Pain education policies and initiatives in Europe

With Kirstin Fragemann and Dr Christoph Wiese  |  5 Mar 2015  |  Print

Pain education policies and initiatives in Europe

Kirstin Fragemann is a graduate professional educator specialising in nursing science, Universitätsklinikum Regensburg, Germany; Dr Christoph Wiese is medical director of the Pain Management Center, part of the department of anesthesia, Universitätsklinikum Regensburg, Germany. 

Effective pain management is complex, requiring the knowledge and initiative of the multidisciplinary team as well as the implementation of appropriate management structures. Reviews on pain knowledge amongst healthcare professionals reveal issues regarding poor education and insufficient qualifications.[1,2] Pain education needs to involve healthcare professionals at all levels of qualification in order to improve skills and outcome.[3-5]

Lack of curricula hours and consistency

Learning about pain management

Most existing curricula guidelines have been created by national and international pain societies, to encourage the integration of pain education into medical school curricula. Approximately 20 years ago, the International Association for the Study of Pain (IASP) published the first edition of a core curriculum for professional pain education.[5] Several years later IASP provided specific core curricula for professionals, such as physiotherapists, to ensure access to pain education for all.[5,6]

Recent surveys on the status of contemporary pain education at undergraduate level suggest that current efforts may not be enough to eliminate insufficient pain control.[7-9] Despite advances in curriculum development, a survey of UK universities published in 2011 revealed an average of only 12 hours of undergraduate training allocated to pain medicine.[7,8] A survey of 242 undergraduate medical schools in Europe has also revealed a limited average number of hours allocated to pain-related subjects.[8,9]

There are different approaches towards postgraduate courses at the national level. Country-specific differences in the European Union may mean that there is variation and many countries do not formally control the content and duration of pain education programs. As an example, in Germany there are many different pain education programs for nurses. Whilst these courses demonstrate a general consensus on learning objectives, we have found a huge range in course titles and length, from 8-192 hours.[10] A national committee of the German Nurse Association is attempting to unite the professional interests of German pain nurses.

The status in German universities is probably analogous to that of other European countries. According to the German Pain Society, approximately half of the existing 36 medical schools in Germany are teaching pain management.[11,12] However, the recent introduction of amendments to the medical licensure laws has led to the introduction of pain medicine as a specific topic in the medical curriculum, and this must be implemented by all faculties by 2016.[13]

Interprofessional education

The major goal of interprofessional education is to enhance patient-centered care in a collaborative manner, in order to improve patient safety. Greater co-operation is urgently required to ensure that graduates entering clinical practice are trained for interprofessional collaboration and patient-centered care.[4,5] As one of the first providers of an interprofessional pain curriculum for pre-licensed healthcare students, which was implemented and evaluated yearly from 2002-2008, the University of Toronto yielded encouraging data for future learning and development.[4,5] Following delivery of a 20-hour curriculum over a period of one week, statistically significant changes were demonstrated in students’ pain knowledge and beliefs (t=181.28, p<0.001).[5] High ratings were given by most students for the content, relevancy and organization of the information provided.[4] IASP have since published a core curriculum on interprofessional pain education in 2012.[14] In 2014, the British Pain Society is to constitute national recommendations for universities on interprofessional pain education.[8]

In Germany, little effort has been made regarding interprofessional pain management in further education. One national program to enhance the efficacy of pain management is the Regensburg model, which aims to develop an integrated interprofessional pain curriculum.[15] Program evaluation suggests acceptance of interprofessional learning approaches and encourages activities in the field of ongoing education.[16]

Aside from educational deficiencies in the medical field itself, we also need to look at other professional liaison groups, such as pharmaceutical sales representatives (PSRs). A descriptive question-based study from Germany revealed that most PSRs do not meet their self-proposed ideal high standards of being equal partners to the specialist physicians they visit.[17]


Integrating research evidence into practice requires an educational strategy aimed at the multidisciplinary team as a whole. There is more chance of success if pain management representatives are defined within the team, enabling clearly defined tasks and responsibilities. Creating interprofessional algorithms for pain assessment and treatment may help to co-ordinate care and transfer concepts into practice.


1. Bhamb B, Brown D, et al. Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin 2006;22:1859-1865.
2. Johnson M, Collett B, et al. The challenges of pain management in primary care: a pan-European survey. J Pain Res 2013;6:393-401.
3. Carr E, Watt-Watson J. Interprofessional pain education: definitions, exemplars and future directions. Br J Pain 2012;6:59-65.
4. Hunter J, Watt-Watson J, et al. An interfaculty pain curriculum: lessons learned from six years experience. Pain 2008;140:74-86.
5. Watt-Watson J, Hunter J, et al. An integrated undergraduate pain curriculum, based on IASP curricula, for six health science faculties. Pain 2004;110:140-8.
6. Briggs EV, Carr EC, et al. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain 2011;15:789-795.
7. Briggs E. “Pain care: overhaul education for the next generation”. Nurs Times 2014;110:13.
8. Mundipharma International. A Blueprint for Pain Education – Advancing the Provision of Pain Education and Learning (APPEAL), 2013.
9. Fragemann K, Wiese CHR. Weiterbildung in der Schmerztherapie – Stand mono- und interprofessioneller Konzepte im deutschsprachigen Raum. P17.6. Poster presentation. German Pain Congress 2011, Congress Center, Rosengarten, Germany, 5-8 October 2011.
10. Deutsche Schmerzgesellschaft e.V. Medizinische Fakultäten in denen das Deutsche Schmerzgesellschaft e.V. Curriculum implementiert ist, 2012. Available at: Accessed 19 February 2014.
11. Ärztekammer Nordrhein. Medizinische Fakultäten und Fachschaften in Deutschland, Österreich und der Schweiz, 2014. Available at: Accessed 24 February 2014.
12. Dusch M, Benrath J, et al. Cross-sectional field 14 pain medicine. Implementation of the German Pain Society (DGSS) core curriculum in the model study course MaReCuM. Schmerz 2013;27:387-394.
13. IASP. Interprofessional Pain Curriculum Outline, 2012. Available at: Accessed 12 February 2014.
14. Fragemann K, Meyer N, et al. Interprofessional education in pain management: development strategies for an interprofessional core curriculum for health professionals in German-speaking countries. Schmerz 2012;26:369-382.
15. Fragemann K, Lindenberg N, et al. Interprofessionelle Lehre – ein Zukunftsmodell? Einstellungen und Kenntnisse zur Schmerzmedizin und zum berufsgruppenübergreifenden Lernen im Rahmen eines interprofessionellen Weiterbildungscurriculum. P09b.2. Poster presentation. German Pain Congress 2013, Congress Center, Hamburg, Germany 23-26 October 2013.
16. Lassen CL, Fragemann K, et al. Knowledge levels of pharmaceutical sales representatives in pain therapy: a descriptive questionnaire-based study. Eur J Clin Pharmacol 2012;68:161-170.