Attitudes toward and Knowledge of Chronic Pain: A Survey of Medical Social Workers
Sieppert, Jackie D., Health and Social Work
Chronic pain inflicts a staggering, though often unrecognized, toll on society. Over a decade ago, Golden and Steiner (1981) suggested that chronic pain was the United States's most costly health problem. Since that time it has been estimated that 88 million people in the United States suffer from clinically significant levels of acute and chronic pain annually. Of these, 77 million individuals suffer from chronic pain (Wu & Grzesiak, 1987). Low back pain alone affects over 8 million Americans annually, making this affliction the major cause of disability in people under 45 years of age (Mims, 1989). Turk, Meichenbaum, and Genest (1983) stated that over $900 million was spent on over-the-counter analgesics and other related products in 1983. These and other consequences of pain translate into a cost of at least $60 billion a year for the United States, and the costs in terms of human suffering cannot be measured (Kodiath, 1991; Wu & Grzesiak, 1987).
Chronic pain affects much more than somatic or bodily functions. It also has significant and enduring psychosocial effects. For example, the sufferer of chronic pain has usually endured numerous unsuccessful medical interventions (Roy, 1981; Turk & Rudy, 1989). This fruitless search for health becomes a focal point of the patient's life. It disrupts family roles and relationships, destroys careers, and causes the individual to withdraw into personal isolation. It creates a sense of hopelessness and helplessness, which further erodes psychological functioning. In short, chronic pain can cause severe emotional, physical, economic, and social problems for the patient (Crue, 1988; Roy, 1985; Subramanian & Rose, 1988b; Vasudevan, 1988; Wall, 1989).
Unfortunately, it can be argued that current health care policies, structures, and practices in Canada and the United States do not adequately alleviate the problems and costs associated with chronic pain. These systems are built on the acute illness model, which has encountered limited success in assessing and treating pain of a chronic nature (Benjamin, 1989; Craig, 1984; Garon, 1991; Kodiath, 1991; Melzack, 1973; Melzack & Wall, 1988; Mims, 1989). Medical professionals often cannot provide relief to chronic pain sufferers through traditional medical techniques. As a result, patients engage in an urgent search for answers to their pain while coping with its concomitant hopelessness, despair, and depression (Wall, 1989).
A relatively recent trend in chronic pain management has shown promise in breaking the ongoing cycle of pain and medical treatment for pain patients. This trend is shifting toward a more holistic, comprehensive, and multidisciplinary model. As a result, more and more helping professions, including the social work profession, are becoming directly involved in the treatment of chronic pain (Aronoff & Mcalary, 1988).
Because the traditional medical model is not sufficient for managing chronic pain, a useful approach to assessment and treatment is the ecological systems model used by many social workers (Subramanian, 1987, 1991a, 1991b, 1994; Subramanian & Rose, 1988b). This model allows for the evaluation of personal, psychological, social, and situational factors in a thorough assessment of the pain experience. It also provides the basis for cognitive - behavioral interventions that recognize the full range of personal and environmental realities inherent in the patient's experience of pain.
Social work is in an extraordinary position to broaden the research base on both the assessment and treatment of chronic pain (Subramanian, 1987, 1991a, 1991b, 1994; Subramanian & Rose, 1988b). Social workers are becoming more commonly represented in multidisciplinary pain centers (Subramanian, 1994), and social workers provide services in settings other than pain clinics to many clients who suffer from chronic pain (Subramanian, 1991b, 1994). In general, social workers are likely to find increasing numbers of clients whose presenting problems involve chronic pain.
Although social workers are increasingly likely to serve on pain management teams and to fulfill professional pain management roles, this evolution creates a dilemma for the profession. Chronic pain has not traditionally received much attention in social work education; thus, most practitioners may lack training and experience in this area. A question therefore arises about the extent to which social work practitioners are adequately prepared to recognize issues of chronic pain and to deliver pain management services. To date no empirical study has established the underlying knowledge base, practices, and professional preparation of social workers who deliver these services.
This article discusses a study that investigated the degree to which medical social workers are adequately prepared to recognize issues of chronic pain and deliver pain management services. Specifically, the research revolved around questions first posed by Golden and Steiner (1981):
* How many social workers, by formal training or job responsibilities, are viewed as specialists in chronic pain?
* What types of training and experiences have social workers received to prepare them to work with chronic pain patients?
* How do these workers perceive the experience of chronic pain?
