A Conversation with Dr. Beth Murinson, Director of Pain Education at Johns Hopkins School of Medicine

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

The Pain Research, Education and Policy Program is looking forward to welcoming guest lecturer, Dr.Dr Beth Murinson Beth Murinson, Director of Pain Education at Johns Hopkins School of Medicine and Co-Chief of the Chronic Pain Program at the Veterans Administration Medical Center, Washington, DC on Wednesday, April 8, from 4-5 PM (DuBlois Auditorium, Sackler Building, 145 Harrison Ave, Boston, MA).  Dr. Murinson, a distinguished  thought leader in the area of pain education, will be speaking on the topic of “Expertise, Skillfulness and Professional Comportmant: Preparing Trainees for Clinical Effectiveness in Pain Care”.

I recently had the pleasure of interviewing Dr. Murinson about her thoughts on the need for creation of robust interdisciplinary models of pain education.

Pamela Ressler (PR): “What are we doing well and what might be improved in educating new clinicians in treating pain?”

Dr. Beth Murinson (BM): “Educating new clinicians in treating pain starts with the fundamentals of clinical assessment but needs to be augmented with several important concepts, including the multi-dimensional impact of pain, e.g. social, functional, sleep quality, etc.; the importance of assessing and re-assessing for efficacy; developing capacity as a clinician to deliver care that is attuned to the natural history of specific pain-associated conditions, e.g. recognizing and anticipating the difference between ligamentous strain and nerve injury; as well as consistently providing care that is compassionate and patient-centered, e.g. responding to patient’s report of pain with the utmost seriousness and empathy while not being incapacitated or hardened by high levels of self-reported pain; and finally demanding of ourselves and others the development of comprehensive, multi-modal treatment plans for those devastated by treatment-resistant chronic pain.”

PR:How can the interdisciplinary nature of pain management be brought into medical education?”

BM:The interdisciplinary and interprofessional nature of pain management brings several opportunities for advances in step with recent developments in medical education: development of teaching teams that are interprofessional, the creation of curricular innovations that bring together students from different health professions programs, and the exposure of trainees to clinical settings where physicians of different disciplines as well as different types of health professionals are working together collaboratively. Although the current mantra is ‘assessment drives learning’, the reality is that the most enduring lessons that most of us absorb are those of the enlightening example: both positive and negative role models, as well as especially insightful teachers give us the most important and durable guidance in our careers.”
PR:How can we be change agents in pain education?”

BM:The study of change is a field in itself and merits study by those of us wishing to foment a positive revolution. Perhaps Gandhi said it best: “We must be the change we wish to see in the world.” But change is most often the result of sustained, positive effort. Few people realize that Charles Darwin’s grandfather Erasmus actually had a well-developed theory of neuroembryologic phylogeny. In recent years he has been acknowledged as the founder of evolutionary biology popularly credited to his grandson Charles. In short, we must demand of ourselves a long-range vision, but maintain nimble readiness to innovate and insert curricula at a moments notice. Consistently reflective, eloquent advocacy with policy makers, institutional and national leadership is also essential. Know what you need to say and be ready to say it: ‘Why do you need time in the curriculum?’ ‘How will this improve care?’ and ‘Are you updated on trends in general medical education and prepared to deliver curriculum that is timely and effective?’”

The conversation is happening in this field, will you be a part of it?  Please join us on Wednesday, April 8, 4-5 PM at the DuBlois Auditorium to continue the dialogue with Dr. Murinson and the PREP program students, alumni and faculty.

Add comment April 7th, 2015

A Nation in Pain: Healing Our Biggest Health Problem

by Anna Schlissel, Pain Research Education and Policy Program (PREP), Tufts University School of Medicine

The Pain Research, Education and Policy Program (PREP) is honored to present Judy Foreman, nationally syndicated Health Columnist and Author, on Thursday, March 14, 4:00-5:30 PM in the Merritt Auditorium at Tufts Dental School. Ms. Foreman is a nationally syndicated medical journalist with 37 years of experience. She has covered a variety of health issues including fitness, aging, cancer, heart disease, pain, nutrition, numerous specific diseases and basic biological science.

