Discussion:
”There is more than enough pain around, and no pain should be added, it
is worthwhile, if possible, to reduce it, not to sprinkle more salt on
open wounds”; Writes author Amos Oz, in his book “A Perfect Peace”13. Our medical altruism always strives to help reduce
the suffering and pain that exists among our patients. Unfortunately
there is a big gap between the therapeutic ideal and the actual pain
treatment. Consequently, the frustration is on both sides- physicians’
and patients’ alike. This gap, as observed in previous studies is mainly
due to insufficient knowledge, and lack of efficient work protocols.
In this study, an educational intervention was mostly associated with an
increase in the doctor’s satisfaction from the department performance.
The educational process encouraged new norms in the department with
regard to pain monitoring, which is the first and essential stage in the
treatment of the painful patient. The implementation of the educational
intervention manifests by itself a commitment to the process; a
department that chooses to secure time for this process recognizes the
gaps that exist within it and essentially declares that it is committed
to responding to the pain experienced by their patients. Our research
shows that the commitment that a department takes upon itself yields
fruit and permeates to the entire medical staff in the department.
The personal satisfaction of doctors increased significantly but not, as
much as we expected. The reasons for this may be that the educational
intervention is deficient, and certain content must be strengthened and
practiced.
The level of knowledge regarding pain relief, increased and improved
among the medical staff, thus providing a basic and important step in
the will to close the gap and perhaps to improve pain treatment in the
internal medicine department. It is important to note that the median
score was higher than the mean, meaning that the improvement of
knowledge was for most doctors, which reinforces the change that has
emerged following the educational intervention.
The opioid crisis is one of the most urgent medical problems in the
USA12. An improtant lesson from the opioid crisis is
that educational intervention should be dynamic and address changes in
the concept of drug therapy. A significant achievement of the
educational intervention was the rise in confidence and knowledge among
physicians in prescribing opiates. Such change in confidence and
knowledge in prescribing opiates may bring to a better tailored pain
relief treatment with less side effects. It is advised to continue with
a clinical research to track whether the actual treatment of patients
was more accurate and with fewer side effects after opioid treatment.
The prevalence and complications of diabetes and neuropathic pain have
been on a rise in recent years13. Unfortunately, a
lack of improvement in knowledge for neuropathic pain was observed in
the knowledge questionaire, thus indicating a weak point in the
educational process that needs to be improved in future educational
interventions.
In order to maintain the standards of care following the educational
program we recommend setting up a dedicated team of pain trustees that
would maintain the quality of pain relief treatment and perform a
routinely repetitive educational process as needed.