* Is the syndrome recognized as a distinct and significant issue, or is chronic pain relegated to being a symptom of another problem?
* How do typical social work interventions fit with the work of emerging pain management teams?
* To what extent are these interventions applied to the management of chronic pain?
All of these questions remain largely unanswered, and together they are beyond the scope of a single study. Instead, two basic questions from the list provided the focus for the study: What are medical social workers' attitudes toward the management of chronic pain, and how knowledgeable are medical social workers about the issues relevant to chronic pain?
The study was conceptualized and implemented in two phases. In the first phase a series of four focus groups were conducted with medical social workers to identify themes and content areas relevant to social work involvement in pain management activities. These focus groups provided background information that facilitated the design of a questionnaire to explore pain management knowledge levels, attitudes, and therapeutic practices of social workers in health care settings. The second phase of the project involved a cross-sectional survey of medical social workers across multiple health-related facilities.
Sample and Procedures
The population on which this study was based included medical social workers employed in health care settings across Canada. No comprehensive sampling frame of Canadian medical social workers exists. However, the vast majority of these workers were employed in the Canadian medical system. In addition, a national organization called the Canadian Association of Social Work Administrators in Health Facilities (CASWAHF) maintains a directory of all social work departments in hospitals and related facilities. The study's sampling frame was therefore generated by adopting the list of 293 Canadian medical social work departments maintained by CASWAHF. All departments were surveyed between March and May 1994.
Two copies of the questionnaire were mailed to all social work departments included in the sampling frame. Directors were asked to recruit two of their department's clinical, frontline social workers to complete the questionnaires. If available, any workers who specialized in pain management or worked in pain clinics were preferred participants. Two follow-up mailings were sent over the next five weeks to departments from which no questionnaires had been returned.
Because there are issues about the independence of observations when two members of the same organization complete a questionnaire, only the first completed questionnaire from each department was considered for the analyses reported in this article. The response rate for the survey was 72.3 percent, representing a total of 212 departments that returned at least one completed questionnaire.
Survey respondents represented a wide variety of organizations and work environments. Most of the 212 respondents (86.1 percent) worked in an urban area of at least 10,000 people in a very large medical setting. Of those organizations that maintained overnight patient privileges, the average number of patient beds was 280. Respondents were primarily employed in general hospitals (55.8 percent) or specialized hospitals such as rehabilitation, oncology, chronic care, psychiatric, children's, or neurological hospitals (31.9 percent). Exceptions to this rule included seven social workers (3.4 percent) who were employed by a home care agency and 21 (9.9 percent) who worked in nursing homes.
Only 47 (22.2 percent) of the respondents' organizations maintained a program to manage chronic pain. Of these, 40 organizations included social work in some manner on the pain team. Social work was thus involved in chronic pain management in 18.8 percent of all organizations represented in the sample. However, the extent and nature of social work involvement on these pain teams is unknown. Only three of the 212 respondents (1.4 percent) identified chronic pain management as their primary area of practice.
A total of 181 (85.3 percent) of the respondents were female, and the respondents' mean age was 42.8 years. Only 19 (9.0 percent) were age 30 or younger. The respondents averaged 13.9 years of experience, with a mean of 10.5 years of experience in a medical setting and 7.7 years at the current organization.
Based on suggestions derived from phase 1 of the study and relevant literature, the questionnaire comprised five sections: (1) social workers' attitudes toward chronic pain, (2) the use of nonmedical therapies in managing chronic pain, (3) knowledge of chronic pain, (4) organizational factors inherent in social workers' experience, and (5) demographic variables. To pilot test the questionnaire, nine medical social workers were asked to complete and critique the questionnaire, and six social work researchers reviewed its format and style.
Attitude Items. The section of the questionnaire that addressed attitudes included 25 items designed to evaluate attitudes toward nonmedical assessment and treatment of chronic pain. The content of these items examined pain in general, differences between acute and chronic pain, consequences of chronic pain, traditional medical treatments, nontraditional treatments, and social work involvement in chronic pain. Respondents were asked to indicate their agreement with attitudinal statements on a Likert-type scale that ranged from 1 = strongly disagree to 5 = strongly agree. The following are examples of these items:
* Chronic pain is a major health problem in our society.
* Chronic pain is significantly different from acute pain.
* Both chronic and acute pain can usually be traced to biomedical causes.
* Many chronic pain patients exaggerate the levels of their pain.
* Management of chronic pain is best left to physicians and pharmacists.
* Medical treatment can sometimes cause serious difficulties for chronic pain patients.