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 Ms. Foreman’s informative and engaging lecture,  immediately followed by a panel discussion.

For more information about the event, please click here

Add comment March 6th, 2013

PREP Alumni and Faculty Happenings

Among MS-PREP alumni/ae, Hallie Greenberg is redesigning templates for patient-controlled IV and epidural analgesia at the Brigham and Women’s Hospital to enhance quality and safety of pain relief.  Gretchen Kindstedt is working with the Massachusetts Pain Initiative in its legislative outreach, and is on track to earn a second Master’s degree from our department – an MPH — in 2014. Ian Koebner is employed at the Pain Treatment Center at University of California at Davis, dividing his time between clinical acupuncture and interprofessional pain education.  Jessica Peck is growing her acupuncture practice in Maine.  Along with her MS-PREP Capstone preceptor, Jessica will teach at the 7th Annual Palliative Care Conference at Maine Medical Center in Portland in June.  Heather Thomson, working in Health Outcomes and Pharmacoeconomics at Endo, recently conducted a claims analysis with collaborators in New Mexico on the prevalence of chronic pain in patients with pulmonary disease, and will report the findings in 3 abstracts and 2 papers.

Among Certificate alumni/ae, Elizabeth Carpino is now Program Coordinator for ChildKind International.  Based at Boston Children’s Hospital and led by Neil Schechter (whose PREP lecture on ChildKind is viewable at our website), this program improves pediatric pain management worldwide by certifying healthcare institutions according to process and quality measures.  Kathleen Norris is pursuing further studies to be credentialed as both an Adult and a Geriatric Nurse Practitioner, with the goal of positively impacting long-term care pain management practices and policies.

Among PREP faculty, Academic Director Libby Bradshaw has now overseen conversion of 4 PREP courses to a blended onsite/online format. Kudos to Libby, the Course Directors (Richard Glickman-Simon, Ewan McNicol, Pam Ressler and Steve Scrivani), their excellent TAs (Ali Carter, Kelly Murphy and Phuong Nguyen) and the students embarking on this new approach.  Dan Carr recently testified on behalf of the American Society of Anesthesiologists at an FDA workshop on possible relabeling of opioid package inserts, and was elected VP for Scientific Affairs of the American Academy of Pain Medicine. Srdjan Nedeljkoviccontinues work on the BOLD (Back Pain Longitudinal Data) study evaluating outcomes of management of elderly patients with back pain. As Director of the Brigham and Women’s Pain Medicine fellowship, Serge will accept the Fellowship Excellence Award from the American Academy of Pain Medicine at its annual meeting in April. Pam Ressler attended the Narrative Medicine Workshop at Columbia University, led by Rita Charon, a national figure and pioneer in this area. Pam looks forward to using tools of narrative medicine to engage her students next summer in PREP232 (Ethical and Sociocultural Aspects of Pain).

Add comment February 14th, 2013

There’s an App for That!

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

Congratulations to Pain Research, Education and Policy Program (PREP) student, Amy Vaz for an Amy Vaz Capstone Presentationinnovative and informative capstone project and presentation, Chronic Pain: The Good Day Diary.

As a nurse and through her studies within the PREP program, Amy saw an unmet need for those living with chronic pain. For her capstone, Amy envisioned a Smartphone application that would enable individuals with chronic pain to chronicle and track their “good” days. Amy explained that there are currently a number of products on the market that track pain and negative symptoms for chronic pain patients, but none that focus on good days or days with less pain. Amy plans to take her capstone project to the next level, by pursuing market research and product development.

Stay tuned for more from Amy Vaz.

 

Add comment January 15th, 2013

Communicating the Experience of Chronic Pain and Illness through Blogging

When one thinks of chronic or persistent pain one often thinks in terms of the biologic pathways of pain perception.  However, an important component of pain involves of the psychosocial aspects of coping with a chronic illness.  Disciplines across the health professions, including medicine, nursing, psychology, social work, and sociology, are actively engaged  in understanding the psychosocial and emotional consequences of chronic pain and illness: Yet few studies have addressed the  use of web-based tools, such as blogs, in the patient experience of living with chronic pain or illness.

