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A medical school is trying to face an underlying problem of the opioid epidemic. Addictive though they are, opioids are manufactured to address a real problem - pain. That's where the medical school comes in. It's teaching future doctors to think in new ways about pain management. NPR's Nell Greenfieldboyce went to class.
NELL GREENFIELDBOYCE, BYLINE: Over a hundred would-be doctors are gathering in a lecture hall in Baltimore. This is Johns Hopkins University, home to one of the top medical schools in the country. Its first-year medical students have gathered for a mandatory part of their education.
SHRAVANI DURBHAKULA: OK, good morning. Welcome to the pain course.
GREENFIELDBOYCE: The pain course - four whole days on nothing but pain. Annie Cho is one of the students.
ANNIE CHO: I initially was a bit scared and I guess a bit wary coming into this course because of the opioid crisis. And that seems like that's the only thing people have been talking about nowadays.
GREENFIELDBOYCE: She's about to become a doctor at a time when physicians are under pressure to limit prescriptions for opioid painkillers. Yet every day, they face patients who are hurting, from injuries, surgical procedures, diseases. Around 20% of adults in the U.S. live with chronic pain. The students seem well aware of the challenges they'll face. Jenny Franke says she's been shadowing doctors in a clinic and has already seen new patients come in with pain.
JENNY FRANKE: And it seems that the therapy that they're on hasn't been working. And a lot of the times, their past primary care providers have just kept prescribing the same thing over and over. And sometimes, those patients will ask for opioids, and then it turns into kind of an awkward conversation.
GREENFIELDBOYCE: This kind of clinical experience is the traditional way that doctors have learned to deal with this. Shravani Durbhakula is assistant professor in the division of pain management at Johns Hopkins. She's directing the course this year.
DURBHAKULA: Most medical schools get about nine hours of formalized pain education. If I was to think back to my training, it probably is somewhere about that much time.
GREENFIELDBOYCE: She recalls lectures on a few types of painkillers.
DURBHAKULA: But I don't remember a lot of formal pain education, certainly not any kind of course that was given to me. And it was something you just kind of learned as you went along.
GREENFIELDBOYCE: Here, the students learn what pain is, how it's a physical and emotional experience, how doctors tend to underestimate pain, how it can be affected by people's moods or cultural expectations or individual sensitivity. They discuss problems with the usual way of asking patients to rate their pain on a scale of one to 10. They learn to instead ask if and how pain limits people's daily activities. And, of course, they talk about opioids. Beth Hogans is a neurologist and pain specialist at Johns Hopkins who helped create this course. About a decade ago as the crisis was taking off, she looked to see what medical schools were teaching.
BETH HOGANS: U.S. medical students were getting less than one hour on average of opioid-related instruction in medical school. That's not enough.
GREENFIELDBOYCE: This course explores not just the nuts and bolts about prescribing opioids but also how these students feel about them. A doctor named Ryan Graddy asked the students to pull out their cellphones. He says they should text him a few words in response to this question.
RYAN GRADDY: What comes to mind when I say chronic opioid therapy?
GREENFIELDBOYCE: Their answers start to appear on a big screen behind him. The first word is bad.
GREENFIELDBOYCE: Other words pop up - addiction, drug abuse.
GRADDY: So interesting - right? - so a lot of negative connotations that people have with chronic opioid therapy.
GREENFIELDBOYCE: Yet he says some of his patients have successfully been on opioids long term. Opioids can be a useful tool in the toolbox. Though, these painkillers have to be used thoughtfully and carefully. One speaker told a harrowing account of how he was prescribed opioids by about a dozen different caregivers after having an accident in surgery. When he became physically dependent and wanted to stop taking opioids, he couldn't find a doctor willing to help him get through his agonizing withdrawal.
DAVID BOTROS: Ended up in a very, very difficult situation where he was handling withdrawal all on his own.
GREENFIELDBOYCE: David Botros is one of the medical students. He says the story surprised him.
BOTROS: I really didn't expect that to be - I don't want to say possible but even a factor in the health care world I guess.
GREENFIELDBOYCE: He and the other students heard about other possible medications to try, and they learned that pain control goes way beyond just prescribing drugs. Patients could benefit from physical therapy, cognitive behavioral therapy and all kinds of exercise like yoga. Graddy thinks the medical profession overall has done a disservice to patients when it comes to chronic pain.
GRADDY: I see that certainly in my own practice, a lot of patients who have bounced around from place to place and not really been treated with respect or dignity or empathy that they deserve.
GREENFIELDBOYCE: That's why this medical school invited patients and their families to this lecture hall. They movingly spoke about how pain impacts their entire lives. And these students definitely get the message. Tony Wang took this course two years ago. He just finished his third year of medical school.
TONY WANG: The message that I distinctly remember leaving with was pain management is extremely complicated. It's not just give this medication and they'll feel better.
GREENFIELDBOYCE: He's now doing his clinical rotations in the hospital and says most of the patients he sees there have some kind of pain. Nell Greenfieldboyce, NPR News.
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