Nurse Leads Effort in Pain Care Management Program for Emergency Department

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.

Click here to read a interview with Mr. Masterson

Add comment May 16th, 2011

Wounded Warriors: Pain Management in the Military

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

Chronic Pain: Focus of Time Magazine and Sackler Lecture

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

Health Professionals Making a Difference in Pain Care

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

Belief of Relief

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 influenceBelief in Relief 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

Can Love Reduce Pain?

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?

1 comment February 14th, 2011

Global Year Against Acute Pain

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.

Add comment January 30th, 2011

A New Year…What Advances in Pain Management Will We See in 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.

Add comment January 3rd, 2011

Progress and Challenges in Pain Research

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

Add comment December 10th, 2010

New Release: Approaches to Pain Management with foreward by Daniel Carr, MD, FABPM

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator

Untreated or under-treated pain causes needless suffering and negatively affects the quality of life. That is why the management of pain remains a critical area of health care and why the concept is addressed throughout the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements. 

We congratulate the Tufts University School of Medicine’s Pain Research, Education and Policy Programs co-founder, Daniel Carr, MD, FABPM for providing the forward to the newly published second edition of Approaches to Pain Management: An Essential Guide for Clinical Leaders  

Approaches to Pain Management: An Essential Guide for Clinical Leaders, published by the Joint Commission Resources, provides an overview of pain assessment and management, identifies what the standards require regarding the treatment of patients with pain, and offers guidance on making pain management an integral part of care services.   Dr. Carr, an internationally recognized expert in pain management, provides both perspective and vision on the complex nature of pain.

The majority of the book is devoted to the best practices of health care institutions that have adopted focused pain programs. This updated guide also incorporates a global view of pain management, additional organizational best practices—including some from non-U.S. institutions.  Other features include the following:

  • Summaries of every Joint Commission and Joint Commission International pain assessment and management requirement across all health care settings
  • Strategies for identifying and using evidence-based medicine resources for pain management
  • Expanded case study chapters from clinical leaders describing how their organizations developed and implemented their pain management activities
  • Techniques and ideas for understanding and meeting pain-related standards
  • Guidance on committing an organization to pain management improvements

For more information about  the newly released edition of Approaches to Pain Management: An Essential Guide for Clinical Leaders, click here 


Add comment November 29th, 2010

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