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
March 7th, 2010
by Richard Glickman-Simon, MD, Program Director, Pain Research, Education & Policy Programs, Tufts University School of Medicine
Welcome to the Programs in Pain Research, Education and Policy at Tufts University School of Medicine! Our multidisciplinary masters program is the only one of its kind in the United States, and our joint program with the New England School of Acupuncture is the only one in the world. This blog serves as a useful and engaging resource, not just for information about our program, but for timely articles on the latest developments in the field of pain and its management. Contributors include our faculty, alumni and students.
Who are we?
The mission of the Programs in Pain Research Education and Policy (PREP) is to equip our graduates with the knowledge and skills necessary to meaningfully improve the lives of people anywhere suffering from chronic or recurrent pain. Most of our students and recent graduates fall into one of two categories:
• Clinicians working with patients suffering from chronic pain (e.g., nurses, physical therapists, physicians, psychologists) who wish to be more effective on their behalf
• Students training to practice in a field that frequently serves patients in pain (e.g., acupuncture occupational therapy).
However, PREP is also well suited for those engaged in a variety of other professions including clinical research, dentistry, public health, health communication, grass-roots advocacy, legislation and the pharmaceutical industry. Recent college graduates have also enrolled in our program in preparation for medical school or other related fields.
For more information about our two masters programs and certificate program, please visit our program website.
Why do we exist?
PREP was created ten years ago in response to a number of disquieting trends in the world of pain that continue to this day. Mounting research from the biomedical and social sciences clearly demonstrate that, despite their superficial similarities, acute and chronic pain share little in common. Clinicians who manage their chronic pain patients with the same methods they use for acute pain inevitably fail their patients. Acute pain results from tissue damage or other causes of inflammation as a signal to the sufferer that something is amiss and needs attention. Chronic and recurrent pain, however, often occur in the absence of any identifiably persistent cause. (See Is Pain a Disease or Symptom article in this blog.) In fact, it is hard to imagine how such pain could be construed as beneficial in any way. Simply treating chronic pain with long-standing doses of anti-inflammatory (e.g., ibuprofen), narcotic (e.g., morphine) or other analgesic medications may provide a modicum of short-term relief. However, this approach does not address the underlying problem, which is far too complex and multifaceted for any medication (or equally simplistic treatment) to manage alone.
We now know that the experience of chronic pain involves far more than the persistent transmission of noxious stimuli through the nervous system. It is the culmination of a highly elaborate and dynamic process inextricably tied to the sufferer’s cognitive, psychological, social and cultural history. Standard analgesic treatments that downplay or ignore these dimensions of suffering should not be expected to adequately serve anyone in chronic pain. A far more sophisticated approach is required if these patients are to find adequate and sustainable relief. Fortunately, this is now possible. But does it happen?
Modern medicine is quite capable of ameliorating many, if not most, acute problems, including pain. It is can also effectively manage a variety of chronic or recurrent conditions like heart disease, diabetes and peptic ulcers, largely though the use of medications and invasive procedures (e.g., surgery). It is not surprising, therefore, that most clinicians are sufficiently trained to successfully take on these common illnesses. However, for patients presenting in chronic pain, for which there is often no identifiable cause, standard methods are often not up to the task, particularly the kinds of expedient treatments emphasized in clinical training and practice. Under these circumstances, otherwise highly competent clinicians are forced to settle for symptomatic interventions that serve as stopgap measures rather than actual solutions. Many chronic pain patients, therefore, continue to suffer despite their clinician’s best efforts.
• According to data from the National Health and Nutrition Survey conducted from 1999 to 2002, 26% of Americans reported being in pain for more than 24 hours during the prior month, 42% of whom had been suffering with their pain for a year or more.
• In a 2004 survey, 27% of respondents reported low back pain, 15% reported severe headache or migraine, another 15% reported neck pain, and 4.3% reported face or temperomandibular joint (TMJ) pain in the previous three months.
• Also in 2004, 31% of adults reported joint pain (other than neck, back or TMJ) in the past 30 days; among those over 65, the proportion rose to 52%, with 17% of respondents in this age category characterizing the pain as severe.
• In 2003-04, narcotic analgesics were prescribed or provided during 23% of all emergency room visits, and for the period 1999-2002, 4.2% of adults reported using narcotic drugs in the previous month
(Data from Health, United States, 2006 from the Centers for Disease Control and Prevention)
Of course, many of these patients are benefiting from the services they receive from the physicians, nurses, physical therapist, acupuncturists and numerous other professionals providing high quality care. And, the numbers would certainly be even worse without their efforts. But what these and other troubling statistics strongly suggest is that we as a society have a long way to go before the formidable public health problem of persistent pain is brought under control.
