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School of Medicine

A New Approach to Pain

The original Hippocratic Oath includes the following pledge: “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.” This quote speaks to what has become a central concern for contemporary medical practitioners: how to best assess and treat patients who suffer from chronic pain in a world plagued by prescription drug misuse.

Studies have shown that one in five Americans suffer from chronic pain, and physicians whose patients experience persistent, debilitating pain struggle to honor the spirit of the Hippocratic Oath while offering the best patient care possible. Leanne Yanni, M.D., Assistant Professor of Internal Medicine at Virginia Commonwealth University's School of Medicine (SOM), witnessed this struggle while working with patients and residents in primary care at VCU Medical Center’s Ambulatory Care Center.

She discovered that the VCU School of Medicine and Medical Center, like so many medical institutions throughout the country, “lacked a comprehensive approach to education about chronic pain management at both the undergraduate and graduate training levels.” Quoting a Needs Assessment published in the Journal of Opioid Management, Yanni explained that “lack of knowledge contributed to practice deficiencies, lack of preparation undermined trainee confidence, and lack of awareness and access resulted in underutilization of practice resources.” These discoveries, coupled with her interest in curriculum development, inspired Yanni to create an online course to teach trainees, residents and health care providers new strategies for assessing and treating patients with chronic pain.

She launched her project without any formal funding, recruiting talented colleagues from a variety of disciplines including pharmacology, toxicology, palliative care, biostatistics, instructional design and graduate medical education to assist her. The research and writing process began in 2005. This written content evolved into a web-based curriculum over the next year, and by August 2006, Yanni’s team successfully integrated the site into the School of Medicine’s M3 Internal Medicine Clerkship and several Graduate Medical Education programs. They spent the next two years testing the site, enlisting national peer reviewers and refining the content design.


Chronic Non-Malignant Pain Management course home page. This page can be accessed from the Pain Education Web site.

The online Pain Management Curriculum is a comprehensive, interdisciplinary learning resource designed to help its users develop a standard approach to pain assessment and treatment. The curriculum design allows learners to study at their own pace. This emphasis on self-directed learning encourages those using the site to incorporate the material into their own knowledge base and current practice.

The curriculum’s seven modules cover over 25 specific Accreditation Council of Graduate Medical Education competency-based objectives. It has been evaluated by medical professionals across the country and is currently the most extensive program of its kind. The Pain Education Web site has become a home for VCU’s Pain Management Curriculum. It functions as a central repository, housing clinical practice tools for residents, faculty and practicing physicians.

A Pain Medicine journal article written by Yanni (Development of a Comprehensive E-Learning Resource in Pain Management) describes the curriculum’s development and initial evaluation data. Over 350 medical students and 250 residents in various Graduate Medical Education programs have completed the online curriculum. The Virginia Department of Health Professions evaluated the site and decided to provide free access to the curriculum for all Virginia health care providers. Since then, more than 100 Virginia physicians, nurses, pharmacists and ancillary health care providers have taken the course, and over 200 health professionals have registered at the site, which provides its users with access to case studies, reference tables and other resources for developing pain management strategies.

In a recent letter to Jerome Strauss, M.D., Ph.D., Dean of the VCU School of Medicine, a physician from Abingdon, Virginia wrote: “I will change the way I practice based on what I learned [from VCU’s Pain Management Curriculum]… In addition to improving patient care, it will also improve the education of future physicians… Without the support of institutions like VCU, we would not have access to unbiased and research based resources… in our rural area where issues of pain management and prescription drug abuse are so pertinent.” This letter confirms what Yanni has always believed: the online Pain Management Curriculum addresses a pressing need felt both in the world of medical education and in the world of medical practice.

Yanni and her many collaborators feel their online Pain Management Curriculum demonstrates VCU School of Medicine’s commitment to excellence and highlights the skill, creativity and expertise of its faculty, staff and students. She hopes the site will become a self-sustaining, collaborative and unbiased educational resource which will change the way people think about pain and help the medical community provide safe, effective care to patients who suffer from chronic pain.