportion of the work of an inpatient pain team (audits suggest 25-33% of consultant time). However, 50% of inpatient pain services feel they are not integrated with chronic pain services and 60% have no members with expertise in chronic pain management. Inpatient pain consultants need to be able to manage these patients effectively, but would seem to be under-trained at present.
The management of patients with opioid tolerance or addiction is currently part of the advanced pain curriculum, but needs to be introduced at the higher training level. Trainees need to understand the risks of starting opioids and anti-neuropathic medications. Some training within a drug misuse service is highly desirable.
PM_AK_04 describes the principles of pain management in patients with problem drug use, physiological tolerance, psychological dependence and addiction
