An estimated 116 million US adults suffer from chronic pain at an estimated cost of $635 billion and, unfortunately, existing pain management training is not adequately preparing health professionals to address this area [1]. Opioid prescription drugs, obtained originally via a prescription, resulted in almost 15,000 overdose deaths in 2008 [2]. To address this gap we propose to create The Pain Treatment Simulator for Computer Tablets, a computer tablet-based application to provide a learning and shared experience environment for health professional students to enhance best practice skills related to pain assessment and control, specifically: 1. generalizable instruction related to the intricacis of patient communication and need for clarity, 2. addiction detection for substances including alcohol, tobacco, prescription drugs and illegal drugs, 3. the clinical challenge of diagnosing pain and developing a treatment plan with the patient, 4. careful and thoughtful prescribing of opioid medications, 5. achieving treatment and medication adherence 6. vigilance to avoid diversion, overdose, and misuse of prescription opioid medications. The Pain Treatment Simulator for Computer Tablets will echo the clinic treatment environment and include virtual (e.g., computer generated) patients to be assessed via history, physical examination, and laboratory tests. Users will need to present a plan to the patient (e.g., non-medication options, medication treatment, treatment agreements, regular urine drug screens for opioid treatment) and will receive differing feedback (e.g., acceptance, refusal, suspicious behavior). Feedback from choices and decisions made will be based on best practice. The instructor will have control over the clinical components of the application by providing increasing or decreasing clinical information, challenge, feedback, or prompts. Phase I will proceed with a carefully planned formative analysis involving needs analysis surveys, semi- structured interviews, guidance from consultants, specification design, creation of prototype experiences, and usability assessments of The Pain Treatment Simulator for Computer Tablets with health professional students and educators. Phase II would complete the program and conduct an evaluation using a randomized, cross-over [wait-list control], pretest-posttest design with an estimated 60 students to assess if the Pain Treatment Simulator for Computer Tablets positively impacts target clinical skills and increases core competencies. Ongoing assessment of the product will determine areas of weakness which can be refined and improved over time.

Public Health Relevance

Chronic pain, previously ignored, is now a significant cause of an epidemic of prescription drug abuse leading to misuse of opioid painkiller medications, diversion to the public, and overdose deaths. Lest we fall back into a world where pain is undertreated, we must prepare future health professionals with the skills to intervene in pain without causing undo harm. This product will enhance the education of health care providers via a simulated clinical encounter where they can develop proper pain management and opioid risk assessment and intervention skills including screening (for pain and addiction history), full assessment and diagnosis (again of pain etiology and addiction), treatment interventions, and when necessary referral to a specialist in pain control and/or addiction. Future health professionals who are more proficient in core competencies related to pain management will be better equipped to reduce the suffering and costs of inadequate pain treatment.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Small Business Innovation Research Grants (SBIR) - Phase I (R43)
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Special Emphasis Panel (ZRG1-HDM-R (11))
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Denisco, Richard A
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Clinical Tools, Inc.
Chapel Hill
United States
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