19 , 25 The training of community orthopedists poses a unique problem, since their training is surgery-oriented, while most of the musculoskeletal problems encountered in the community call for conservative, bio-psycho-socially oriented

management. 26 Until recent years, pain training programs were few and offered mainly theoretical Inhibitors,research,lifescience,medical teaching, with little practical training. In recent years more pain training courses have become available, and several pain medicine schools are currently active, training primary care physicians. We are aware that many primary care physicians will have less interest in pain and musculoskeletal problems than in diabetes FTY720 in vitro mellitus and metabolic syndrome for example, but we are Inhibitors,research,lifescience,medical convinced that a basic working knowledge of the diagnosis and treatment of patients suffering from pain necessitates further postgraduate training even for those with less interest. We propose that most of the primary care physicians undergo theoretical and practical training, thus becoming qualified pain trustees. Vision for Community Primary Care Physicians Community primary care physicians will receive continuous theoretical and practical training in pain medicine both Inhibitors,research,lifescience,medical during their residency and as continued medical education.

Primary physicians will be able to take pain mechanism-based history, perform a focused physical and neurological examination, and manage the treatment of patients’ pain based on the bio-psycho-social model, including referral to imaging studies, tailoring appropriate pharmacotherapy, and orchestrating other pain treatment modalities: physical therapy, mental health services, and pain clinics. SECONDARY CARE Inhibitors,research,lifescience,medical PHYSICIANS, CERTIFIED IN COMMUNITY PAIN MEDICINE

All fields of medicine benefit from community-based medical experts. Pain medicine as well would benefit from certified physicians serving as secondary referral addresses, mid-way between primary care medicine and tertiary pain centers. To date, few such secondary pain clinics Inhibitors,research,lifescience,medical are available in Israel, which are naturally unable to address the needs of the myriad patients in pain. The residency program in pain medicine, which opened recently, is not expected Parvulin to solve the problem adequately due to the enormous gap between number of residents (around 10 nationally) and the national need of pain specialists (estimated in hundreds). We therefore suggest that the solution lies in the training of primary care physicians in pain medicine, which should take place in two steps: first, basic training as pain trustees, and then diploma studies in pain medicine. At the end of the 300-hour training program, including theoretical and practical training, certified physicians will be awarded a diploma in pain and musculoskeletal medicine.