A New Year…What Advances in Pain Management Will We See in 2011?

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED Blog Administrator and Moderator

As we enter a new year, pain is still the #1 reason individuals seek out medical care (American Pain Foundation data).  Those who are involved in research, as well as direct caregivers of patients, know that pain is complex and needs to be addressed by a multi-modal and interdisciplinary approach.  Let’s take stock of where we are and where we hope to go in 2011.  We invite you to comment, discuss and brainstorm ways that we can more effectively manage pain on this site  Let’s envision a day when pain is no longer the #1 reason individuals seek medical care.

Happy New Year…may your year be filled with opportunities and possbilities.

Add comment  Tagged:  , , , , , , , , January 3, 2011

Progress and Challenges in Pain Research

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student, PREP-AIRED blog moderator and administrator

Thank you to Dr. Daniel Carr, founder of the Tufts University School of Medicine’s Pain Research Education and Policy Programs (PREP) for alerting us to a collection of articles in a recent edition of Nature Medicine which review progress and challenges in pain research from the bench to the bedside.  Take a look at some of the interesting issues being addressed with a focus on pain research and treatment.

Click here to view the table of contents

Add comment  Tagged:  , , , , , , , , December 10, 2010

New Release: Approaches to Pain Management with foreward by Daniel Carr, MD, FABPM

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator

Untreated or under-treated pain causes needless suffering and negatively affects the quality of life. That is why the management of pain remains a critical area of health care and why the concept is addressed throughout the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements. 

We congratulate the Tufts University School of Medicine’s Pain Research, Education and Policy Programs co-founder, Daniel Carr, MD, FABPM for providing the forward to the newly published second edition of Approaches to Pain Management: An Essential Guide for Clinical Leaders  

Approaches to Pain Management: An Essential Guide for Clinical Leaders, published by the Joint Commission Resources, provides an overview of pain assessment and management, identifies what the standards require regarding the treatment of patients with pain, and offers guidance on making pain management an integral part of care services.   Dr. Carr, an internationally recognized expert in pain management, provides both perspective and vision on the complex nature of pain.

The majority of the book is devoted to the best practices of health care institutions that have adopted focused pain programs. This updated guide also incorporates a global view of pain management, additional organizational best practices—including some from non-U.S. institutions.  Other features include the following:

  • Summaries of every Joint Commission and Joint Commission International pain assessment and management requirement across all health care settings
  • Strategies for identifying and using evidence-based medicine resources for pain management
  • Expanded case study chapters from clinical leaders describing how their organizations developed and implemented their pain management activities
  • Techniques and ideas for understanding and meeting pain-related standards
  • Guidance on committing an organization to pain management improvements

For more information about  the newly released edition of Approaches to Pain Management: An Essential Guide for Clinical Leaders, click here 

 

Add comment  Tagged:  , , , , , , , , , , , , November 29, 2010

The Pain Research, Education, and Policy Programs at Tufts University Welcome Wendy Williams

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator

You may see a new face if you are on the Tufts University School of Medicine campus in Boston these days.  Wendy Williams, BSN, M.Ed, is in a new role with the Pain Research, Education and Policy Programs at Tufts University School of Medicine, focusing on program development and administration. I recently had the opportunity to sit down with Wendy to ask her a few questions about herself and her visions for the PREP programs.  

Welcome Wendy…Can you tell us a bit about yourself?

I just arrived at Tufts from spending 8 years at Northeastern University in the School of Nursing working to ensure high quality clinical nursing education placements for both the undergrad/pre-licensure students and the advanced practice students seeking both clinical and non-clinical nursing master’s degrees.   My own clinical nursing background centers around oncology and HIV/AIDS.    I spent wonderful years at both Dana Farber Cancer Institute, during the time they had inpatient units, and at Harvard Community Health Plan/Harvard Vanguard with other highly skilled nurses on the HIV/AIDS Resource Team.I married a great guy back in 1996 who had a couple of sweet little boys who are now terrific college age young men, studying here in Boston.  My husband, Jeff, and I live in Framingham with our 3-legged cat, Punky, and hairless dog, Diddy.

What interests you about the PREP programs?

The concern for under-treated pain and pain management are steady threads that ran throughout my own clinical practice.  Ensuring adequate pain management is a strong cornerstone of quality nursing care and practice, so the PREP programs of study are very attractive to me and tie together much of what I value.  The chance to work collaboratively with the three program leaders (who are also physicians), Dr. Dan Carr and Dr. Richard Glickman-Simon and Dr. Ylisabyth Bradshaw, is an opportunity I want to leverage.I have long sought ways to be a force behind strengthening linkages between medicine and nursing and other health care disciplines to encourage both multidisciplinary and interdisciplinary approaches to health care.  The PREP programs present an ideal setting to have broad-based conversations around the area of pain issues.  Also, my own master’s degree is in education, specializing in adult and organizational learning, so .  the opportunity to develop a program of study and optimize learning for students globally is a really strong draw for me to be here at Tufts working with the PREP programs.

