The Traveling Pain School’s curriculum is based on the International Association for Study of Pain’s recommendation for pain education among doctors. We have a very distinguished faculty to match. Whether you are a post-graduate student or a practising doctor, there is much to be gained by attending the Traveling Pain School. The atmosphere would be such; you could interact freely with the faculty. This is to enable you to share and gain knowledge, explore opportunities for training in pain medicine or setting up a pain practice, and above all meet like-minded doctors who obsess over the same things as you do.

  • Considerations for Management of Pain
    The topic will cover:
    • Definition of pain, difference between acute pain and chronic pain, how acute pain may progress to chronic pain.
    • Epidemiology of pain, Bio-psychosocial model of pain.
    • Pain as a public health problem with social, ethical, legal and economic consequences.
    • Patient issues
      • Access to clinics, treatment center, advantages of early intervention.
      • Patient involvement / understanding of management plan/motivation to change.
      • Cultural / societal limitations.
    • Caregiver issues:
      • Understanding of pain (false beliefs).
      • Fears and anxieties (e.g. drug addiction, side effects).
      • Understanding of patient goals/needs.
    • Health professional issues:
      • Understanding of pain (false beliefs).
      • Fears and anxieties (e.g. drug addiction, side effects).
      • Understanding of current evidence supporting management strategies.
    • Political issues:
      • Pain management as a human right.
      • Access to clinics, treatment centres.
      • Access to pain relieving medications.
      • Access to interventional treatment.
    • Ethics:
      • Ethical standards of care (provision of measures to minimize pain and suffering) for health care professionals.
      • Ethical standards and guidelines related to use of analgesics (e.g. inadequate analgesic prescribing; over-medication; confusion regarding physical dependence, tolerance and addiction, abuse screening, use of placebos).
      • Political and societal issues related to access to pain management and attitudes to marginalized populations.
    • Goals of Pain Management:
      • Reduction of pain intensity.
      • Enhancement of physical functioning.
      • Improvement of psychological functioning.
      • Reduction of healthcare utilisation.
      • Promotion of return to work/school and/or role within the family/society.
      • Improvement of health-related quality of life.
  • Neuroanatomy and Neurophysiology of Pain
    • Peripheral receptors, afferent fibres, transduction and transformation, peripheral sensitisation.
    • Spinal terminations and spinal processing of nociceptive information, spinal reflexes, ascending tracts, transmitters (peptides and amino acids).
    • Brainstem mechanisms of pain (autonomic reflexes, ascending reticular activating system).
    • Thalamic nuclei, nociceptive cortical network, cortical reorganisation.
    • Descending control of nociceptive information and pain modulation. Central sensitization. Genetics in relation to pain mechanisms.
  • Assessment – History, Physical examination & Investigations
    • Pain location, onset and duration, severity, quality, alleviating and aggravating factors.
    • Impact on mood, usual activities/function/quality of life/sleep.
    • Previous pain and treatment history.
    • Ongoing response to treatment, adverse effects.
    • Comorbidities impacting pain (e.g. chronic disease, surgery, trauma, mood, cognitions, abuse history, medications). Personal characteristics (e.g. age, sex, race, religion, culture, language).
    • Expectations of pain management and current understanding of the condition.
    • Neurological and musculoskeletal assessment.
    • Posture and range-of-motion evaluation.
    • Distinction between nociceptive and neuropathic pain
      • Distinction between acute, recurrent, incident, and or persistent (chronic) pain (may have combination of more than one type).
      • Distinction between nociceptive (somatic, visceral) and non-nociceptive (neuropathic) pain (may have both nociceptive and neuropathic pain).
      • Distinction between commonly used pain terms in clinical practice (e.g. allodynia, analgesia, dysesthesia, hyperalgesia, paresthesia, pain threshold, pain tolerance)
    • Laboratory tests.
    • Imaging studies, e.g.
      • X-rays (flexion/extension views if needed)
      • Ultra Sound (U/S)
      • MRI, CT, Bone scan
  • Pharmacological methods of managing pain
    • Mechanisms of action
    • Indications for use
    • Pharmacokinetics including mechanisms of toxicity
    • Adverse effects and their management, Equianalgesic dosing, Interactions with other drugs
    • Formulations (short and long acting)
    • Administration routes
    • Age-specific therapies (including, neonate, infant and elderly) of the following drugs:
      • Local anaesthetics,
      • Nonsteroidal anti-inflammatory drugs,
      • Opioids (Clarify tolerance, physical dependence and psychological dependence)
      • Other relevant drugs (e.g. anticonvulsants, anti-depressants)
  • Non-pharmacological methods of managing pain
    • Clinician therapeutic use of self
      • active-listening
      • being empathic
    • Physical strategies to support home and occupational function and activity
      • heat
      • cold
      • positioning
      • exercise
      • massage
      • wound support
      • exercise
      • mobilisation
      • manipulation
      • reach devices
      • other comprehensive rehabilitation approaches
    • Psychological and behavioural strategies
      • cognitive-behavioural strategies
      • coping strategies
      • biofeedback
      • patient-family education
      • counselling
      • hypnotherapy
      • operant approach
      • stress management
  • Overview of pain syndromes
    • Cancer Pain (primary pain, local invasion, metastatic spread, treatment-related, end-of-life).
    • Visceral Pain {referred patterns, cardiac and non-cardiac chest pain, abdominal, peritoneal, retroperitoneal pain, pelvic pain (male and female)}.
    • Neuropathic Pain:
      • Central: (multiple sclerosis, post-stroke, spinal cord injury, traumatic brain injury, syringomyelia).
      • Peripheral: (degenerative disc disease with radiculopathy in neck and low back, peripheral neuropathies (diabetes, cancer, alcohol, HIV), post herpetic neuralgia, acute disc herniation with radiculopathy, complex regional pain syndrome II (CRPS II) (causalgia), phantom limb.
      • Mixed or unclear origin: (complex regional pain syndrome I (CRPS I) (reflex sympathetic dystrophy), irritable bowel syndrome, fibromyalgia, other).
    • Musculoskeletal (rheumatoid arthritis, osteoarthritis, neck pain, whiplash and referred pain, low back pain and referred pain, myofascial pain syndrome).