Challenges Facing Clinicians Treating Patients with Pain

From a clinical perspective, one of the most important problems associated with the educational deficits about pain and substance use disorders is a lack of standardization and consistency not only with respect to how pain is treated, but also how pain is assessed. This chapter begins by re-emphasizing the importance of consistently defining pain and reviews the 2020 revised definition of pain by the International Association for the Study of Pain. Additionally, a variety of challenges that clinicians often fact when treating patients with pain will be reviewed including the prevalence of pain in adults in the U.S., along with the estimated annual financial burden of pain on the U.S. economy, clinician-level challenges including lack of education, system-level challenges including those at the clinic or institutional level, patient-level challenges including socio-economic factors, regulatory challenges which in some cases may undermine clinician willingness to treat people with pain (especially if opioid analgesics may be considered appropriate) due to fear of regulatory scrutiny, and the multitude of issues which could negatively impact the likelihood of adherence to a pain treatment plan. This chapter will also explore the culmination of these challenges which often create other challenges, including a lack of scientific evidence basis about how pain should best be treated, the existence of the overdose epidemic our country faces, uncalibrated goals and expectations of pain treatment, and mixed messages being received by clinicians and patients resulting from several “knee-jerk” approaches to mitigating the increasing number of drug-related overdose deaths.