by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student, PREP-AIRED blog moderator and administrator, Tufts University School of Medicine
Chronic pain is elusive, often impossible to visualize or describe, and a continuing challenge for patients and health care providers alike. The National Center for Health Statistics estimates that 76.5 million Americans suffer from chronic pain, an all encompassing term which includes pain that persists for months or years, often with no visible evidence of underlying injury. A recent Time Magazine Health Special featured an informative series of articles on the issue of chronic pain with new insights from the bench and the bedside, as well as patient stories reflecting on the challenges of living with pain.
Leading voices in pain management are quoted extensively in the Times Magazine health special focusing on chronic pain, one of whom is Dr. Rollin M. Gallagher, editor of Pain Medicine and the American Academy of Pain Medicine’s Past President. The Tufts University Pain Research, Education and Policy Program is honored that Dr. Gallagher will be presenting the annual Sackler Lecture at Tufts Medical Center on April 21. Dr. Gallagher will be addressing the complex pain management issues of today’s combat veterans.
For more information about the 2011 Sackler Lecture, please click here.
March 27th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator and administrator, Tufts University School of Medicine
The American Pain Foundation has produced a number of helpful online videos for patients, families and health care professionals highlighting the complex nature of pain, especially chronic pain. It is essential that pain care be a multidisciplinary process with the patient an active participant in care. You may want to check out the American Pain Foundation’s selection of online videos on their YouTube site. Take a look at “Health Professionals Making a Difference in Pain Care” to listen to health professionals and pain patients share their message.
March 17th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator and administrator
Anticipate, Assess, Alleviate
The International Association for the Study of Pain (IASP) is the leading professional forum for science, practice and education in the study of pain. Each year the IASP focuses on an area of importance in the field of pain management. This year’s focus is acute pain, with 2010-2011 being designated as the Global Year Against Acute Pain by the IASP. Acute pain is the most frequent reason why patients visit an emergency department. Unfortunately, inadequate acute pain control is common. If uncontrolled or inadequately controlled, acute pain can result in increased health care costs due to longer hospital stays and a higher liklihood of the development of chronic pain. By raising awareness of acute pain as a significant health care issue, the IASP hopes to lessen the gap between acute pain knowledge and research and current clinical practice.
Click here to access resources and information about acute pain mangement and how to become involved in the IASP Global Year Against Acute Pain.
January 30th, 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.
January 3rd, 2011
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 firstname.lastname@example.org, or simply stop by my office in the M&V building, Room 142A. I’d love to meet you.
November 15th, 2010
By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED 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
November 9th, 2010
by 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?
November 2nd, 2010
Thank 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 email@example.com
October 10th, 2010
By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Thank you to 2010 MS-PREP alumna, Nancy Mitchell, for sending along a recent update to the Cochrane Library and the Cochrane Database of Systemic Reviews addressing acupuncture and tension-type headaches. In a previous Cochrane Review (2001), acupuncture was found to be inconclusive as a treatment for tension-type headaches. However an updated 2009 Cochrane Review on acupuncture and tension-type headaches, which included 11 randomly controlled trials, concluded that acupuncture may be a valuable treatment option for patients suffering from frequent tension-type headaches.
The Cochrane Review stated: “We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or ‘fake’ acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies. In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.”
Cochrane Reviews are an integral part of evidence based medicine. It is important to include both allopathic and integrative medicine studies in the rigorous review process to further our knowledge of effective strategies to treat and manage chronic pain conditions.
May 23rd, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student, PREP-AIRED blog moderator
Thanks to Cyndie Rodman, MS-PREP ’09, for sending along the press release from the recent Massachusetts Pain Initiative Survey. Cyndie writes that “the survey not only quantified the incidence of chronic pain among the Massachusetts general population, but also the differences and disparities experienced by minorities versus non-minorities. This is the first Massachusetts study we are aware of to look at how pain is experienced by minorities compared to non-minorities.” Tufts University School of Medicine’s Pain Research, Education and Policy (PREP) faculty member, Carol Curtiss, RN, MSN, as well as PREP guest lecturer, Paul Arnstein, PhD, APRN-BC, played instrumental roles in the survey. Click here to read the Massachusetts Pain Initiative’s press release about the survey. For more information about the Massachusetts Pain Initative, click here.
May 10th, 2010