Which is challenging: Chronic Pain or Chronic Pain-associated Medical Education/ Training?

Chronic pain is perceived by physicians and healthcare systemsworldwide as a major challenge, costing US $650 billion per year,which is more than the costs of cancer, cardiovascular diseases, anddiabetes [1]. Despite major efforts to find cost-effective solutions,these efforts are heading in the wrong direction. Worldwide, chronicpain-associated knowledge and pain practices are dissociated,and approaches to diagnosis and treatment are mostly based onoutdated knowledge and are highly reductionist. Research, medicaleducation, legislation priorities, and directions are influenced byeconomic dominance, and chronic pain clinical practices, for asignificant majority, are going against medical ethics, evidencebased medicine, and cost-effectiveness. In USA, chronic painpatients are misdiagnosed 40-80% of times according to researchfrom John Hopkins Hospital physicians [2]. Over the past 30 yearsto date, a huge body of research evidence from the perspectivesof conventional pain medicine, complementary/integrative painmedicine, and regenerative pain medicine has not been incorporatedinto chronic pain medical education/training. Therefore, an extensiveand comprehensive 30-month clinical fellowship training programwas created at McMaster University in Canada (2007–2010) to fillthese gaps. Its main outcome is a major shift in pain managementgoals from extremely costly, unsafe pain relief to the cost-effectivetreatment or curing of most chronic pain syndromes and theirunderlying causes.