From treating pain to promoting health: a competency-based salutogenic framework for pain medicine education

Chronic pain is a leading cause of disability worldwide and remains a challenge for healthcare systems, medical education, and public health. Although advances in pain neuroscience and interventional therapies have improved pain management, biomedical approaches alone are insufficient to address the multidimensional nature of persistent pain or promote adaptive recovery, participation, and long-term functioning. Contemporary pain medicine therefore requires educational models integrating health promotion, resilience, relationship-centered care, and sustainable professional practice. To develop and describe a competency-based salutogenic educational framework for pain medicine integrating contemporary concepts from pain science, health promotion, behavioral science, and medical education. The framework was developed through conceptual integration of complementary theories from pain medicine, psychology, health promotion, and competency-based medical education. It combines total pain, salutogenesis and sense of coherence, resilience, Social Cognitive Theory, therapeutic alliance, and physician professional sustainability within a longitudinal educational structure. Rather than replacing existing biopsychosocial or salutogenic models, it integrates their complementary strengths by explicitly linking adaptive recovery, relationship-centered care, competency development, authentic assessment, and health promotion. Educational implications include longitudinal competency-based curricula, reflective practice, interdisciplinary learning, patient partnership, workplace-based assessment, and validated psychometric instruments alongside competency-based educational assessments to evaluate learner and patient outcomes. The proposed framework reorients pain medicine education beyond symptom management toward adaptive recovery, participation, equity, and person-centered care. By integrating health promotion with competency-based medical education, it provides a conceptual foundation for curriculum development, implementation research, and evaluation of educational strategies to improve outcomes for patients, healthcare professionals, and health systems.