What do you see as the strengths and challenges of the PREP program?

A real strength of the PREP programs is its unique position in masters level education  that delves deeply into the many physical/clinical, social and scientific aspects of pain.  There is not a population of people, worldwide, that is not impacted by pain issues.  Also, the fact that the PREP programs are not solely clinically based creates a rich learning environment for many types of students… clinicians seeking to be subject matter experts in pain issues learn side by side with non-clinicians who may be seeing the PREP programs as a way to become well-informed advocates for pain issues.  After about a month in this role, I see two challenges to the PREP programs that I would like to positively impact.  One challenge is getting more and more people in the greater Boston area to know about this great set of programs and to become students in the program.  I happen to know one graduate of the program, Hallie Greenberg, a nurse from the Brigham & Women’s Hospital, and know that there are so many others that would be really inspired to become proficient in this area.  The other challenge is understanding and communicating to others clear linkages between getting one of the certificates and/or the master’s degree and a specific career enhancement.  There seems to be a certain pioneering element to encouraging students to go for the certificates or the degree as a natural next step in career growth.

What are your hopes and vision for the PREP program?

I hope that PREP grows steadily, both in numbers and in innovative educational initiatives, and sustainably with input from all communities of interest: students and alumni and staff and our steering committee and faculty and leaders in pain issues globally.  I would love to speak with students and alumni and gain their insights on how we can best lead the way in pain research, education and policy.  I welcome calls, 617 636-0815, emails wendy.williams@tufts.edu, or simply stop by my office in the M&V building, Room 142A. I’d love to meet you.

Add comment  Tagged:  , , , , , , , , , , , , November 15, 2010

Love Induced Pain Relief

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIREDLove Induced Pain Relief blog moderator

Thank you to Tufts University School of Medicine, MS-PREP alumna Nancy Mitchell for forwarding this intriguing study from Stanford University School of Medicine on love induced pain relief.  In their study, Dr. Sean Mackey and colleagues suggest that intense, passionate feelings of love can alter the perception of pain. 

“When people are in this passionate, all-consuming phase of love, there are significant alterations in their mood that are impacting their experience of pain,” said Sean Mackey, MD, PhD, chief of the Division of Pain Management, associate professor of anesthesia and senior author of the study. “We’re beginning to tease apart some of these reward systems in the brain and how they influence pain. These are very deep, old systems in our brain that involve dopamine — a primary neurotransmitter that influences mood, reward and motivation.”

While love is not the only answer to relieving pain, it appears that similar areas of the brain are activated by intense love and also by pain relieving pharmaceuticals.  Further study of the neural reward pathways  that are triggered by intense feelings of passion could lead to a more complete undertanding of the neural mechanisms involved in the pain experience.

Click here to read the complete study

Add comment  Tagged:  , , , , , , , , November 9, 2010

Do Cortisone Injections Make Pain Worse?

cortisone injectionby Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator

A recent study published by The Lancet (to read the study abstract, click  here ) explores the question of efficacy and safety of corticosteroid injections for tendinopathy, both short-term and long-term. Using a systematic review of randomized control studies, researchers observed that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms.  

As this research indicates, there is a need for multidisciplinary pain management approaches in the treatment of chronic pain conditions.  What have been your experiences with using corticosteroid injections?

Add comment  Tagged:  , , , , , , , November 2, 2010

Can Changing How You Pay Attention Help Ease Pain?

Dissolving Pain by Fehmi and RobbinsThank you to our guest blogger, Dan Fields, for this informative and timely book review of Dissolving Pain: Simple Brain-Training Exercises for Overcoming Pain by Fehmi and Robbins. 

Can changing how you pay attention help to ease pain? Yes, suggest psychologist and biofeedback expert Les Fehmi, PhD, and science writer Jim Robbins in their new book, Dissolving Pain: Simple Brain-Training Exercises for Overcoming Chronic Pain (Trumpeter, 2010). The conventional understanding of pain is that it results from an injury to the body—such as a slipped disk, in the case of back pain. However, the authors contend that “pain, whatever its causes, resides principally in the brain and can therefore be treated by working with the mind in specific ways.”

Consider the phenomenon of phantom limb pain, in which pain persists in a limb after it has been removed. “Areas of the brain associated with the missing limb can still, mistakenly, generate pain, probably because they are [abnormally] sensitized,” according to Fehmi and Robbins.

