By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
The Pain Research, Education and Policy Program at Tufts University has reached an important milestone by celebrating its first ten years of existence. In the Fall of 1999, the first two students were welcomed into the new master’s program, the first of its kind in the United States, founded by two prominent pain specialists, Daniel Carr, MD, an anthesthesiologist-internist, and sociologist Kathryn Lasch, PhD; and housed within the Tufts University School of Medicine. Recent MS-PREP alumna, Xu Cheng, discovered an archive edition of the Tufts Daily announcing the MS-PREP program’s launch on October 26, 1999.
Click here to view the Tufts Daily 1999 article
In 2009, the PREP program remains an innovative, multidisciplinary program that has grown and evolved since its launch a decade ago. As one of the foremost experts in the field of pain management, Dr. Daniel Carr continues to be a guiding presence in the growth and direction of the Pain Research Education and Policy program. On the occasion of the 10 year anniversary of the program, I asked Dr. Carr to share his reflections about the PREP program with the PREP-AIRED blog community. Dr. Carr’s remarks appear in the italicized text below:
“Ten years ago, a front page article in the Tufts Daily announced the launch of a new Masters of Science degree program in Pain Research, Education and Policy (“MSPREP”). Kathryn Lasch PhD, a medical sociologist now with an international outcomes research consultancy, and I were its co-founders. The inaugural class had 2 students. Shahnaz Turkistani, a physician, returned to her native Saudi Arabia after graduation and now treats women with pain. Ewan McNicol, a Tufts-based pharmacist now on the PREP faculty, is known internationally for systematic reviews of pain therapies with the Cochrane Collaboration and others.
The first of its kind in the United States, our program remains unique and has grown slowly and steadily since 1999. We now offer a shorter, certificate track in addition to the original MS track. We owe much to the Sackler family, whose initial and ongoing support has been indispensable, the Hermanson family for funding scholarships, and the Saltonstall family for supporting pain research in the Department of Anesthesia at Tufts Medical Center, the source of many PREP faculty. Jeanne Connolly-Horrigan combined a marketing background and passion for pain control to help us grow enrollment during the mid-2000s. Richard Glickman-Simon MD, now its Director, brought a career-long interest in complementary and alternative medicine and built a successful dual degree program between PREP and the New England School of Acupuncture.
Our faculty have taught students, treated patients, advised policymakers and professional organizations, and authored many articles and books. Our next book is a guide to pain treatment for busy clinicians practicing in the current era of health care reform. The editors of this volume are Ewan McNicol MSPREP, Carol Curtiss MSN RN BC, a distinguished nurse educator and PREP faculty member, and me; other contributors include Richard Glickman-Simon MD, Libby Bradshaw DO, MS, PREP’s Associate Director, and Steven Scrivani DDS PhD, another valued faculty member. We 6 faculty comprise PREP’s Steering Committee. Given pain’s burden upon public health, it is most appropriate that PREP is housed within the Department of Public Health and Community Medicine, capably led by Dean Harris Berman and more recently, Dean Aviva Must.
For me, the best thing about the first 10 years of PREP has been seeing our students succeed as they extend and enhance their careers, helping those with pain and becoming educational resources for their new colleagues. Students have come to PREP from across the US and from many countries, with diverse healthcare and non-healthcare backgrounds, and from other graduate programs at Tufts and affiliates. They have been MDs, RNs, DDSs, pharmacists, PTs, OTs, EMTs and others interested in pain, whether making a mid-career change from another field or beginning their graduate training immediately after college. One is the principal pain nurse educator in a large urban medical center. Another works with a world-famous outcomes research consultancy, on pain. Yet another accepted a high-profile advocacy position at a major pharmaceutical company. Another works in a hospice. Others have proceeded to medical or osteopathic school or to seek a PhD.
Our students are a very special group of altruistic people. We are proud of all they have achieved. We look forward to serving more and more students as society at large and the health professions increasingly understand how fundamentally important pain control is for quality of life, and accept pain control as a basic human right.”
Thank you to Dr. Carr and the PREP faculty for their vision and passion in the field of pain control, may the PREP program continue to blaze the trail for many years to come.
October 29th, 2009
by Daniel Carr, M.D, FABPM, Founding Director PREP program Tufts University School of Medicine and Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
As the healthcare system has become more patient-centered, one sees increasing reference to patient rights to aspects of care, such as pain care. What does it mean for something — in particular, pain management
– to be a “human right”?
Do entitlements evolve into rights, or are rights something that have always existed but whose formal recognition may be slow to come? How is the human right to pain management operationalized within national legislative, judicial and regulatory systems, and healthcare policy? Dr Dan Carr, Founding Director of the PREP program, explores whether there is a fundamental human right to pain management in a comprehensive review available at
http://www.anesthesia-analgesia.com/cgi/reprint/105/1/205. Co-authored with two distinguished international authorities, this article was published in the official journal of the International Anesthesia Research Society along with an unprecedented four editorials including a very affirming one from the World Health Organization. Those with a deeper interest in this important topic may wish to read the white paper prepared by Human Rights Watch, available at http://www.hrw.org/sites/default/files/reports/health0309web_1.pdf .