* Consideration of psychological factors is central to managing chronic pain.
* Chronic pain patients may benefit from advocacy in dealing with the medical system.
* Medical therapies usually provide relief from chronic pain.
* Social workers should become actively involved in managing chronic pain.
* Social workers should be trained in the area of pain management.
Total scores for this section of the questionnaire were generated on a scale from 0 to 100, with higher scores reflecting a more positive orientation toward nonmedical management of chronic pain. Cronbach's alpha for the attitude items was .85, and the standard error of measurement was 4.02. A multiple-group factor analysis was also conducted on the attitudes section of the questionnaire. No factor loading failures were found, providing initial evidence of factorial, construct, and content validity for the attitude items.
Knowledge Items. The knowledge section of the questionnaire included items that examined such areas as theories and definitions of pain, prevalence of chronic pain, consequences of pain, assessment and treatment of pain, measurement of chronic pain, and social work involvement in chronic pain management. All items from this section were drawn from published chronic pain literature. Respondents were asked to review a series of statements about chronic pain management. For each statement, they were asked to agree with the statement, disagree with the statement, or check a "don't know" option. The following are examples of the knowledge items:
* The theory that categorizes pain as purely physiological is called "specificity theory."
* Nociception is the body's perception that tissue damage is taking place or has already occurred.
* Chronic pain is usually accompanied by increases in autonomic indicators like blood pressure and muscle tension.
* Chronic backache represents the major cause of disability among people age 50 or younger.
* Studies consistently show high levels of depression among chronic pain patients.
* There are strong cultural differences in pain tolerance levels.
* The majority of chronic pain patients achieve adequate pain reduction through purely somatic measures.
* The technique that uses an external device to apply electrical stimulation to a painful area is called TENS (transcutaneous electrical nerve stimulation).
* The most commonly used instrument to measure chronic pain is called the Memorial Pain Management Inventory.
* Family therapy has become a well-tested treatment modality for addressing chronic pain issues.
* Traditional social work populations are especially prone to experiencing chronic pain.
Answers were recoded into a binary correct-in-correct variable for all knowledge items. Knowledge scores were then calculated as a percentage of correct responses. Because the data were dichotomously scored, the Kuder-Richardson formula 20 (K-R 20) was used to measure internal consistency. The resulting estimate of .81 showed the knowledge items to have solid reliability. A multiple-group factor analysis was conducted on these items. Factor loadings formed a hierarchical structure as predicted by a priori hypotheses about the instrument, thereby providing evidence of factorial, construct, and content validity for these items.
Attitudes toward Chronic Pain Management
Survey respondents displayed positive attitudes toward nonmedical assessment and treatment of chronic pain. They were most positive about statements that reflected two general themes. The first theme reflected the items that dealt with the nature and consequences of chronic pain. Respondents showed strong positive agreement with items stating that chronic pain is different from acute pain (M = 4.43, SD = 0.75), chronic pain is more difficult to treat than acute pain (M = 4.57, SD = 0.63), consideration of psychological factors is central to managing chronic pain (M = 4.39, SD = 0.78), and cognitive-emotional factors directly affect chronic pain (M = 4.41, SD = 0.75). The results of these items suggest that respondents were aware of the multidimensional nature of chronic pain.
Respondents also expressed positive opinions about items that reflected the theme of the profession's systemic or ecological perspective. They recognized that chronic pain can cause family disruption (M = 4.56, SD = 0.69) and that treatment should include spouses or partners (M = 4.52, SD = 0.58). There was also agreement that chronic pain should not be the sole domain of physicians and pharmacists (M = 4.41, SD = 0.81) and that advocacy for the chronic pain patient is important when dealing with the medical system (M = 4.35, SD = 0.69).
Finally, three items suggested positive attitudes toward social work involvement in chronic pain management. Respondents felt that social work's ecological perspective is well suited to managing chronic pain (M = 4.02, SD = 0.76) and that social workers should become involved in chronic pain management (M = 4.21, SD = 0.76). They also felt that social workers should be trained in chronic pain management (M = 4.46, SD = 0.66). Perhaps most noteworthy, 195 (90.0 percent) of the 212 respondents expressed a desire for more training in chronic pain management.
The total score calculated for the attitude items may be considered to measure the respondents' openness to nonmedical approaches to chronic pain; a higher attitude score reflects a positive orientation toward nonmedical assessment and treatment of pain. The mean attitude score was 77.6 (SD = 10.3), indicating that respondents maintained a strong positive orientation toward nonmedical assessment and treatment of chronic pain.
