By Pamela Katz Ressler, MS, RN, HN-BC, adjunct faculty, Pain Research, Educationand Policy Program, Tufts University School of Medicine
The National Institutes of Health (NIH) recently announced a new multidisciplinary pain program that will be focused on the role of the brain in perceiving, modifying, and managing pain. The program, lead by internationally recognized pain researcher and neuroscientist, Catherine Bushnell, PhD, will be based in the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health.
“Dr. Bushnell’s work has profoundly changed the ways in which we understand and study this very important problem,” said NCCAM Director Josephine P. Briggs, M.D. “Under her leadership, this program will continue to work toward the development of better ways to safely and more effectively treat chronic pain, and advance research on the intersection and integration of pharmacological and non-pharmacological approaches.”
The NIH announcement of the pain program comes at a critical time in the growing burden of chronic pain in our society. The Institute of Medicine reports that more than 100 million people suffer from chronic pain conditions and nearly $635 billion is spent annually for treatment and lost productivity.
Research projects for the new program will include investigating how chronic pain produces changes in the brain that may modify how the brain reacts to pain medications, such as opioids; as well as exploring factors such as emotion, environment and genetics in pain perception.
The Tufts Pain Research, Education and Policy program faculty and students will look forward to future collaboration with this innovative new program.
Read the July NCCAM Clinical Digest on Chronic Pain and Complementary Health Practices
July 17th, 2012
by Pamela Katz Ressler, MS-PREP, RN, HN-BC, adjunct faculty Pain Research, Education and Policy Program, Tufts University School of Medicine, PREP-Aired Blog moderator
Jessica Peck, MAc, LAc, MS-PREP candidate presented her capstone research project on December 9, 2011 to a group of students, faculty members and invited guests at the Tufts University School of Medicine. Jessica initiated an ambitious, ongoing study for her capstone project which is being conducted at the Maine Medical Center’s Palliative and Supportive Care Clinic. The focus of her pilot research study is the implementation and evaluation of the feasibility of using acupuncture plus standard care to treat pain and associated symptoms in cancer patients. Jessica will continue to work with her capstone preceptor, Dr. Lauren Michalakes, Director of Palliative Care at Maine Medical Center as her study progresses.
Congratulations, Jessica, for embracing the collaborative nature of the Pain Research, Education and Policy Program by creating a working partnership between eastern and western models of health care.
Jessica Peck and NESA's Amy Hull
January 6th, 2012
by Pamela Katz Ressler, MS-PREP, RN, HN-BC, adjunct faculty Pain Research Education and Policy Program (PREP), Tufts University School of Medicine, and PREP-Aired blog moderator
Social media forums and online communities surrounding health topics are prevalent on the Internet. The most frequent reason individuals seek medical care is pain; so it is not surprising that there are numerous of active pain-related online communities. Most of these communities are focused on pain conditions, treatment, advocacy and support of the individual living with chronic, persistent pain. In contrast to the robust nature of these pain-related online communities for patients and advocates, there has been a paucity of similar online communities for pain researchers and investigators. The sharing of information and relevant research surrounding the complex nature of persistent pain has historically been relegated to periodic academic conferences and print publications researchers. However, that may now be changing with the development of the Pain Research Forum. Launched in June 2011 by the Harvard NeuroDiscovery Center and Massachusetts General Hospital’s Science Collaboration Foundation, the Pain Research Forum seeks to speed the translation of scientific knowledge into novel pain therapies by fostering the collaborative nature of an online community and by raising interest in pain research to a wider audience.
We in the Pain Research, Education, and Policy Program (PREP) at Tufts University School of Medicine applaud the collaborative nature of the Pain Research Forum and look forward to participating in this important pain research-based online community.
November 9th, 2011
by Pamela Katz Ressler, MS-PREP, RN, HN-BC, adjunct faculty member Pain Research, Education and Policy Program (PREP) Tufts University School of Medicine, PREP-Aired blog moderator and administrator
The Tufts Pain Research, Education and Policy Program congratulates Dr. Harris Berman on his recent appointment to the position of Dean of the Tufts University School of Medicine. Dr. Berman, a visionary leader in providing healthcare to populations, has a keen interest in the intersection of public health and medicine. In a recent interview in Tufts Now, Dr. Berman discussed his belief that public health should be a part of medicine, an integral part of how we care for the health of our population. Dr. Berman’s interest in population health and prevention began as a Peace Corps physician in India and continued into his leadership roles of healthcare organizations and academia.
The Tufts Pain Research Education and Policy Program began in 1999 when Dr. Berman held the position of Chair of Tufts’ Department of Public Health and Family Practice (as it was then known). A fellow visionary regarding pain as a public health concern, he welcomed PREP into that department where it has been happily housed ever since, now under the Dean of Public Health and Professional Degree Programs, Dr. Aviva Must.
