Global leaders describe the challenges and fears about the inclusion of pain education in medical curricula. Professor Joan Marston (South Africa), Dr Kathleen Foley (USA), Dr Cynthia Goh (Singapore), Dr MR Rajagopal (India), Dr Natalya Dinat (South Africa), Liliana de Lima (Colombia), Dr Anne Merriman (Ireland) and Dr Sophia Bunge (Argentina) provide notable quotes:

Professor Joan Marston (South Africa) reflects; “If you don’t have doctors and nurses who are adequately trained in pain management and how to use the drugs… it doesn’t matter how much morphine you’ve got in the country – it’s not going to get to the patients.”

“When the Institute of Medicine reviewed why we had so much difficulty in providing palliative care and providing access to pain relief,” states Dr Kathleen Foley (USA), “The report began ‘we’ve identified the problem and it’s us,’ i.e., the health care professionals.”

“Pain has never been a priority in the training of medical schools and nursing schools, “continues Dr Cynthia Goh (Singapore).

Dr MR Rajagopal (India) explains how medical students in his hometown of Trivandrum graduate without having seen a single tablet of oral morphine. We see Dr Rajagopal challenging students from Trivandrum Medical College; “Do you think there is something lacking from our medical education?”

Dr Natalya Dinat (South Africa) reflects on testimony from a peer proudly pronouncing that the ward they oversee in a large hospital in Johannesburg is “morphine sparing.”

Liliana de Lima (Colombia) reports, “When you look at what curriculums are out there for physicians and nurses, they are getting very little training if anything, and most of the countries do not even address the issue of pain evaluation.”

Dr Rajagopal reiterates a key principle during a nurse training session in Trivandrum, “This is the most important definition that we have: ‘Pain is what a patient says hurts’.”

Dr Anne Merriman (Ireland) continues; “In every country I’ve been into, the doctors are the biggest opposition, particularly the senior ones who have been trained that morphine is addictive and they think we’re making addicts out of everybody.

“I personally was afraid of using morphine when I started my internal medicine residency,” admits Dr Sophia Bunge (Argentina), “As if it was a really scary drug to use but it turns out it was really easy.”

“If all the physicians at least have some basic training on how to do appropriate pain assessment,” concludes Liliana de Lima, “I think that would make a difference.