Although attitudes toward nonmedical treatment of chronic pain were found to be strongly positive among the study's respondents, it is reasonable to expect that individual attitudes might vary as a function of personal background and organizational influences. A number of bivariate analyses were conducted to assess this possibility. Results of these analyses suggest that attitudes toward pain management are independent of most demographic and organizational variables. Only involvement of the social worker on a pain management team and employment in rehabilitation or chronic care were significantly related to more positive attitudes toward nonmedical treatment of chronic pain [t(60.2) = 2.46, p = .017; F(5, 198) = 4.58, p = .000].
Knowledge about Chronic Pain Management
Across the 25 items used to assess knowledge about chronic pain, the range of correct responses varied widely, ranging from a low of one correct response (0.5 percent) to a high of 164 (77.4 percent). (The low of one correct response was from a response set in which the respondent answered "don't know" to all but one item.) A clear pattern emerged in these correct and incorrect responses. The items that respondents most often failed to answer correctly all dealt with concepts and issues fundamental to chronic pain management. For example, only 22 individuals (10.4 percent) answered correctly the item dealing with the role of gate-control theory in pain management. In a similar fashion, the literature states that estimates of the prevalence of depression among chronic pain patients are markedly inconsistent (Romano & Turner, 1985; Roy, 1992). Only one respondent correctly recognized this fact. Finally, the most common instrument used to measure chronic pain is the McGill Pain Questionnaire (Melzack, 1973). Only twelve (5.7 percent) of the medical social workers knew this to be the case.
Total knowledge scores were also calculated to determine respondents' knowledge of concepts and issues relevant to chronic pain. Scores were presented as a percentage and could range from 0 to 100. In this study they ranged from 8 percent to 76 percent correct, with a mean of 42.7 (SD = 13.3). The distribution showed a negative skew, reflected in the median of 44.0. Only about 31 percent of the 212 respondents scored below 40 percent on the knowledge section of the questionnaire. The majority (61.2 percent) scored between 40 percent and 60 percent, and approximately 7 percent of respondents scored over 60 percent. The results generally indicate that medical social workers in this study had limited exposure to concepts and issues relevant to chronic pain management. It must be emphasized, however, that the knowledge score generated for the study assessed only exposure to the chronic pain literature. Scores do not relate to general social work expertise, professional competence, or skill among the medical social workers who responded to the survey.
Bivariate analyses were used to examine the relationship between knowledge scores and selected demographic and organizational variables. Knowledge scores were significantly higher for respondents who worked in a setting that maintained a pain management program [t(82.1) = -2.27, p = .025]. Respondents' involvement on a pain team was also significantly related to their knowledge scores [t(64.7) = -3.38, p = .001]. Analyses of t test scores also found significant differences in knowledge scores for two other variables: whether the respondent had received any formal training in pain management [t(76.8) = -4.78, p = .000] and whether the respondent had received any substantial informal exposure to pain management [t(172.0) = -5.95, p = .000]. Respondents who were exposed to either source of pain-related information scored significantly higher on the knowledge section of the questionnaire.
Predictors of Attitudes and Knowledge
The extent to which organizational factors or individual respondent experiences could directly influence or confound social workers' responses was analyzed. Two sets of multiple regression analyses were performed to identify organizational and demographic variables that might predict these medical social workers' attitudes toward and knowledge of chronic pain management.
Respondents' total scores for both the attitudes and knowledge sections of the questionnaire served as dependent variables in regression analyses. Organizational variables regressed on attitudes and knowledge scores included organization type, number of inpatient beds maintained by the organization, presence of a pain management program, size of the social work department, field of practice, and ratings about the extent of social work involvement in case planning. Demographic variables regressed on attitudes and knowledge scores included age, professional certification, years of experience in social work, medical settings and current organization, gender, and exposure to pain management training. Because a number of these predictor variables were categorical in nature, methods of dummy coding and contrast coding were used to include them in the analyses (Cohen & Cohen, 1983). Results of these analyses are reported in Table 1.
Table 1 shows the last phase in stepwise models in which nonsignificant predictors of attitudes and knowledge were removed. For the sake of brevity, only significant predictors of attitudes toward chronic pain and knowledge scores have been reported. No significant demographic predictors of attitudes or significant organizational predictors of knowledge scores were found. However, the average attitude score for rehabilitation social workers was 8.70 points above the means of social workers from all other areas of practice. Conversely, as the number of inpatient beds increased in an organization, predicted attitude scores decreased. It should be noted, however, that the model resulted in an [R.sup.2] of .21, which suggests only a moderate capacity for predicting attitude scores from the model.
