Add comment August 16th, 2011
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 entitled – Pain 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
On June 29, 2011, the Institute of Medicine (IOM) released a report addressing the issue of pain in the United States and called for “a cultural transformation in the way pain is viewed and treated” (IOM report p. 3). The 313-page report entitled: Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, examines the enormity of the burden of pain from many measures. Chronic pain affects at least 116 million U.S. adults and the financial cost of pain to society, measured in 2010 dollars, is estimated to range between $560 and $635 billion annually. In comparing these staggering numbers to other chronic diseases, the cost of pain is greater than the cost of heart disease, cancer and diabetes combined.
The authors of the IOM report base their recommendations for change and transformation of pain on nine underlying principles:
- A moral imperitive
- Chronic pain can be a disease in itself
- Value of comprehensive treatment
- Need for interdisciplinary approaches
- Importance of prevention
- Wider use of existing knowledge
- Conundrum of opioids
- Roles of patients and clinicians
- Value of a public health and community-based approach
The IOM report highlights the importance of education in the multidisciplinary nature of pain issues and includes it as a key action item in the proposed blueprint for transformation of pain in our society. On the topic of professional education IOM report recommends:
- Expansion and redesign of education programs to transform the understanding of pain
- Improving the curriculum and education for health care professionals around the issue of pain
- Increasing the number of health professionals with advanced expertise in pain care
We, at the Tufts Pain Research Education and Policy program (PREP), applaud the IOM for increasing awareness of the enormous burden of pain in our society by issuing the report: “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research“. We are also extremely proud that the Tufts PREP program has been providing the type of comprehensive pain curriculum proposed by the IOM report for over a decade, since 1999, and remains the first and only multidisciplinary postgraduate program of its kind in the United States.
Your comments and thoughts on the IOM report are welcome; please click here to read a full, unabridged online version of “Relieving Pain in America: A blueprint for Transforming Prevention, Care, Education and Research”.
Add comment July 5th, 2011
As we mentioned in our last blog post, 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 spotlighting the global burden of inadequate pain treatment in the project: LIFE Before Death.
This week’s short film is entitled: Quality of Life and focuses on the dramatic benefits of palliative care services offered to patients and families facing end of life issues.
We welcome your comments on the overall LIFE Before Death project or the specific short films, which we will continually highlight on the Tufts University Pain Research, Education and Policy Program’s PREP-Aired blog throughout the year.
Add comment June 17th, 2011
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
Add comment June 7th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP candidate, PREP-AIRED moderator and administrator, Tufts University School of Medicine
When Bat Masterson, RN, a former Navy nurse, was hired as the emergency department case manager at Kootenai Medical Center, a 246 bed acute care hospital in Coeur d’Alene, Idaho, he recognized that an effective, collaborative, multidisciplinary pain management plan was needed. He saw that repetitive emergency department visits for pain issues were often the norm for patients without primary care health care providers and there was limited follow-up for effective pain management for these patients. Additionally, staff were often burdened by responding to drug-seeking or doctor-shopping individuals who visited the emergency department repeatedly to attempt to obtain narcotic prescriptions. In 2006, Mr. Masterson and a multidisciplinary team of health care professionals developed the Pain Care Management Program that embraced a coordinated care model and electronic communication tools to monitor and support pain patients who visited the emergency department. Four goals of emergency department pain care were identified by the team and served as guiding principles in the development of strategies and interventions of the Pain Care Management Program of Kootenai Medical Center.
- Manage patients with chronic pain or pain related complaints through coordination of care with the patient’s primary physician and the Emergency Department.
- Support the treatment goals of the primary physician without encumbering the Emergency Department.
- Use non-narcotic pain relief, whenever possible, and as a standard of care for the treatment of headaches.
- Provide the best care for the patient for the condition they have that day
The results of the Pain Care Management Program have been impressive:
- A 77% reduction in emergency department visits for pain care management.
- An increase from 42% to 89% of individuals in the pain care study with primary care providers
- Improved patient and nursing satisfaction scores
Congratulations to Bat Masterson, RN and the emergency department pain care management team at Kootenai Medical Center for an innovative and collaborative model of pain care.
Add comment May 16th, 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.
Add comment April 19th, 2011
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student, PREP-AIRED blog moderator and administrator, Tufts University School of Medicine
Chronic pain is elusive, often impossible to visualize or describe, and a continuing challenge for patients and health care providers alike. The National Center for Health Statistics estimates that 76.5 million Americans suffer from chronic pain, an all encompassing term which includes pain that persists for months or years, often with no visible evidence of underlying injury. A recent Time Magazine Health Special featured an informative series of articles on the issue of chronic pain with new insights from the bench and the bedside, as well as patient stories reflecting on the challenges of living with pain.
Leading voices in pain management are quoted extensively in the Times Magazine health special focusing on chronic pain, one of whom is Dr. Rollin M. Gallagher, editor of Pain Medicine and the American Academy of Pain Medicine’s Past President. The Tufts University Pain Research, Education and Policy Program is honored that Dr. Gallagher will be presenting the annual Sackler Lecture at Tufts Medical Center on April 21. Dr. Gallagher will be addressing the complex pain management issues of today’s combat veterans.
For more information about the 2011 Sackler Lecture, please click here.
Add comment March 27th, 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
The American Pain Foundation has produced a number of helpful online videos for patients, families and health care professionals highlighting the complex nature of pain, especially chronic pain. It is essential that pain care be a multidisciplinary process with the patient an active participant in care. You may want to check out the American Pain Foundation’s selection of online videos on their YouTube site. Take a look at “Health Professionals Making a Difference in Pain Care” to listen to health professionals and pain patients share their message.
Add comment March 17th, 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.
Add comment March 6th, 2011