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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

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Volume 18, Issue 3

Differences in Swedish and Australian medical student attitudes and beliefs about chronic pain, its management, and the way it is taught

Linda Rankin
  • Corresponding author
  • Department of Pharmacology and Clinical Neuroscience, Umeå University, SE-90187 Umeå, Sweden
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Britt-Marie Stålnacke / Christopher J. Fowler / Gisselle Gallego
Published Online: 2018-04-30 | DOI: https://doi.org/10.1515/sjpain-2018-0039


Background and aims

Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician’s knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student’s attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education.


An online survey was conducted with final year Australian and Swedish medical students from two different universities between December 2016 and February 2017. Attitudes and beliefs towards chronic pain patients were measured using the Health Care Providers’ Pain and Impairment Scale (HC-PAIRS). A thematic analysis was conducted on open end questions regarding their views on their education and important skills for chronic pain management.


A total of 57 Swedish and 26 Australian medical students completed the HC-PAIRS scale. The Swedish medical students showed statistically significantly lower total mean HC-PAIRS scores compared to Australian medical students (46 and 51, respectively). Australian students had statistically significantly higher scores than the Swedish students for two of four factors: functional expectations and need for cure, whereas no significant differences were seen for the factors social expectations or for projected cognition. From the open end questions it was evident that final year medical students are knowledgeable about key chronic pain items described in clinical guidelines. However, both cohorts described their chronic pain training as poor and in need of improvement in several areas such as more focus on the biopsychosocial model, working in multidisciplinary teams, seeing chronic pain patients and pharmacological training.


Attitudes and beliefs are formed during medical education, and our study exploring attitudes of medical students towards chronic pain and how it is taught have provided valuable information. Our survey provided detailed and cohesive suggestions for education improvement that also are in line with current clinical guidelines. This study indicates that the Swedish final year students have a more positive attitude towards chronic pain patients compared to their Australian counterparts. The majority of students in both cohorts perceived chronic pain management education in need of improvement.


This study highlights several areas of interest that warrant further investigation, for example, the impact of a changed medical curriculum in alignment with these clinical guidelines requested by students in this survey, and correspondingly if their attitudes towards chronic pain patients can be improved through education. Further, we conclude that it would be valuable to align the implementation of the HC-PAIRS instrument in order to achieve comparable results between future studies.

This article offers supplementary material which is provided at the end of the article.

Keywords: chronic pain; HC-PAIRS; medical education; attitudes; medical students


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About the article

Received: 2018-02-19

Revised: 2018-03-27

Accepted: 2018-03-30

Published Online: 2018-04-30

Published in Print: 2018-07-26

Authors’ statements

Research funding: Part of this work was supported by grants from the Swedish Research Council (a Scheele visiting fellowship to GG and a project grant, no. 12158 to CJF). For the remaining authors, none were declared.

Conflict of interest: No conflicts of interest are declared.

Informed consent: Consent was obtained from all study participants. All responses were codified and kept confidential.

Ethical approval: This study was reviewed by both the Regional Ethical Review Board in Umeå 2015-09-08 and by the University of Notre Dame Ethics Committee. Ethics approval was granted by The University of Notre Dame Ethics Committee (HREC Ref 0170025). The Regional Ethics Review Board in Umeå returned it with an advisory opinion; because participation in the survey was fully anonymized, it was not considered to require a formal approval.

Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 3, Pages 533–544, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0039.

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©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

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