Pain is one of the most common reasons people seek help from healthcare professionals – whether from a physician, physiotherapist, or nurse. Yet many professionals acknowledge that they lack sufficient knowledge to understand the nature of pain, assess its significance, or provide patients with modern, evidence-based support. This is particularly relevant in persistent or chronic pain, where the original illness or injury may no longer be clearly related to the cause or nature of the pain.
Patients whose pain is still in the subacute phase but who are at high risk of developing chronic pain are also often overlooked. If these risk factors are not identified and addressed early, the patient may not receive adequate attention and may go on to develop chronic pain over the following months.
This is where evidence-based continuing education becomes essential. Because healthcare professionals’ initial training is already extensive and demanding, it inevitably cannot cover everything they may need in clinical practice. Continuous professional development is therefore crucial.
We believe that most healthcare professionals would benefit from evidence-based continuing education in pain to provide patients with the best possible care.
1. Pain is one of the most common complaints in healthcare
Pain is one of the main reasons people seek healthcare services. This is not surprising, as pain can directly affect a person’s ability to function and lead to a range of activity limitations and participation restrictions. It may limit movement, impair concentration, disrupt sleep, and contribute to the development of anxiety, depression, and other mental health problems.
Pain can prevent people from engaging in meaningful activities, whether at work, with family, or in their hobbies. In cases of persistent or chronic pain, people may be absent from work for months or even years. Social life can also be affected, making it difficult to participate in social activities or maintain important roles within the family and community.
Because pain affects daily life on physical, psychological, and social levels, it is important for every healthcare professional to understand its multifaceted nature. Up-to-date knowledge of pain mechanisms, assessment, and patient education is essential for providing meaningful, evidence-based support.
2. Pain is covered too superficially in healthcare education
Although pain is one of the main complaints that brings patients to healthcare professionals, education about pain remains surprisingly limited in basic healthcare training. According to a 2011 international study, pain education accounted for less than 1% of the total curriculum in medical education. No similarly comprehensive study has yet been conducted in Estonia, but it is known that medical education does not include a compulsory course dedicated specifically to pain. Pain is addressed only briefly and across different subjects, without a systematic and comprehensive approach. Nursing curricula likewise do not include a dedicated pain course, so much of the knowledge is acquired through clinical practice, where the quality and evidence base may vary. In physiotherapy, the situation has improved: the University of Tartu has now introduced a compulsory pain management course at master’s level.
Gaps in pain-related knowledge have also been measured empirically. One of the most commonly used assessment tools is the Neurophysiology of Pain Questionnaire (NPQ). In an international study, third-year medical students answered only 55% of NPQ questions correctly, compared with 69% of physiotherapy students and 42% of nutrition science students. A master’s thesis at the University of Tartu (Barkova, 2021) found similar results in Estonia: final-year medical students answered an average of 65% of the questions correctly, physiotherapy students 52%, and nursing students only 45%.
Considering that the NPQ assesses only basic knowledge of pain, these findings clearly suggest that pain education in healthcare degree programmes is insufficient and that continuing education is necessary to support modern, evidence-based patient care.
3. In clinical practice, pain is often managed using outdated concepts and methods
Long-term experience working in healthcare has shown that pain is still often explained to patients using an outdated biomedical model. This means that pain is attributed mainly to structural factors such as the type of injury, posture, restrictions in joint mobility, or muscle flexibility. Although biological factors do play a major role in acute pain, this is not the case with chronic pain, where pain is a much more complex and multifaceted phenomenon. Many healthcare professionals are not sufficiently familiar with the different types of pain and do not adapt their approach accordingly.
A biomedical approach to pain may be not only insufficient in chronic pain, but potentially harmful. When patients are given misleading explanations, they may develop misconceptions that influence their behaviour: they may begin to avoid movement, live in constant fear, and experience mental health problems.
Modern evidence-based pain management is based on the biopsychosocial model. According to this model, psychological and social factors are important alongside biological factors – including the patient’s beliefs, previous experiences, emotional state, working conditions, and social support. Understanding this model makes it possible to identify risk factors for chronic pain at an early stage and intervene in ways that can positively influence the course of pain and improve the patient’s ability to cope.
