November 2025

Pain is invisible, difficult to define, measure and treat. The research records the negative attitudes that medical students and nurses have to patients reporting pain. Medical students have a perception that because cure is frequently not possible the value of patients with persistent pain to education is low. 

Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value.[i]

The amount of allotted time for all aspect of medical education is limited and precious. All disciplines can make a cogent argument that their specific interest is essential and cannot be omitted.

Traditional medical education devoted very little time to any aspect of pain medicine or its management. The pharmacology of opioids or anti inflammatories were covered in pharmacology. Local anaesthetics may have been explored when managing skin lesions and the importance of urgent neurosurgical decompression in cauda equina syndrome will be emphasised in the emergency room. 

Managing the distress of patients presenting with long histories of pain, which may be accompanied by the distress of an adverse childhood, trauma, mental health disorders or substance misuse, rarely get the attention it deserves. 

The medical students eventually qualify as junior doctors, largely unprepared for one of the most common symptoms presenting to hospital, emergency departments or primary care.  They will have a basic knowledge of some pharmacology intervention which are generally disappointing. They may have read or seen some surgical procedures with varying success. 

The distress of patients repeatedly presenting, following repeated therapeutic failure and repeated fruitless investigations may lead to frustration of the doctor, the patient and their family and eventual resentment and distrust.

Professor Rollin Gallagher elegantly outlined this nearly 20 years ago[ii]. He described the fact that students and doctors had to be successful to get into and through medical school, pass exams and rejoice in positive outcomes. Patients with pain frequently report less satisfactory outcomes despite the best efforts of the practitioner.  These competing approaches and outcomes eventually clash.

Deakin University's School of Medicine was established in 2008, making it Victoria's first rural and regional medical school. From the outset the school recognised the importance of education in pain, through the department of anaesthesia (acute pain) and in conjunction with the musculoskeletal (orthopaedic) modules. This was unique in Australian medical education. The medical students reported high levels of satisfaction with their structured exposure to patients with persistent pain and learned important principles of multidisciplinary care, history taking and comprehensive formulation, by following patient lived experience. 

When the curriculum structure changed, more clinical opportunities emerged (both in public and private) and through COVID, resulted in how this educational experience was managed.  Our practice was enthusiastic in maintaining medical student education in pain. Students spend one week with Specialist Pain Medicine Physicians as part of their 6-week critical care (anaesthesia/critical care) attachment. 

During this week, the student learns history taking in a different environment. This will include use of motivational interview techniques, exploration of developmental history, the role of procedures, the importance of allied health colleagues and the management of distress. The student spends some time with one patient, specifically to get an insight into that individual’s lived experience and the impact that persistent pain has one their life. The student then presents this work to one of the consultants. Students are encouraged to introduce their own style in the language and structure of the work. Influences outside of medicine from sport, music, interests, hobbies or experiences can be leveraged. Finally, the work requires editing to no more than 500 words. 

The medical students experience demands time and effort on behalf of the specialist and the clinic. This may have an impact on throughput and (in private practice) perhaps revenue. It is however extremely rewarding, and students report very high levels of satisfaction even after their brief exposure. Some have commented that it has been a pivotal impact on their medical aspirations. One student remarked that the pressures of their studies during COVID had brought them to a point of seriously considering quitting. That student successfully completed the degree and is now serving patients 

We have, as doctors an obligation to teach, to instruct, to encourage and give direction to medical students as Hippocrates us encouraged years ago…

…and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer's oath.

The following is an example of the quality of writing that can emerge after such an exposure.  The author with a background in ballet dancing at a high level, qualification in pharmacy and fitness was able to introduce an artistic style, losing nothing in substance and uniquely enhancing the work. 

We believe that, their albeit brief, exposure to complex persistent pain and its management will give confidence to the student when they (inevitably) encounter it again and have important transferrable benefits to many if not most other disciplines in medicine. 

 

An Interstate visit……a persistent pain journey

Her story starts as just a child.

Her brother experimenting with a curiosity of private parts.

This assault against her child body led to years of a crashing need. For anything that would soften the edges of the pain she experienced.

She would find her hands on the top shelf, wherein lurked the comfort foods – chocolates, chips, biscuits – open it, pour a bunch in her hand, and start eating… and eating. She’d eat until there was no room left. All she can think about is her need to eat. Now. This very minute. She needs to eat, fast, she needs to eat a lot of things very fast. Her mouth needs to be full, she needs to be chewing on something, something salty.

And then, as a child, in our 90’s diet culture, she was the fat one. Her mother, never understanding why she required so much comfort, comfort that only came from food. Something else on the lips, saving her from the confession of being molested by her own brother.

She wore her body like a shield, then like a burden, each curve misunderstood by a world that saw gluttony instead of grief. Despite these judgements, and against society saying larger bodied woman are lazy. She was anything but. She worked hard. She moved out of home and was called to education. She’s in her 20’s and she has faith in the world and what she can create. The change she can impact.

By 29, she’s bought her first home, paying a mortgage. She’s moved to the country, is playing in a band, local netball, and obtained permanency in teaching. She values family, friendships and connections. She’s going to be a principal one day.

She’s about to turn 30. She books two things to celebrate such a milestone.

1. A cruise with her closest friends, and

2. A Laparoscopic Sleeve Gastrectomy (LSG). It was time to have the outside start looking like how she felt on the inside.

Her 30’s was when she changes her life.

And her life did change. She lost over 60kg.

And she lost so much more than that.

Her job. Her identity.

Her band.

Her friends.

Being pain free.

The gastric sleeve was too tight. And created a stenosis, that twisted on itself creating a pinched, writhing source of pain. She presented to Mt Gambier hospital, was driven to Adelaide by her friend, and was in morning surgery having a stent inserted to allow passage of food once again. Personal numbers between surgeon and patient were exchanged. A sign of trust – or so she thought.

Over two years, she was hospitalised repeatedly, enduring fourteen dilatations and two emergency stents. She was dismissed, gaslit, accused of chasing opioids when she was only begging for breath.

Her weight dropped, but so did her hope.

She wasn’t an addict – but she relied on pain relief to function, to stand upright in front of a class.

Her surgeon's words: “She shouldn’t need that much pain medication.”

So, she questioned everything.

Was she the failure?

Was this pain her fault?

 

She kept showing up.

To yoga.

To the classroom.

Her surgeon’s words: “It usually only takes my patients two or three of these” The grief compounded.

And then – a car crash. The friend who brought her bone broth, the one who curled up beside her on a hospital bed – gone.

They had literally just gone to yoga together.

Her job was lost.

Her dog died. COVID limited her access to pain medication. She moved through the world as a ghost – hungry, hurting, unheard.

Until Adelaide. A new surgeon. A new pain doctor.

A new story.

She relocated with her mother, frail but not broken. This time, the surgeon listened. This time, they saw. Nutritional rehab began.

Then, a revision surgery. Now, just 50mL of stomach remains — a thimble of hope, but hers to hold.

She is rebuilding.       

She teaches again, part-time.           

Her classroom is smaller, but her voice is stronger.         

She is taking her surgeon to court – not out of anger, but out of justice.

Out of the belief that her story might protect the next woman whose pain is doubted, whose body is questioned, whose trauma is unseen.

She grieves.

For children she won’t have.

For the school holidays that fund her survival instead of rest.

For the principal she could’ve been.

But she’s doing yoga. Still in pain – but the kind she can breathe through. She is not a drug addict. She is not broken. She is resilient. Brilliant. Luminous with purpose

And for those of us privileged enough to walk into her room, we are reminded: She didn’t need saving. She just needed to be seen, so she could save herself.