Regression analyses of respondents' knowledge about chronic pain reveal a very different pattern. Only two variables were found to be significant predictors of knowledge scores (Table 1). The model suggests that any formal training in chronic pain management in the past would predict a 5.86 percent increase in respondents' knowledge score. Similarly, any informal exposure to chronic pain management would predict an 8.00 percent increase in their knowledge score. It is interesting to note that informal exposure to chronic pain management was found to be the single best predictor of knowledge among respondents. Again, however, the reader is cautioned, because the [R.sup.2] of .16 provides only a low capacity for predicting knowledge scores from the model.
Table 1. Regression of Attitude and Knowledge Scores on Predictor Variables
Variable b [Beta] t
Rehabilitation worker (1 = yes, 0 = no) 8.70 0.26 2.76(*)
Number of beds (0-1,700) -0.02 -0.47 -3.85(*)
F(13, 153) = 3.15, p = .0003 [R.sup.2] = .21
Formal training in chronic pain management (1 = yes, 0 = no) 5.86 0.18 2.35(*)
Informal exposure to knowledge of chronic pain management (1 = yes, 0 = no) 8.00 0.29 3.88(*)
F(9, 182) = 3.72, p = .0041
[R.sup.2] = .16
* p [less than or equal to] .05.
Bywater (1986) and Kane (1983) both argued that little is or has ever been known of the overall extent or content of medical social work. Lack of knowledge is even more evident in emerging areas of social work involvement in health care settings. The current study has shed light on one of these emerging areas of medical social work involvement - the management of chronic pain.
The present study's findings show that medical social work is indeed becoming involved in the management of chronic pain. The fact that 40 of the 47 organizations that maintain a chronic pain program employ social workers as part of the pain team is significant and encouraging. It supports Subramanian's (1994) assertion that the social work profession is becoming a more common profession in multidisciplinary pain centers. Moreover, it also implies that the social work profession offers theoretical foundations and skills that are valued by those who maintain multidisciplinary pain centers. However, only three respondents identified chronic pain management as their primary area of practice. Therefore, it is evident that medical social workers have just begun to explore chronic pain as a domain of professional interest.
A number of factors hint that medical social workers find chronic pain to be a distinct and significant issue in health care settings. Perhaps most telling is the number of medical social workers who said they would like to receive additional training in pain management. Moreover, those who expressed a desire for more training in chronic pain management consistently reported interest in two general areas: social work involvement in chronic pain (n = 138, 65.1 percent) and nonmedical management of chronic pain (n = 117, 55.2 percent). Together these findings indicate that medical social workers recognize the importance of chronic pain treatment in their settings and the significance of chronic pain to their own professional practice.
When the positive attitude score is considered in conjunction with response patterns to individual attitude items, it is clear that medical social workers support the expansion of social work practice into the field of pain management and the training of social workers as practitioners of chronic pain management. The pattern of responses to attitude items also reveals that the themes underlying this support are consistent with recommendations made by Hudgens (1977), Golden and Steiner (1981), Subramanian (1987, 1991a, 1991b, 1994), and Roy (1989, 1992). These themes indicate the value of social work's role in assessing and treating psychosocial issues related to chronic pain and disruption in patients' families and in advocacy on behalf of the pain patient.
The contrasts between rehabilitation and other types of medical social workers and number of inpatient beds in the organization were the only significant predictors of attitudes toward nonmedical management of chronic pain. It might be suggested that rehabilitation workers would be more positive toward the nonmedical treatment of chronic pain because of the nature o f the chronic pain patients they work with. The pain patients served by rehabilitation workers are likely to have already undergone the full range of surgical and pharmacological treatments traditionally applied to pain. After these acute care regimens have failed, the patient is directed to the longer-term intervention of rehabilitation specialists. These pain patients may in fact experience the exasperation, despair, and depression that Wall (1989) associated with failed medical intervention. Therefore, when rehabilitation workers interact with such patients, they may associate traditional medical pain treatments with failed intervention and thus be more receptive to nonmedical treatment of chronic pain.