As we, in the Pain Research, Education and Policy Program move forward in our efforts to address the immense burden of pain globally, we are pleased to have Dr. Harris Berman at the helm of the Tufts University School of Medicine.
October 13th, 2011
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
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
September 1st, 2011
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
June 7th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP candidate, PREP-AIRED blog moderator and administrator, Tufts University School of Medicine
Please join the Pain Research Education and Policy Program’s (PREP) faculty, students and alumni for the 2011 Sackler Lecture on Thursday, April 21 at 4 PM in the Tufts Medical Center’s Wolff Auditorium. The PREP program is honored to host Dr. Rollin (Mac) Gallagher, MD, MPH for this year’s lecture. Dr. Gallagher, a prominent expert in the field of pain management, will address the complex pain issues confronting the military in today’s wars and how the VA Health System is managing these from acute injury through rehabilitation. His lecture is entitled: “The Veterans Administration Department of Defense Systems Redesign: Pain Management for Wounded Warriors from Injury to Recovery”.
Dr. Gallagher currently serves as Director of Pain Management, Philadelphia Veteran Affairs Medical Center. He is also Clinical Professor of Psychiatry, Anesthesiology and Critical Care and Director for Pain Policy Research and Primary Care, Penn Pain Medicine Center, University of Pennsylvania School of Medicine. He is Editor-in-Chief of Pain Medicine, the official journal of the American Academy of Pain Medicine, that he has also served as president. He currently serves on the National Pain Management Strategy Coordinating Committee for the Department of Veterans Affairs.
If you cannot join us in person for Dr. Gallagher’s lecture, we will have a link to his recorded lecture posted here next week.
April 19th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator and administrator, Tufts University School of Medicine
In honor of Valentine’s Day and in celebration of “heart month”, February, today’s blog entry asks the question…can viewing a photograph of a romantic partner reduce pain? This was the research question posed by investigators from Stanford University in a study entitled: Viewing Pictures of a Romantic Partner Reduces Experimental Pain published in PLoS ONE. Using functional magnetic resonance imaging (fMRI), the investigators examined fifteen individuals in the early stages of a romantic relationship (first nine months). Participants completed three tasks under periods of moderate and high thermal pain: 1) viewing pictures of their romantic partner, 2) viewing pictures of an equally attractive and familiar acquaintance, and 3) a word-association distraction task previously demonstrated to reduce pain. Viewing pictures of a romantic partner and the distraction task both decreased the amount of self-reported pain experienced by the study participants. However greater pain relief was reported while viewing pictures of a romantic partner and this was the only study condition associated with increased activity in several reward-processing regions of the brain. According to the research team lead by Dr. Jarred Younger, ”The results suggest that the activation of neural reward systems via non-pharmacologic means can reduce the experience of pain”. In the clinical setting, creating an environment that encouraging patients to have pictures of loved ones within view may help to achieve more effective pain management.
What are your thoughts on this study?
February 14th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator and administrator
Anticipate, Assess, Alleviate
The International Association for the Study of Pain (IASP) is the leading professional forum for science, practice and education in the study of pain. Each year the IASP focuses on an area of importance in the field of pain management. This year’s focus is acute pain, with 2010-2011 being designated as the Global Year Against Acute Pain by the IASP. Acute pain is the most frequent reason why patients visit an emergency department. Unfortunately, inadequate acute pain control is common. If uncontrolled or inadequately controlled, acute pain can result in increased health care costs due to longer hospital stays and a higher liklihood of the development of chronic pain. By raising awareness of acute pain as a significant health care issue, the IASP hopes to lessen the gap between acute pain knowledge and research and current clinical practice.
Click here to access resources and information about acute pain mangement and how to become involved in the IASP Global Year Against Acute Pain.
January 30th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog administrator and moderator
Congratulations to two MS-PREP candidates who recently presented their capstone projects to a group of faculty, alumni and students of the Tufts University School of Medicine’s Pain Research, Education and Policy Programs and the New England School of Acupuncture.
Kai-Yin Hsu investigated the clinical use of the MYMOP form and outcome of acupuncture treatment from a U.S. traditional Chinese Medicine teaching clinic.
Pratchi Morajkar conducted a systematic review of Dexmedetomidine and its implications for non-narcotic-based analgosedation in cardiac surgery.
Prachi Morajkar, Dr. Libby Bradshaw, PREP academic director, Kai-Yin Hsu
Both presentations reflect the diverse interests and broad scope of the Tufts University Pain Research, Education and Policy Programs.
Kai-Yin Hsu presenting her PREP capstone project
January 13th, 2011