Four Tufts University School of Medicine faculty members, Pamela Katz Ressler (Pain Research, Education and Policy Program), Libby Bradshaw (Pain Research, Education and Policy Program), Lisa Gualtieri (Health Communications Program), and Kenneth Chui (Public Health and Community Medicine) from the Tufts University School of Medicine in the Department of Public Health and Community Medicine recently published the results from a  formative research study,  Communicating the Experience of Chronic Pain and Illness through Blogging, in the Journal of Medical Internet Research.

The goal of this research was to explore the use of patient illness blogs as a means of communicating the experience of chronic pain  and illness and to articulate the unique set of benefits and barriers of blogging.  Qualitative data from 230 current illness bloggers were collected and analyzed to better understand the self-perceived psychosocial and health effects associated with the blogging activity. Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. While the authors’ acknowledge the study limitations, they are hopeful that further research will be conducted to explore the observed associations between communicating the experience of chronic pain through blogging and patients’ coping and self-efficacy when living with chronic pain or illness.

To read the full paper, Ressler, PK; Bradshaw, YS; Gualtieri, L ; Chui, KKH: Communicating the Experience of Chronic Pain and Illness through Blogging,  in the Journal of Medical Internet Research, please click here.

 

1 comment December 11th, 2012

Can Diet Play a Role in Pain Management?

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

Can diet be a tool in our pain management arsenal?  According to McGill professor and researcher, Dr. Yoram Shir the answer is yes.  The Pain Research, Education and Policy Program (PREP) was honored to host Dr. Shir on  February 9, 2012 and hear about his fascinating research on the association of pain and diet.  Dr. Shir, director of the Alan Edwards Pain Management Unit at McGill University Health Centre, related that moving his lab from Israel to the United States created an unexpected opportunity to study the effect of different standard diets on pain in animal models (lab rats).  The combination of type of protein as well as type of fat suggested an influence on pain in the animals studied.

Exploring the observation of a correlation between diet and pain, Dr. Shir began testing various combinations of protein and fat.  Interestingly, a diet high in soy protein and omega-3 fatty acids appeared to inhibit pain, while a diet rich in canola oil appeared to increase the pain response.  Small pilot studies with human subjects, those suffering from neuropathic pain, have been promising, but larger studies will be needed to further generalize the findings.

The Pain Research, Education and Policy program thanks Dr. Shir for sharing with us his exciting research in diet and pain.

4 comments February 27th, 2012

LIFE Before Death Documentary Screening

by Pamela Katz Ressler, RN, MS-PREP, HN-BC, adjunct faculty Pain Research, Education and Policy Program, Tufts University School of Medicine, PREP-Aired blog moderator

On February 2, 2012, at sites around the world, a remarkable documentary will be premiered.  LIFE Before Death seeks to raise awareness of the global issue of untreated and under-treated pain and the lack of adequate access to palliative care.

Dr. Dan Carr, director and founder of the Pain Research, Education and Policy Program (PREP) within Tufts Public Health recently commented on the selection of the Tufts’ PREP program as one of the U.S. movie screening locations, and global issue of pain relief as a human right.  “PREP is honored to be one of the sites at which this remarkable film will be premiered worldwide. Sponsored by international pain relief and anti-cancer organizations, LIFE Before Death presents a moving, sobering and ultimately inspiring picture of courage amidst suffering. Tragically, much of the suffering at the end of life documented in this film in emerging economies is the unnecessary consequence of the unavailability of morphine and other inexpensive, effective medications. In first-world countries, patients are caught within health systems whose major goal is curbing prescription drug abuse. At a time when access to pain control is seen as a human right, this film appropriately pushes us out of our comfort zone”, stated Dr. Carr.