A surprising predictor of attitudes toward non-medical treatment of chronic pain was the number of inpatient beds maintained by the organization. This suggests that the most positive attitudes toward non-medical treatment of pain are held by individuals who work in those organizations least likely to offer a full range of services specifically directed toward chronic pain. A number of potential factors could explain this relationship. It is possible that social workers from large organizations specialize to a greater extent and have contact with a narrower range of patients. In most medical settings this range would be limited to acute care patients. This difference in experiences would logically make social workers from smaller organizations more likely to consider nonmedical treatment of chronic pain. Or perhaps the large medical settings are simply more traditional in their belief in the primacy of standard medical interventions.
Overall the social workers included in this study performed poorly on the knowledge section of the questionnaire. Relatively few respondents were able to correctly identify basic items from the pain management literature, clearly demonstrating that medical social workers have had very limited exposure to the chronic pain concepts and issues identified by the literature.
The lack of knowledge about chronic pain is a major barrier for social workers who wish to work in the field of pain management and those who are currently part of multidisciplinary pain teams. If the social workers are not aware of the basic knowledge components requisite to informed management of chronic pain, it must be concluded that they are ill equipped to participate in, plan, or implement optimal levels of chronic pain service delivery.
Lack of knowledge about chronic pain is a serious impediment for all social workers who encounter clients who suffer from chronic pain, in a formally structured pain program or any other form of social work service delivery. If Golden and Steiner (1981) were correct, a significant proportion of social services clients are particularly prone to the effects of chronic pain. Moreover, these clients are found not only in acute care settings but also in many other settings related to work, mental health, and aging (Subramanian, 1991b). If social workers from health care settings are unfamiliar with chronic pain and its effects, one can expect even less knowledge on the part of those from non-health care settings. The clear implication is that a significant proportion of social services clients in both health and nonhealth settings are unlikely to have issues of chronic pain adequately assessed and treated.
The inadequacy of current training is illustrated by the finding that formal and informal training in pain management accounted for only a small amount of variance in knowledge scores. If training is naturally beneficial to knowledge levels, why would training variables not account for more variation in knowledge scores for these social workers? One possibility is a variation in the depth or intensity of training experienced by these social workers. The questionnaire simply asked respondents to indicate any formal training in, or informal exposure to, chronic pain management. It is not known how long ago this training was experienced or how detailed and extensive the training was.
Also, the fact that knowledge scores were low, even for many of those who reported some previous exposure to pain concepts, suggests that previously obtained knowledge had not been retained. There is evidence to support this conclusion. Forty-two (19.8 percent) of the 212 social workers reported formal training in pain management, and 72 (34.0 percent) reported significant exposure to informal sources of pain knowledge. But the very low proportion of correct responses to basic chronic pain items (ranging from 5 percent to 10 percent) shows that many of these same individuals did not know about basic pain concepts.
This study suggests that medical social workers do not yet possess the knowledge base necessary for delivering effective pain management services. For the profession to expand its role in pain management two basic processes must occur. First, individual practitioners must make a determined effort to explore the pain management literature and become more familiar with the seminal works in the area. Already available is an extensive literature in the area of pain management that covers a wide range of issues: physiology, pain measurement, efficacy of treatments, patient characteristics, and psychosocial issues inherent in the pain experience. Medical social workers should have a rudimentary knowledge of pain mechanisms in the body and the assumptions of gate-control theory. They should understand that psychosocial factors play a role in shaping pain and that pain can in turn shape psychosocial factors. Also, social workers should be knowledgeable about the systemic nature of chronic pain and be prepared to intervene on that level. All this can be gained from the available literature.
Second, practitioners should not have to do this alone, and it is here that social work educators must assume responsibility for developing systematic pain-related training for social work practitioners. This training may occur in any number of ways, including development and delivery of university or continuing education curriculums, in-service workshops, or presentations by pain management professionals. Regardless of the exact nature of this education, it is clear that social work's traditional ignorance of pain management must end. As health care practitioners and members of a profession that engages people especially prone to chronic pain, social workers owe clients this effort.
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Jackie D. Sieppert, PhD, is assistant professor, Faculty of Social Work, University of Calgary, 2500 University Drive, NW, Calgary, Alberta T2N 1N4 Canada; e-mail: email@example.com.…
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Publication information: Article title: Attitudes toward and Knowledge of Chronic Pain: A Survey of Medical Social Workers. Contributors: Sieppert, Jackie D. - Author. Journal title: Health and Social Work. Volume: 21. Issue: 2 Publication date: May 1996. Page number: 122+. © 1999 National Association of Social Workers. COPYRIGHT 1996 Gale Group.