Is treating chronic pain torture? Internal medicine residents' experience with patients with chronic nonmalignant pain

Purpose: To assess internal medicine residents' confidence in, experiences with, and attitudes toward managing chronic nonmalignant pain (CNMP) in their outpatient practices. Methods: We surveyed internal medicine residents with regard to their experiences with and attitudes toward patients with CNMP. Mean responses across residency year of training were analyzed. Results: Sixty-three percent of respondents reported feeling somewhat or much less confident in managing CNMP than in managing diabetes. Confidence did not increase with level of training (p = .72). Sixty-three percent rated their preparation for managing patients with CNMP as fair or poor, and self-rated levels of preparation did not increase with level of training (p = .71). Thirty-eight percent of respondents reported having being threatened by a patient over the prescription of pain medication. Conclusion: Residents in this setting found CNMP management to be difficult. They lacked confidence in managing CNMP and did not gain confidence over the course of training. Substantial opportunities exist for improving resident education in CNMP.