EFIC pain curricula

Core Curriculum for the European Diploma in Pain Medicine (EDPM)

This is the founding curriculum of the EFIC^® series, first launched in 2016 and setting the standard for medical education on pain across Europe. It defines the knowledge, skills, and competencies required for basic proficiency in pain medicine, and it is the reference document for the European Diploma in Pain Medicine examination.

The curriculum is written for physicians rather than for pain medicine specialists alone. It assumes a trainee may be pursuing a primary fellowship in anaesthesia, psychiatry, rehabilitation medicine, general practice, or a physician or surgical specialty, and sets out the additional grounding in pain that any of those routes should provide. It is the largest and most detailed of the six curricula, reflecting the breadth of the specialty it defines.

At a glance
Profession	Medicine (all specialties whose trainees see and treat pain)
Level	Postgraduate, specialist
Current version	Second edition, September 2023
Structure	5 sections, 30 sub-sections, approximately 525 topics^*
Developed by	EDPM review chaired by Professor Bart Morlion, with the EFIC^® Education Committee, based on a curriculum used with permission from the Faculty of Pain Medicine of Australia and New Zealand
Endorsed by	Reviewed via the European Pain Forum, with contributions from the European Academy of Neurology, the European Society of Anaesthesiology and Intensive Care Medicine, the European Psychiatric Association, the European Federation of Psychologists Associations, the European Society of Physical and Rehabilitation Medicine, the European Region of World Physiotherapy, the European Specialist Nursing Organisation, the European Cancer Organisation, the European Society of Regional Anaesthesia, the European Federation of Addiction Specialists, the European Headache Federation, the Council of Occupational Therapists for European Countries, the European Association of Hospital Pharmacists, and the World Organisation of National Colleges, Academies and Academic Associations of GPs/Family Physicians
Linked examination	European Diploma in Pain Medicine (EDPM)
Languages	English
ISBN	9789082740233

^*The published numbering contains a small number of gaps (see version history), so this figure is close but not exact.

Cover of the EFIC Core Curriculum for the European Diploma in Pain Medicine, September 2023

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Who this curriculum is for

The EDPM is aimed at physicians training toward the European Diploma in Pain Medicine, drawn from a wide range of primary specialties, including anaesthesia, psychiatry, rehabilitation medicine, neurology, rheumatology, orthopaedics, neurosurgery, and general practice. It sets out the grounding in pain medicine expected in addition to a trainee's existing specialist abilities.

Beyond individual candidates, the curriculum is used by:

Universities and postgraduate training bodies mapping educational activities against the learning outcomes it defines.
National pain societies and healthcare authorities developing or benchmarking their own pain medicine qualifications.
EFIC^® Academy and the EFIC^® Pain Schools, whose e-learning materials and live teaching are mapped to it.
Other professions in an interprofessional pain team who need to understand the scope of the specialist pain medicine physician (SPMP) role.

What the curriculum aims to do. It articulates the scope of practice of a specialist pain medicine physician, guides supervisors on suitable learning experiences, fosters trainees' self-directed learning, provides consistency of standards and outcomes across European training settings, and gives a framework for continuing professional development. It uses the CanMEDS framework from the Royal College of Physicians and Surgeons of Canada as the basis for Section 2, and is developed, with permission, from a curriculum originally created by the Faculty of Pain Medicine of Australia and New Zealand.

What the curriculum covers

The curriculum is organised into five sections, moving from foundational science and professional roles, through the management of specific pain types, to special patient populations and interprofessional working. The summaries below give the structure and scope of each section; the full text of every topic is in the PDF.

Section 1. Foundations of Pain Medicine

9 sub-sections · 72 topics

1.1 Background (1 topic). The CanMEDS roles as they apply to the specialist pain medicine physician.
1.2 Fundamental Concepts (5). Bioethical principles, the IASP definition of pain, the distinction between nociception and pain, acute versus chronic pain, biopsychosocial model.
1.3 Terminology used in Pain Medicine (3). IASP-defined terminology; treatment modality terms; and the placebo, nocebo, and lessebo effects.
1.4 Neurobiology of Pain (8). Ascending and descending nociceptive pathways; the neuroanatomy of the pain experience; peripheral and central sensitisation; acute pain, inflammatory and neuropathic pain mechanisms; the physiology of tolerance, dependence, and addiction.
1.5 Research Methodology of Pain (9). Clinical trial design; research ethics; clinical epidemiology; data analysis; power, effect size, and significance; principles of assessing scientific evidence.
1.6 Bio-psychosocial Aspects of Pain (24). Patient triage; physical, psychological, and social aspects of assessment and management; validated assessment and treatment tools; implementing a biopsychosocial Management Plan.
1.7 Assessment of Pain (8). Factors influencing the experience of pain and illness; DSM and ICD frameworks for mental disorders; basic assessment and investigations; screening questionnaires for psychological and somatic symptom burden.
1.8 Management of Pain (6). Pharmacokinetics, pharmacogenetics, and pharmacodynamics; major drug classes used in pain medicine; opioid and analgesic equivalence; routes of administration.
1.9 Digital medicine and telehealth (8). The principles, benefits, and limitations of digital medicine and artificial intelligence in pain management; health apps and wearables; data security and privacy.