You can reduce the intensity of any type of pain, the authors suggest, by expanding your focus of attention—like zooming out with a camera. “When you are narrow-focused on something, including pain, it represents 100 percent of your awareness. When you broaden your attention beyond the pain, the pain becomes a fraction of your total awareness,” they write.

And the quickest way to expand your focus is “to become aware of space,” say Fehmi and Robbins. The book and an accompanying CD include guided exercises that ask if you can imagine the distance between various parts of the body. These exercises supposedly encourage the brain “to produce more of the slower, more rhythmic brainwave frequencies associated with healing, balance, and well-being,” they write.

In contrast, a narrow focus of attention “increases the frequency of our EEG, tenses muscles, and generally makes us more sensitive to pain,” claim the authors.

The book includes many anecdotes of how the attention exercises have helped Fehmi’s patients with back, joint, or other types of pain. However, this reviewer is not aware of any solid research on this mind-body approach.  So it’s up to readers to try the exercises for themselves and see if they help.

Dan Fields is a freelance health writer and former editor in chief of Dr. Andrew Weil’s Self Healing newsletter.  He lives in the Boston area, and his email address is dfields820@gmail.com

1 comment  Tagged:  , , , , October 10, 2010

The Gender Gap in Pain

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by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator

Researchers and clinicians are coming to the realization that there is a gender difference in how pain is experienced between men and women.  While males and females seem to have comparable patterns of pain in childhood, at puberty certain types of pain become more common in females.  And females report a higher pain severity as compared to males after puberty.  Some research suggests that one explanation may be that estrogen protects against pain at high levels and enhances or amplifies pain at low levels, consistent with menstrual cycles.  However, gender based pain research is in its very early stages, one obstacle being that most basic pain research has been done only on male mice and rats.  Researchers are now beginning to understand that, in fact, males and females may process pain very differently due to hormonal and other factors.  Dr. Daniel Carr, founder of the Tufts University School of Medicine’s Pain Research, Education and Policy Program and an internally recognized expert in pain management recently stated in a Boston Globe article, “The conditions that cause pain affect men and women differently in terms of prevalence and severity.”  Carr noted that some drugs affect men and women differently, as well as the social and cultural dimension of gender which may modify treatment choices.  “Whatever pain therapy one selects should have some flexibility to it”, added Dr. Carr.

To read the Boston Globe article The Gender Gap: Learning Why Men and Women Experience Pain Differently, click here

Add comment September 27, 2010

Music Prescription for Physical and Emotional Pain

Music and Pain Relief by Nancy Mitchell, MS-PREP

A prescription for music may be a beneficial adjunct to more traditional therapies according to research at Glasgow Caledonian University. Check out this article in Science Daily.

Add comment  Tagged:  , , , , September 21, 2010

MS-PREP August 2010 Capstone Presentations

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator

 

August 11, 2010 marked the culmination of intensive research and planning for two candidates for Master’s degrees in the Pain Research, Education and Policy Program at the Tufts University School of Medicine with the presentation of their capstone projects.

Margaretta Elizabeth (Beth) Sangree, a student in the joint program with the New England School of Acupuncture (NESA), presented her capstone project entitled

PREP%20August%202010.jpg

Pictured L-R: Ylisabyth (Libby) Bradshaw, DO, MS, Associate Director of the Pain Research, Education and Policy Program; Margaretta Elizabeth (Beth) Sangree, MS-PREP candidate, Richard Glickman-Simon, MD, Director of the Pain Research, Education and Policy Program; and Sherry Brink, RN, BSN, MS-PREP candidate

“Measures of the Patient-Provider Relationship in Acupuncture Treatments”. Beth highlighted several studies that support the importance of relationship-centered care in effective pain treatment. Future directions will include quanitfiable, replicable, randominzed control studies to continue to document the effect of patient-provider relationship on treatment effectiveness.

Sherry Brink, RN, BSN, presented her capstone project on “Post-Op Pain Management in the Pediatric Patient” with emphasis on bringing best practices of post-op pain managment to underserved, international patient populations. Sherry recounted her experience bringing comprehensive pain management methods to a small rural hospital in the Andes mountains of Peru and her development and integration of a bilingual nursing education module on pain management currently being used by the staff in Peru. Sherry hopes to use her MS-PREP degree to further her international medical mission work by continuing to educate nurses worldwide in effective, compassionate pain management methods.

Congratulations to these two exceptional MS-PREP degree candidates!

Add comment  Tagged:  , , , , , , , , , , August 23, 2010

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