by Pamela Katz Ressler, MS, RN, HN-BC, Faculty, Pain Research Education and Policy program, Tufts University School of Medicine
Dr. Dan Carr, founder and director of the Tufts Pain Research, Education and Policy program was recently featured in a video posted by PainWeek. Dr. Carr has passionately advocated for interprofessional pain education from the inception of the Tufts PREP program. His keynote address from 2012 PainWeek argues that pain is much more than a biophysical model. Watch Dr. Carr’s 2012 keynote address by clicking here.
Learn more about interprofessional team management of pain by participating in a new course offered by Tufts PREP program this summer (click here). Dan Carr, MD, FADM and Sharon Schwartzberg, EdD, will be co-directors of this relevant and innovative blended learning course. Learn from the leaders in the field of pain, connect and network with other professionals in Boston for one weekend and then return home to learn online. For more information about Tufts’ innovative blended learning courses in the Pain Research, Education and Policy Program, click here.
May 8th, 2013
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
January 21st, 2013
by Pamela Katz Ressler, MS-PREP, RN, HN-BC, adjunct faculty Pain Research, Education and Policy Program, Tufts University School of Medicine and PREP-Aired blog moderator
As has been discussed previously in this blog, the under-treatment of chronic or persistent pain p
laces an enormous burden on individuals, the health care system, the economy and our society. In June 2011, the Institute of Medicine reported that there are an estimated 116 million individuals in the United states who report chronic pain, at an economic cost of $635 billion per year. According to a recent article by Matthew Brady in the magazine of the site, Angie’s List, (which reviews numerous categories of service and health care providers;) “health care providers in the pain management category garner negative reviews at twice the average of other Angie’s List categories” Additionally, Angie’s List members reported that their “health care provider didn’t take their problem with pain seriously”.
While reports of patient dissatisfaction with chronic pain management are disturbing, they are understandable when one recognizes the paucity of training most clinicians receive in chronic pain management. According to the Association of American Medical Colleges less than 1 in 4 of the 133 accredited medical schools in the country teach students about chronic pain management and most students receive less than 11 hours of pain management training in their entire 4 years of medical school.
Addressing the systemic lack of comprehensive pain education is a key mission of the Tufts University School of Medicine’s Pain Research, Education and Policy Program (PREP). The founding director of the PREP program, Dr. Dan Carr, states that the high level of dissatisfaction and complaints among patients seeking effective chronic pain management may reflect the traditional training of clinicians to focus only on objective measures and procedures to alleviate pain, without regard to the social and psychological aspects of persistent pain. “There is an enormous social component to pain,” states Dr. Carr. “Patients will be more satisfied if they feel they have been cared for. That has more to do with their satisfaction with pain control than the actual intensity of their pain.”
While there are no easy answers to chronic pain management; patients, clinicians, educators and health care stakeholders all agree that our current approach to pain management is inadequate and needs to be addressed as we prepare to meet the increasing health needs of an aging baby-boomer population.
What are your thoughts on how we can create a more comprehensive model of chronic pain management?
December 8th, 2011
Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator and administrator, Tufts University School of Medicine
Beliefs and expectations of a medication’s pain reducing ability may influence
the amount of pain relief a patient receives from the drug, suggests a study recently published in the journal Science Translational Medicine Science. In the study, The Effect of Treatment Expectation on Drug Efficacy: Imaging the Analgesic Benefit of the Opioid Remifentanil, investigators observed that the expectation of efficacy or lack of efficacy of the potent opioid Remifentanil shaped both therapeutic and adverse effects of the medication. Those participants who believed that the drug would have a positive effect on the experimental pain condition had double the pain relief benefit as compared to those who believed that the drug would have a negative or exacerbating effect on their pain. Evidence from behavioral and neuroimaging data suggest a multifocal expression of pain in the study participants with brain activity changes correlated to the expectation of efficacy of the analgesic. The study authors conclude that integrating patients’ beliefs and expectations into pain management may produce better treatment outcomes in the future.
March 6th, 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, 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
December 10th, 2010
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.
November 15th, 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 dfields820@gmail.com
October 10th, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Forcing a cough while receiving an immunization appears to decrease perceived pain a study published in the February 2010 issue of Pediatrics suggested. Dustin Wallace, PhD, one of the study authors states, “Pediatric immunizations are the most common painful procedures occurring in pediatric medical settings. Although a number of strategies are available to help reduce immunization pain, they often are not used because of time, effort, or cost associated with use.”
The goal of the study was to assess the efficacy of a “cough trick” technique on self-reported pain of children receiving routine pediatric immunizations. The “cough trick” technique consisted of a “warm-up” cough of moderate force, followed by a second cough at the time of needle puncture. Self-reported pain was decreased in the experimental group versus the control group. Limitations of the study included small sample size, refusal of some children to comply with intervention, and use of visual analog pain scale which has not be validated for use in young children.
“Belief in the value of pain management is relevant not only for patients but also for staff members,” the study authors conclude. “A significant barrier to the clinical implementation of any pain management strategy may be the perception of some that the pain associated with pediatric immunizations is not worth treating. In this study, however, nurses were observed to use a variety of strategies in the control condition to help children manage the pain, which suggests that the nurses were interested in helping to reduce immunization pain.”
To read more about this study, <a href="click here
February 2nd, 2010
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