Section 2. Pain Medicine Roles in Practice

7 CanMEDS-based roles · 133 topics

2.1 Clinician (38 topics). Clinical assessment and formulation; preparing and implementing management plans.
2.2 Professional (25). Ethical practice; cultural awareness and sensitivity; the legal and regulatory environment, including controlled substances; health and sustainable practice of Specialist Pain Medicine Physician.
2.3 Scholar (15). Ongoing personal learning; critical appraisal of evidence; teaching and mentoring others; contribution to innovation in Pain Medicine.
2.4 Communicator (21). Therapeutic relationships; investigate and communicate relevant information with patients (person-centered approach, health literacy, and shared decision-making).
2.5 Collaborator. As a collaborator, the specialist pain medicine physician (SPMP) effectively works in a healthcare team to achieve optimal patient care.
2.6 Manager (and Leader) (16). Organisational and personal work practice, equitable allocation of finite health resources, participation in administrative and leadership roles.
2.7 Health Advocate (18). Patient, personal, and community advocacy, to advance the health and wellbeing of patients and caregivers, colleagues, communities and populations.

Section 3. Managing Different Types of Pain

10 pain-type sub-sections · 215 topics

3.1 Acute Pain (29). Acute Pain Service models, the transition from acute to chronic pain, clinical assessment and management of acute pain.
3.2 Neuropathic and related Pain (11). Mechanisms of allodynia, hyperalgesia, and hyperpathia; assessment tools and different presentations of neuropathic pain; pharmacological and non-pharmacological treatment.
3.3 Cancer-related Pain (32). The WHO analgesic ladder; neurophysiological cancer-related and treatment-related pain mechanisms; breakthrough pain, persistent background pain, incident pain, and incompletely relieved background pain; management of opioid analgesics; oncological emergencies; interventional options; management at the end of life.
3.4 Musculoskeletal Pain (14). Joint, muscle, and bone pain; the influence of repetitive injuries in MSK pain; and the management of MSK pain, including self-management, exercise, and rehabilitation.
3.5 Neck and Back Pain (30). Classification and risk stratification tools; neuroanatomy and function of the spine; major risk factors for transition of acute to chronic pain; red flag pathologies; evidence base for injections, radiofrequency treatment, and surgery.
3.6 Fibromyalgia Syndrome and Chronic Widespread Pain (17). Diagnostic criteria and competing aetiological theories; heterogeneity of clinical presentations of Chronic Widespread Pain; interprofessional/multidisciplinary management (including self-management, graded exercise, medications, and cognitive behavioural therapy.
3.7 Headache and Orofacial Pain (36). Neurobiological mechanisms for primary and secondary headaches, orofacial pain, and dental pain; cranial nerve, temporomandibular system, and intraoral examination; pharmacological, surgical, and neuromodulation treatment options.
3.8 Visceral Pain (17). Primary and secondary visceral disorders; somatic and visceral pain syndromes; neuroanatomy of thoracic, abdominal, and pelvic viscera; red flag' features that suggest active visceral disease; pharmacotherapy, physiotherapy, non-invasive neuromodulation, and invasive therapies.
3.9 Complex Regional Pain Syndromes, Type I and II (9). The New IASP diagnostic criteria; sympathetically maintained pain; functional assessment of the CRPS-affected limbs; management strategies including cognitive behavioural therapy, physiotherapy, pharmacotherapy and invasive treatment options.
3.10 Pain in Hereditary Connective Tissue Disorders (20). Public health dimensions of the problem of pain in HDCT; potential specific causes of acute and chronic pain in HDCT; physical examination tests, psychological and functional questionnaires; management strategies including cognitive behavioural therapy, physiotherapy, pharmacotherapy and invasive treatment options.

Section 4. Special Patient Populations

3 sub-sections · 94 topics

4.1 Pain in Older Adults (39). Prevalence and onset of pain in later life, age-related pharmacokinetic and pharmacodynamic change, pain in people living with dementia, and palliative, cancer, and nursing care in this population.
4.2 Pain in Infants, Children, Adolescents and Young Adults (34). Developmental neurobiology of pain, age-appropriate and validated assessment tools, family-centred and interprofessional management, safeguarding, and transition to adult pain services.
4.3 Pain and Problem Substance Use (21). Tolerance, dependence, and Opioid Use Disorder, risk stratification for opioid prescribing, supervised withdrawal, and the provision of naloxone.

Section 5. Interprofessional Working and Learning

1 sub-section · 11 topics

A single sub-section that underpins every other section. It covers the barriers and facilitators to team-based pain care, working respectfully in partnership with patients, families, and colleagues, reflecting on one's own contribution to the team, negotiating shared responsibilities, resolving interprofessional conflict, and conveying relevant information when transferring a patient's care.

Using this curriculum in your programme

Reading and citing

The curriculum is published openly on this page and may be read, downloaded, and cited in programme documentation, accreditation submissions, and published work, with the EFIC^® attribution retained.

Benchmarking a programme

The curriculum can be used as a reference standard against which to map or review existing postgraduate teaching in pain medicine. We would be glad to hear from you if you do so.

Adaptation and translation

Please contact us before reproducing, adapting, or translating any part of the curriculum. Requests are discussed individually, and we will work with you on wording, review, and attribution.

Contact us first

Write to secretary@efic.org, telling us which curriculum you are interested in, your institution or organisation, the language or context involved, and how you intend to use it. We will come back to you to discuss how best to proceed.

How to cite this curriculum

European Pain Federation EFIC. EFIC^® Core Curriculum for the European Diploma in Pain Medicine. 2nd ed. Brussels: European Pain Federation EFIC; 2023. ISBN 9789082740233. Available from: https://europeanpainfederation.eu/education/pain-curricula/pain-medicine-edpm/

Download the full curriculum

The complete document contains the full text of every topic, together with forewords from the EFIC^® President and the curriculum review chair, the introduction on the scope of pain medicine practice, the list of endorsing societies, and the acknowledgements.