Like any social or health problem, additional research has the potential to reduce the enormous burden of suffering from chronic pain. Even the most remarkable advances in research, however, will help no one unless they are translated into action by clinicians, educators, advocates and policymakers. It has become abundantly clear that an overly simplistic, one-dimensional strategy is no match for the complexity and tenacity of chronic pain. Pharmacologic and surgical interventions are often essential, but they are rarely sufficient. What chronic pain sufferers require is a sophisticated, multidimensional strategy worthy of the challenge.
PREP was created for precisely this reason. Our programs encourage students to take on the problem of pain from every conceivable angle: biological, psychological, sociological, cultural, spiritual, ethical and legal. Our graduates emerge with an perspective and expertise few of their colleagues possess. More than anyone else, they have the capacity to meaningfully change the lives of people suffering from chronic pain.
Again, welcome. I hope you find our blog to be an interesting, provocative and enlightening gateway into the rapidly progressing and widely divergent field of pain and its management. I look forward to your comments, suggestions and contributions.
March 1st, 2009
by Ylisabyth (Libby) Bradshaw, D.O., M.S.,FACEP, Academic Director of the Pain Research, Education and Policy program at Tufts University School of Medicine
Does it matter whether pain is a disease or a symptom?
For people living and suffering with pain, such a question may seem irrelevant. Perhaps like splitting hairs.
“Just make the pain better.”
“I don’t care what category you put it in!”
“Don’t just talk about it. Do something! Anything to relieve this agony.”
Why would it matter whether and how medical professionals want to categorize pain?
Symptoms are defined as subjective experience; diseases are defined in objective terms, with specified causes, or associated signs and symptoms.
People with pain certainly have a personal, internal experience of pain. And, aside from asking a person to describe and rank the intensity of their own pain, there’s no medical test for determining the type of pain or its severity.
The predominant medical view for centuries has been that pain is a symptom, and viewed as an entirely subjective experience by an individual. Physiologically, pain has been seen as simply the transmission through nerves of information about damage or potential damage to parts of the body.
After all, when pain is caused by something inside the body – a ruptured disk, nerve disease, or compression from an expanding tumor – it seems that something is irritating or pressing on a nerve, which is then communicated, allowing us to feel pain. Pain is a classic symptom, it would seem.
And pain could hardly be expected to be a disease when it’s caused by forces from outside the body – a fall, an automobile crash, or even surgery; it seems completely straightforward – and easy to understand when nerves are compressed, crushed, or cut – pain is the symptom.
Yet, accumulating evidence in neuroscience says pain is more complicated. No matter what initiates pain – from traumatic forces to specific neurological disorders – if conditions continue, and the pain signal is maintained, specific bodily changes occur.
Measurable now in research labs, such characteristic, physiological alterations, arising from actively transmitting information about pain, can unfortunately become sustained biochemical changes. Ordinarily, our bodies reverse this process when the initial circumstances causing pain are relieved. Yet, too often these changes become irreversible, and permanent, resulting in chronic pain.
Two imperfect examples from our material world – Once cement is mixed and sets up, it becomes a new substance. Once glue is used, it can bind to a substance, and be impossible to remove. The science of pain is still discovering answers, and resolving uncertainties. OK, our brains and nerves are not comparable to cement, glue, or jello. Yet it is clear, signals about definite or potential tissue injury turn on many biochemical processes that transmit information about pain through our nerves. Over time, these can become irreversible changes. Pain, then, is beyond being merely a symptom.
Please join this initial discussion on the Pain Research, Education and Policy blog at Tufts University School of Medicine, and include your thoughts regarding, “Is pain a symptom or a disease?”
If pain is more than a symptom, does that make it a disease?
Common definitions of “disease” include impaired functioning*. From your knowledge and experience, how do pain conditions have impaired functioning?
We look forward to interesting exchanges from students, faculty, practitioners, alumni and members of the general public committed to improving the conditions treatment and prevention of individuals across all ages with acute and chronic pain problems.
* Disease -
“a condition of the living animal …[or one of its parts] that impairs normal functioning and is typically manifested by distinguishing signs and symptoms” MeriamWebster
“an impairment of the normal state of the living animal … or one of its parts that interrupts or modifies the performance of the vital functions, [and] is typically manifested by distinguishing signs and symptoms…” Medline
February 22nd, 2009