What are your thoughts about pain managment as a fundamental human right? Please share your thoughts and comments.
July 29th, 2009
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP Student, and PREP-AIRED blog moderator
On June 30, a Food and Drug Administration (FDA) advisory committee voted to recommend restrictions on both over the counter and prescription acetaminophen and acetaminophen combination products. Citing the danger of acute liver failure due to overuse of acetaminophen containing products by consumers, the committee voted to recommend reducing the maximum single adult dose of acetaminophen to 650 milligrams from 1000 milligrams. The advisory committee also recommended removing from the market frequently prescribed combination prescription pain relievers, such as Percocet (oxycodone and acetaminophen) and Vicoden (hydroocodone and acetaminophen).
How does this recommendation affect patients, healthcare providers and pain management specialists? If patients switch to other non-steroidal anti-inflammatory drugs (NSAIDs) because of fear of liver failure, are they setting themselves up for increased complications related to gastric bleeding, cardiovascular or kidney function? The American Association of Family Physicians published an interesting review of the recommendation by David Mitchell (click here to read).
What are your thoughts about the FDA advisory committee’s recommendation?
July 2nd, 2009
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
The current issue of the NIH National Center for Complementary and Alternative Medicine’s (NCCAM) newsletter focuses on low-back pain: research and care. Since 4 out of 5 individuals will experience low-back pain in their lives, most healthcare practitioners will be asked to treat this condition at some point. Patients, as well as healthcare practitioners are often frustrated with treatment options for low-back pain. Understanding types of complementary strategies patients may be utilizing and may not be disclosing to their physicians is helpful in exploring the full context of low-back pain.
June 22nd, 2009
by Lisa Neal Gualtieri, Ph.D., Adjunct Clinical Professor, Tufts University School of Medicine
I teach Online Consumer Health and Web Strategies for Health Communication in the Health Communication Program . While this doesn’t have to do with pain per se, the Web is an important way people learn about pain and seek peer support. The Web also is used for tracking pain. I first thought about this when speaking to a Rheumatoid Arthritis group at Brigham and Women’s Hospital, when it struck me how much information about the fluctuations in pain were not available for a physician during the patients’ visits. At the same time, input challenges are presented when a patient’s pain prevents him or her from using a computer.
Twitter, which has been recently popularized by Oprah, allows “microblogging”: writing 140 character or less messages. Twitter has been used for health applications, including the charmingly-named Qwitter . Twitter is now being promoted for pain tracking as well, and a blog post provides five easy-to-follow steps for someone new to Twitter to use it for this purpose. It has the advantages of ease of use and being free; there are tools specifically designed for pain tracking but they may have a steeper learning curve. Of course, the real question is if it provides benefits to the patient through peer support or tracking.
June 9th, 2009
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.
May 24th, 2009
Thank you to MS-PREP/NESA student, Nancy MItchell for sending along the link to a thought provoking documentary series that recently aired on WBUR in Boston. The documentary entitled: Quality of Death: End of Life Care in America, raises many questions about the type of care and medical interventions our current health care system promotes at the end of life. The documentary challeges those of us involved in health care to consider how we can make the end of life more compassionate and meet the needs of our patients and their families more effectively and humanely. You will find it well worth your time to listen to the documentary and check out the website for more information and further discussion about Quality of Death: End of Life Care in America. Feel free to post your comments on this blog for a focused discussion on pain and palliative care.
May 10th, 2009
Congratulations to the Massachusetts Pain Initiative for an excellent educational symposium on Friday, April 3. Familiar faces from the Tufts Pain Research, Education and Policy faculty served as expert speakers at the event: Dr. Dan Carr delivered the keynote, while Dr. Kate Faulkner, Carol Curtiss, RN, MSN, and guest lecturer, Dr. Edgar Ross, engaged and encouraged the audience to work towards a new paradigm of pain care.
April 15th, 2009
by Marie Belle Francia, M.D., M.S.
As an Internist and future Oncologist, pain assessment and management will play a vital role in my practice. That said, one issue I’ve come to realize based on personal experience and discussions with other practitioners is that the field of pain management often receives a disproportionately lower emphasis and share of investment in training programs. This issue is magnified in developing countries (like the Philippines where I will be practicing long term) where latest treatment may sometimes not be available or patients may not be able to afford. This is one of the primary reasons why I pursued the Master of Science in Pain Education, Research and Policy (MS-PREP) at Tufts University School of Medicine.
MS-PREP is a pioneering program that provides students with a solid foundation on the multi-faceted nature of pain. The multidisciplinary nature of the program encourages healthcare professionals to view pain from a broader perspective, seeing pain not as disease but as an illness where quality of life can be a therapeutic goal. The program equips students with knowledge on the molecular mechanism of pain to strategies in enabling changes in society. It has inspired me and my fellow students to search for gaps in knowledge and further contribute to the broader research agenda.
March 8th, 2009
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