4. The Impact of Pain Extends from the Individual to Society
Pain affects us at many different levels – from the individual to society as a whole. At the individual level, it often means that a person is unable to participate in everyday activities, withdraws from working life, gives up hobbies, or becomes socially isolated. Meaningful activities are put on hold, often accompanied by a decline in mental wellbeing.
At the societal level, the impact is even broader. The world’s largest study of disease burden – the Global Burden of Disease Study (The Lancet)\ – has repeatedly concluded that the prevalence of pain is increasing and that pain is one of the major contributors to the global burden of disease. The most common problems include low back pain, migraine, neck and shoulder pain, and joint pain caused by osteoarthritis.
Although pain is usually not life-threatening, its effects can be long-lasting and debilitating. A person living with chronic pain may remain outside the workforce for years and may require income support and social services. They may also need extensive healthcare services, ranging from primary care to specialist consultations, repeated diagnostic tests, and long-term, costly therapies.
This is where the role of healthcare professionals becomes critically important. If we can identify pain problems early, treat them more effectively, and improve patients’ ability to cope, we can reduce not only individual suffering but also the wider social and economic burden. This, in turn, creates more capacity to address other important health problems.
5. Patients’ Expectations of Healthcare Professionals Have Changed – They Expect Meaningful Support
In recent years, patient behaviour and expectations have clearly changed. On the one hand, access to information has reached a new level – smartphones and artificial intelligence allow many patients to quickly gain understandable information about their health conditions. On the other hand, distrust in evidence-based medicine has also increased, while misleading information and misconceptions have become more widespread.
This creates a paradoxical situation: more and more patients arrive at appointments with a substantial but uneven body of information – some are genuinely well informed, while others have been misled. In both cases, patients expect clear explanations. Healthcare professionals may therefore find themselves in situations where answering questions requires both up-to-date knowledge and clear, trust-building communication skills. Patients often research pain-related topics before their appointment, and in some cases their level of knowledge may even exceed that of the healthcare professional they are seeing.
This is particularly important in chronic pain, where healthcare professionals may need to challenge myths, help patients develop new ways of understanding their pain, and rebuild trust in the healthcare system. The ability to understand and explain pain begins with basic neurophysiology, but communicating it effectively also requires thoughtful and skilful communication.
This is exactly what our continuing education courses focus on: helping healthcare professionals understand the mechanisms of pain and teaching them how to communicate this knowledge to patients in a way that is clear, reassuring, and supports collaboration.
Continuing education in pain helps healthcare professionals fill gaps in their basic training, gain new perspectives, and strengthen their competence in managing complex cases.
Pain is a complex and multidimensional phenomenon that can profoundly affect people physically, psychologically, and socially. Yet pain-related knowledge is often insufficiently covered in the basic education of healthcare professionals, while common approaches in clinical practice are still frequently based on outdated models. Healthcare systems now face new challenges: better-informed patients, a growing burden of disease, and an increasing need for effective, compassionate, and evidence-based care.
Continuing education in pain helps healthcare professionals fill gaps in their basic training, gain new perspectives, and strengthen their competence in managing complex cases. It is an important step towards more evidence-based practice and better patient outcomes.
If you want to explain pain in a clear and evidence-based way, understand the mechanisms behind it, and be better prepared for the expectations of today’s patients, we invite you to join our training courses.
Explore our training courses here.
References:
- Briggs EV, Carr EC, Whittaker MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011 Sep;15(8):789-95. doi: 10.1016/j.ejpain.2011.01.006. Epub 2011 Feb 16. PMID: 21330174. https://pubmed.ncbi.nlm.nih.gov/21330174/
- Adillón, C., Lozano, È. & Salvat, I. Comparison of pain neurophysiology knowledge among health sciences students: a cross-sectional study. BMC Res Notes 8, 592 (2015). https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-015-1585-y
- Barkova, K. Arstiteaduse, õenduse ja füsioteraapia üliõpilaste teadmised valu neurofüsioloogilistest mehhanismidest. Masters thesis. Tartu Ülikool, 2011. http://hdl.handle.net/10062/81725
- Rice, Andrew S.C.; Smith, Blair H.; Blyth, Fiona M.. Pain and the global burden of disease. PAIN 157(4):p 791-796, April 2016. https://journals.lww.com/pain/citation/2016/04000/pain_and_the_global_burden_of_disease.6.aspx
- https://www.thelancet.com/gbd