Pain education: from the idea to action!

Knowledge acquisition and use have always been challenging to mankind. One day, I received as a gift, “to reflect and to have fun with names and classifications” the book Kant and the Platypus¹ by Humberto Eco. Right from the start, it makes it clear that there is nothing in common between the two characters. The author wants to talk about the act of naming things, which is part of knowledge acquisition. Kant introduced the basis of the empirical concept that goes from the sense to the concept. In turn, the platypus had great conceptual difficulty since it is an obvious mixture of different animals. It took 80 years to be recognized as a mammal. According to the author, the resistance of many scholars was what delayed this recognition. After all, a lot of evidence was required, which is not always easy to obtain. On the other hand, to under- stand, conceptually and in practice, the issue of chronic pain is a challenge for students and educators. Now, just imagine for the patients!

A Brazilian study conducted in 2005 and 2006 asked dental surgeons and doctors who attended Congresses on pain, what they thought about patients with chronic pain². The study showed that most of the professionals graduated more than 10 years ago. However, the training to approach patients with chronic pain was recent. There was also a trend to emphasize the technical background of their own specialty or profession. In addition, the percentage of professionals who considered the professional/patient relationship, the emotional aspects of pain and the patient’s behavior with chronic pain important for the control of the symptom was small. Although the professionals showed an interest in the subject, the results of the study showed a divergence between the clinical approach expressed and the one recommended for the treatment of pain^3-5.

A lot has changed over the years, as the regulation regarding the expertise in pain in several health professions. Conferences, like the recent 8^th Interdisciplinary Pain Congress (CINDOR), showed that undergraduate, graduate students, researchers of the basic area and professionals from several health areas are interested in knowing, updating and discussing the issue of pain.

The experience of physical pain doesn’t seem something simple to understand in practice, and usually, there is no uniformity on the subject. Likewise, it took many years of research and discussion to reach the current concept of pain that still generates debates. When the theme is “Education in pain”, it seems that there is no disagreement as to its importance and need. The International Association for the Study of Pain (IASP) chose it for its 2018 global year⁶, summarizing in one of its educational brochures: “Much work is still to be done: the appropriate education in pain is essential for all healthcare professionals (and patients), and the multidisciplinary teamwork is critical to the success of pain control. Education in pain should be included for the purpose of competence, in the curricula and examinations of health undergraduate and graduate students and should be incorporated into the continuous education programs”.

It is not easy to turn ideas into productive actions. In Jacob’s fight with an Angel painting, Paul Gauguin expresses the idea of transforming the abstract into reality⁷. From the abstract to the empirical. The abstract immersed in reality. It’s as if the artist answered the philosopher, turning the abstract, the conceptual, into an empirical experience. Coming in the opposite direction, showing the abstract in the reality in which it is imagined. In education, it is really necessary to have an integrated effort among professionals, students, patients, family, and managers.

In a digital, real-time and globalized world, the educational activity may be influenced by the social environment, by the attention or negligence of managers, by the influence of the industries and laboratories, by the resistance to change, and even by the professional’s ethical conduct. This has a global reach, but in poor or developing countries, the vulnerability is higher. The challenge of education is huge. And in a country like ours, in which education is heavily criticized at all levels, including the University, action is necessary. The ideas are already set forth.

But when there is the collective suffering in a country that is writhing among several plans (health, public security, education) and that sees or has in soccer a relief, one wonders what to talk about education when the managers are mistrusted, and the elderly become faithless or indifferent. Thinking about this dilemma, and looking for material for this text, I came across a picture of the residents’ schedule of the Oro- facial Pain Dentistry Division of Hospital das Clínicas of the School of Medicine of the University of São Paulo (HC-FMUSP). The photo drew my attention to the phrase written in bold letters “If I could, I would take the pain, put it in an envelope and return it to the sender”⁸, by the poet Mário Quintana.

Suddenly, in a dentistry team, a profession directed to the instrumental practice that involves diagnosis and therapy, the choice of a poem to be on the cover denotes that the lessons about the patient with pain are working. Also, that message based on the apparent simplicity of daily life, a metaphor that addresses a complex suffering issue, points out that we are learning and teaching about the need and importance of seeing on the individual complaint, the integration of all dimensions of pain.

So, let’s turn the idea of “education in pain” into actions necessary to our reality. And there are many examples of pedagogical experi- ence throughout the country, such as the postgraduate, multidis- ciplinary, residence and specialization courses on pain. Let’s copy them, discuss them, recycle them! It is time to reflect and face the challenge of applying the concept to the clinical practice⁹. And let’s move on, because, without hope, no action gives meaning to life, let alone ideas.

And there is no doubt that the fight against pain brings hope, and perhaps meaning to life!

REFERENCES

• ¹
  Eco H. Kant e o ornitorrinco. Rio de Janeiro: Record; 1998.
• ²
  Bérzin MG, Siqueira JT. Study on the training of Brazilian dentists and physicians who treat patients with chronic pain. Braz J Oral Sci. 2009;8(1):44-9.
• ³
  Federal Council of Medicine. The doctor and his work: methodological aspects and results of Brazil. Brasilia: Federal Council of Medicine; 2004.
• ⁴
  Loeser J. Pain, suffering and the brain: a narrative of meanings. In: Loeser JD, Carr DB, Morris D (eds). Narrative, Pain and Suffering. Seattle: IASP Press; 2005.
• ⁵
  Siqueira JTT. Dores Mudas. As Estranhas Dores de Boca. São Paulo: Artes Médicas; 2007.
• ⁶
  Ogboli-Nwasor E. Educação e dor nos países de poucos recursos. Fact-sheet No. 8. Global Year of Education and Pain. IASP; 2018.
• ⁷
  Gauguin P. The vision after the sermon. Galeria Nacional de Arte Moderna da Escócia. 1888.
• ⁸
  Quintana M. Poesia completa. Rio de Janeiro: Nova Aguilar; 2005.
• ⁹
  Sarda Jr JJ. Challenges in pain education in Brazil: where are we going? Br J Pain 2018;1(2):93.

Publication Dates

• Publication in this collection
  Jul-Sep 2018