2013 Sackler Lecture: Dr. Scott Fishman

by Pamela Katz Ressler, MS, RN, HN-BC, adjunct faculty, Pain Research, Education and Policy (PREP), Tufts University School of Medicine

The Pain Research, Education and Policy Program (PREP) is honored to present the Annual Sackler Lecture with guest speaker, Scott M. Fishman, MD, chief, Division of Pain Medicine and Professor of Anesthesiology and Pain Medicine (School of Medicine, University of California-Davis), on Thursday, January 31, 4:00-5:00 PM in the Wolff Auditorium at Tufts Medical Center (800 Washington St, Boston).

Dr. Fishman, a world-renowned authority on pain management, will lecture on the subject of interprofessional and competency-based education for clinicians managing pain. Chronic, or persistent pain, is not only a personal health issue, but a public health and economic challenge for our country.  It is estimated that chronic pain costs the United States economy over $635 billion annually due to medical care and lost productivity. Yet, we are not adequately addressing this societal burden.  As pain management has evolved over the past decades, it has become apparent that a multi-modal and interprofessional approach to pain is necessary.  However, interprofessional pain management is often underutilized for many factors, one being a paucity of interdisciplinary educational opportunities for clinicians. Training our health care professionals to manage pain in an interprofessional model will allow for our health care system to effectively care for the increasing numbers of individuals suffering from chronic or persistent pain. The need for increased interprofessional training in pain management was recently highlighted in the Institute of Medicine’s 2011 report:  Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. In addition to his clinical work at UC-Davis, Dr. Fishman serves as a co-principal investigator of the Interprofessional Pain Management Competencies Working Group of the Mayday Fund.

The Pain Research Education and Policy Program invites students, alumni, health care professionals, clinical staff and faculty,  health communicators, public health advocates, and others to join us for Dr. Fishman’s informative and engaging lecture, immediately followed by an interprofessional panel discussion.

For more information about the event, click here

Add comment January 21st, 2013

Pain Education is a Public Health Imperative: Reflections on Pain Awareness Month and the Institute of Medicine Pain Report

by Daniel B. Carr, MD, FABPM, FFPMANZCA (Hon.), Co-Founder and Director of the Pain Research, Education and Policy Program (PREP) at the Tufts University School of Medicine

Each year, September is “Pain Awareness Month” – a time of intense activity for PREP faculty and the entire pain community  It is also when PREP’s academic year begins.  One key insight connects diverse Pain Awareness activities and PREP’s own vision and mission: PAIN IS A PUBLIC HEALTH ISSUE, AND PAIN EDUCATION IS A PUBLIC HEALTH IMPERATIVE.  Now is a perfect time to step back and place some context around this idea at the heart of not only PREP’s curriculum, but also our entire approach to interprofessional education.

The report issued by the Institute of Medicine earlier this summer – “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research” (ref 1) — is the latest in a series of white papers on pain by governmental and professional groups dating back well over two decades.  These include the first US federal clinical practice guideline (ref 2) on any topic,  numerous international guidelines (ref 3), and white papers from authoritative sources such as the Mayday Fund (ref 4), the American Academy of Pain Medicine (ref 5), and even the World Health Organization (ref 6). Together, they present steadily accumulating evidence that acute, chronic and cancer-related pain are widely prevalent and exact a major economic and human burden in developed nations and even more so in resource-poor countries. Other common themes include lost opportunities for early intervention to control or prevent the transition from acute to chronic pain, the negative outcomes of undertreated pain, the importance of optimal pain control for patient-centered care, disparities in pain assessment and treatment experienced by minorities and other under-represented groups such as women or those at the extremes of age, and the need “to adopt a population-level prevention and management strategy” (ref 1) for pain.  Related to all these is the growing perspective that pain control is a fundamental human right (ref 7) as articulated by Human Rights Watch (ref 8  ) and recently affirmed in the 2010 Declaration of Montreal by delegates to the International Pain Summit (ref 9).

Since its inception in 1999, the Tufts program on pain research, education and policy has been housed in its Department of Public Health and Community Medicine. Although the pain community has long held a consensus that pain is a biopsychosocial phenomenon, most prestigious journal articles and a majority of research funding have emphasized the “bio” end of that word. Thus, the classical Loeser model of pain originates in subcellular nociceptive machinery, then broadens to encompass the experiences of pain and suffering, followed by pain behavior.  The Loeser model is an intrinsically individual one.

(Fig 1. Loeser Model used with permission of Professor John Loeser)

Our program’s framing of pain employs a sociobiological perspective, in keeping with our having been co-founded by a PhD sociologist, Kathy Lasch. Those individuals better able to detect and remember threats to their survival have better odds of propagating their DNA within the collective gene pool. Indeed, within Darwin’s (and more recently, Dawkins’s) “selfish gene” framework, individuals are mere vessels through which genes propagate themselves (ref 10). Whether or not we agree with this view, it sets the stage for interesting discussion by shifting our reference frame to a distinctly supraindividual model of pain. According to PREP’s social model, the experience of pain is still at the core, but to understand it requires research that goes beyond the individual. In human society, research is lost if not translated into education – particularly one that embraces the intersubjective, social and emotional nature of the pain experience. We at PREP are committed to interprofessional education of pain leaders as the most effective way to effect social change – a commitment that led to our program’s specific acknowledgment in the IOM report in its chapter 4, on education.  Among recent PREP graduates and applicants we are beginning to see a few exceptional persons who have chosen to spend their careers as policymakers in the important field of pain. I am delighted to see this, because the continuous translation of the benefits of research and education requires ongoing support through enlightened, population-based health policies.