As emphasized by Dr. Carr, the issue of pain control in emerging global economies is immense.  Global health organizations have estimated that more than 3.3 million individuals die with untreated moderate or severe pain form cancer and HIV each year (2009 WHO and UN Narcotics Control Board).  Advocacy for adequate pain and palliative care is essential, concurred Carol Curtiss, MSN, RN-BC, a palliative care expert and adjunct faculty member of the PREP program.  Ms. Curtiss stated, “Unrelieved pain and other distressing symptoms are challenges to quality of life, yet millions of people worldwide do not have access to  expert care, basic pain medications and the other essential resources. Through viewing this film, LIFE Before Death,  I hope participants will acquire or renew their passion to advocate for changes in policy, education and research that will make access to pain and palliative care a reality for people who experience  life-threatening illnesses. For me, this film reaffirms what I’ve learned over the years by working with colleagues in developing countries and in clinical practice here – we have much more work to do to assure that individuals everywhere have the right to effective  pain management and palliative care throughout their lives. In the U.S., we are facing difficult times dealing with misuse and diversion of medications. We MUST be sure that people with pain have access to evidence-based pain management and palliative care in the U.S. and around the world.”

Join together with clinicians, educators, policy makers, advocates and activists who believe that pain relief is a human right for the Tufts’ PREP screening of LIFE Before Death on Thursday, February 2 from 3:00-5:15 PM at the Wolff Auditorium at Tufts Medical Center.  The Tufts’ screening will be introduced by nationally syndicated health columnist, Judy Foreman and followed by a panel discussion with pain and palliative care experts.

Click here for more information

LIFE Before Death Movie Trailer

Add comment January 30th, 2012

August PREP Capstone Presentations

by Pamela Katz Ressler, MS, RN, HN-BC, adjunct faculty, Pain Research, Education and Policy Program, Tufts University School of Medicine and PREP-Aired blog administrator and moderator
On August 11, three Pain Research, Education and Policy graduating students presented their capstone research projects to faculty, staff, alumni of both Tufts University School of Medicine and the New England School of Acupuncture. The projects highlighted the unique nature of the Pain Research, Education and Policy Program; each focusing on addressing the complex nature of pain through very different means. The presenters displayed their individual passions in working to decrease the enormous global burden of pain: from the development of a strategic survey on pain management needs and goals for a global health organization; to creation of a brochure targeting veterans and returning military personnel on the benefits of acupuncture; and to initiating a book proposal on pain theory curriculum for licensed massage therapists.
Congratulations, Ian, George and Holly. Best wishes for continued success in making a difference in the treatment of pain.
Ian Koebner: Towards a Strategic Plan on Pain Management for Partners in Health: Stakeholder Interviews Preceptor: Giuseppe Raviola, MD
George Koromilas: Veteran Reach-Out Preceptor: Beth Sommers, MPH, LicAc; Pathways to Wellness
Holly Roche, BS, LMT: Finding Insight, Exploring pain education for LMTs Preceptor: Steven Scrivani, DDS, DMSc

Add comment August 16th, 2011

Norwegian Study: Pain Assessment and Management Key in Helping Alzheimer’s Patients

by Wendy Williams, BSN, M.Ed., Associate Director of the Pain Research, Education and Policy Program (PREP),  Tufts University School of Medicine

The evidence continues to mount that proactive pain management makes a difference in lives (in this case, for both the identified patient and the staff and families that care for them in nursing homes).

A research article was published in the British Medical Journal on July 17th and concludes the following: “A systematic approach to the management of pain significantly reduced agitation in residents of nursing homes with moderate to severe dementia. Effective management of pain can play an important part in the treatment of agitation and could reduce the number of unnecessary prescriptions for psychotropic drugs in this population.”

You can listen to a BBC journalist interviewing one of the authors here.   This problem has been outlined before; the challenge of good pain assessment in the non-verbal.  In particular, a 2006 Web-MD article reviews a study done in Australia by Leonie J. Cole and colleagues entitledPain a Problem in Alzheimer’s Disease: Undertreated Pain Plagues Alzheimer’s Patients Who Hurt, but Can’t Tell.

Have you heard of any good studies recently?  We need to keep promoting evidence based practice and advocacy for people with undertreated pain…. Hope to hear from you on any news you might have on this front.

Add comment July 18th, 2011


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