1. Talk therapy, modified for literacy level, helps ease chronic pain for disadvantaged populations
FREE Summary for Patients: http://annals.org/aim/article/doi/10.7326/P18-0001
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Literacy-adapted group cognitive behavior therapy (CBT) and simplified pain education (EDU) interventions delivered at low-income clinics significantly improved pain and physical function for disadvantaged patients with chronic pain. Findings from a randomized controlled trial are published in Annals of Internal Medicine.
More than 116 million Americans suffer from chronic pain, a condition that disproportionately affects economically disadvantaged persons, ethnic minority groups, women, and older adults. As the opioid epidemic spirals out of control, new approaches to pain management are needed. CBT has been shown to be effective for chronic pain, but rigorous trials have not been conducted in populations with low socioeconomic status.
Researchers from the University of Alabama enrolled 290 patients in the LAMP (Learning About My Pain) study to compare literacy-adapted psychosocial interventions (CBT versus EDU) with usual care for treating chronic pain in a disadvantaged patient population. CBT and EDU were delivered in 10 weekly 90-minute group sessions, with all information and materials modified to be accessible to patients reading at or even below the fifth grade level. At follow up, members of the CBT and EDU groups had larger decreases in pain intensity and increases in physical function scores compared with those in the usual care group.
According to the researchers, these findings strongly suggest that CBT can be simplified to improve its accessibility, while retaining its core principles and without reducing its potency. As society struggles with health care costs and the opioid crisis, CBT and EDU show promise as safe, effective, and efficient treatments for chronic pain.
Media contacts: For an embargoed PDF or contact information for the lead author, Beverly E. Thorn, PhD., ABPP, please contact Angela Collom.
2. ACP calls on doctors to practice what they teach
Faculty behavior is the 'hidden curriculum' that shapes ethical development of medical students and should be closely aligned with the formal curriculum
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The American College of Physicians (ACP) calls on physician educators to model positive behavior for their medical students. In other words, the formal curriculum of medical education must be reinforced and enhanced by the hidden curriculum, or faculty behaviors that shape students' ethical development. ACP's new position paper is published in Annals of Internal Medicine.
Seeing a primary care physician visit her hospital patient in the evening after clinic is a positive example of a hidden curriculum. Making disparaging comments about a patient who has frequent admissions is a negative example. Disrespect can also occur between clinicians, such as disparaging comments by academic physicians about nonacademic physicians or about a specialty.
"Medical education -- both in the classroom and at the bedside - must be consistent with medical ethics and professionalism," said Dr. Jack Ende, MD, MACP, president, ACP. "Learners should not experience disconnects between what they are taught about ethics and professional behavior and what they see demonstrated by faculty and others."
ACP's paper includes three position statements calling for the hidden curriculum to become a positive curriculum that aligns with the formal curriculum in which faculty and senior clinicians model empathy, encourage reflection and discussion of positive and negative behaviors in the training environment, and promote learner and clinician wellness. For each position statement, ACP identifies challenges, opportunities, and strategies to identify and address discrepancies between values and actions to help align positive hidden curricula with formal curricula.
Note: For an embargoed PDF or an interview with ACP spokesperson, please contact Steve Majewski at firstname.lastname@example.org or 215-351-2514.
Also new in this issue:
Peripheral Neuropathy and the Ceruloplasmin Gene
Marc C. Hines Jr., MD; Herbert L. Bonkovsky, MD; Sean R. Rudnick, MD; Justin T. Mhoon, MD
Brief Case Report
Annals of Internal Medicine