Fig 2.  PREP model

References

1: Institute of Medicine Report (2011)  http://books.nap.edu/openbook.php?record_id=13172

2: AHCPR clinical practice guideline: acute pain (1992) http://www.ncbi.nlm.nih.gov/books/NBK16501/

3: Carr, DB .”The Development of National Guidelines for Pain Control: Synopsis and Commentary”, European Journal of Pain (2001), 5 (Suppl. A) p. 91-98.

4: “A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform”, Mayday Fund (2009)  http://www.maydaypainreport.org/docs/A%20Call%20to%20Revolutionize%20Chronic%20Pain%20Care%20in%20America%2003.04.10.pdf

5: Dubois, MY, Gallagher, RM, Lippe, PM. “Pain Medicine Position Paper”, Pain Medicine, vol. 10, issue 6, p. 972-1000, Sept 2009. http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2009.00696.x/full

6: World Health Organization press release (Oct 11, 2004)  http://www.who.int/mediacentre/news/releases/2004/pr70/en/index.html

7: Brennan, F, Carr, DB, Cousins, M. “Pain Management: A Fundamental Human Right”, Anesthesia & Analgesia, vol. 105, no. 1, p. 205-221, July 2007.    http://www.anesthesia-analgesia.org/content/105/1/205.full.pdf+html

8: Human Rights Watch 2009 report   http://www.hrw.org/reports/2009/03/02/please-do-not-make-us-suffer-any-more-0

9: Declaration of Montreal 2010 from International Pain Summit http://www.iasp-pain.org/Content/NavigationMenu/Advocacy/DeclarationofMontr233al/default.htm

10: Carr, DB; “What Does Pain Hurt?”, IASP — Pain Clinical Updates, vol. XVIII, issue 3, p. 1-6, July 2009  http://www.iasp-pain.org/AM/AMTemplate.cfm?Section=HOME&TEMPLATE=/CM/ContentDisplay.cfm&SECTION=HOME&CONTENTID=9599

Add comment September 1st, 2011

Quality of Life

 

by Pamela Katz Ressler, MS-PREP, RN, HN-BC, PREP-Aired blog moderator and administrator, Program in Pain Research, Education and Policy (PREP) at Tufts University School of Medicine

As we mentioned in our last blog post, The International Association of  the Study of Pain , along with other prominent pain organizations such as The Mayday Fund, the Institute for Palliative Medicine at San Diego Hospice, the Union for International Cancer Control, have joined with the Lien Foundation by co-sponsoring a series of 50 short documentary films spotlighting the global burden of inadequate pain treatment in the project:  LIFE Before Death.

This week’s short film is entitled: Quality of Life and focuses on the dramatic benefits of palliative care services offered to patients and families facing end of life issues.

We welcome your comments on the overall LIFE Before Death project or the specific short films, which we will continually highlight on the Tufts University Pain Research, Education and Policy Program’s PREP-Aired blog throughout the year.

Add comment June 17th, 2011

Life Before Death

by Pamela Katz Ressler, MS-PREP, RN, HN-BC, PREP-Aired blog moderator and administrator, Program in Pain Research, Education and Policy (PREP) at Tufts University School of Medicine

The global burden of pain is immense.  Pain is universal; including all constructs of ethnicity, nationality, culture, race, socioeconomic status, age and gender.  Although pain is ubiquitous, it is woefully under-treated globally.  The International Association of  the Study of Pain , along with other prominent pain organizations such as The Mayday Fund, the Institute for Palliative Medicine at San Diego Hospice, the Union for International Cancer Control, have joined with the Lien Foundation by co-sponsoring a series of 50 short documentary films, released for viewing each week beginning in May 2011, highlighting the international epidemic of the under-treatment of pain.  The project, Life Before Death, will culminate with the release of a feature film in late 2011, followed by a one-hour TV documentary. 

We welcome your comments on the overall Life Before Death project or the specific short films, which we will highlight on the Tufts University Pain Research, Education and Policy Program’s PREP-Aired blog each week.  Let’s start a dialog, that will be heard round the world, affirming the right of all people to have access to effective pain treatment.

Click here to watch the first short film of the Life Before Death project: Conspiracy of Silence

Add comment June 7th, 2011

Feeling the Pain: Addressing Pain Care in the United States

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by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student, PREP-AIRED blog moderator
The Mayday Fund, a leading organziation dedicated to alleviating the incidence, degree and consequence of human physical pain has announced its recommendations for high-quality, cost-effective pain care in this country as we move forward in the decade. The Mayday Fund special Committee on Pain and the Practice of Medicine has recommended 12 action steps in their report entitled: A Call to Revolutionize Chronic Pain Care in America. The committee was made up of clinicians representing nursing, medicine, pharmacy and other healthcare professionals to provide comprehensive multidisciplinary strategies to move forward in addressing this widespread public health issue. According the Mayday Fund’s report, chronic pain affects as estimated 70 million Americans making the burden of chronic pain on society greater than diabetes, heart disease and cancer combined. To read the complete report, click here

1 comment March 7th, 2010

PREP-AIRED named Link of the Month

We are honored to be named “link of the month” by the Mayday Pain Project. The Mayday Pain Project was begun in 1994 with a grant from the Mayday Fund in New York as an international educational resource with a goal of empowering people in pain and those who care for them. The Mayday Pain Project website provides accessible, user friendly and professionally authoritative information about pain issues for patients, medical professionals and caregivers.
Thank you to the Mayday Pain Project for recognizing the important role that Tufts University’s Pain Research Education and Policy Programs play in educating tomorrow’s leaders in pain management.

Add comment May 24th, 2009


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