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

Institute of Medicine Releases Report on the State of Pain Care in the United States

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

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

Life Before Death

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

Add comment June 7th, 2011

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 PainEDU.org interview with Mr. Masterson

Add comment May 16th, 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

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

The Pain Research, Education, and Policy Programs at Tufts University Welcome Wendy Williams

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

You may see a new face if you are on the Tufts University School of Medicine campus in Boston these days.  Wendy Williams, BSN, M.Ed, is in a new role with the Pain Research, Education and Policy Programs at Tufts University School of Medicine, focusing on program development and administration. I recently had the opportunity to sit down with Wendy to ask her a few questions about herself and her visions for the PREP programs.  

Welcome Wendy…Can you tell us a bit about yourself?

I just arrived at Tufts from spending 8 years at Northeastern University in the School of Nursing working to ensure high quality clinical nursing education placements for both the undergrad/pre-licensure students and the advanced practice students seeking both clinical and non-clinical nursing master’s degrees.   My own clinical nursing background centers around oncology and HIV/AIDS.    I spent wonderful years at both Dana Farber Cancer Institute, during the time they had inpatient units, and at Harvard Community Health Plan/Harvard Vanguard with other highly skilled nurses on the HIV/AIDS Resource Team.I married a great guy back in 1996 who had a couple of sweet little boys who are now terrific college age young men, studying here in Boston.  My husband, Jeff, and I live in Framingham with our 3-legged cat, Punky, and hairless dog, Diddy.

What interests you about the PREP programs?

The concern for under-treated pain and pain management are steady threads that ran throughout my own clinical practice.  Ensuring adequate pain management is a strong cornerstone of quality nursing care and practice, so the PREP programs of study are very attractive to me and tie together much of what I value.  The chance to work collaboratively with the three program leaders (who are also physicians), Dr. Dan Carr and Dr. Richard Glickman-Simon and Dr. Ylisabyth Bradshaw, is an opportunity I want to leverage.I have long sought ways to be a force behind strengthening linkages between medicine and nursing and other health care disciplines to encourage both multidisciplinary and interdisciplinary approaches to health care.  The PREP programs present an ideal setting to have broad-based conversations around the area of pain issues.  Also, my own master’s degree is in education, specializing in adult and organizational learning, so .  the opportunity to develop a program of study and optimize learning for students globally is a really strong draw for me to be here at Tufts working with the PREP programs.

What do you see as the strengths and challenges of the PREP program?

A real strength of the PREP programs is its unique position in masters level education  that delves deeply into the many physical/clinical, social and scientific aspects of pain.  There is not a population of people, worldwide, that is not impacted by pain issues.  Also, the fact that the PREP programs are not solely clinically based creates a rich learning environment for many types of students… clinicians seeking to be subject matter experts in pain issues learn side by side with non-clinicians who may be seeing the PREP programs as a way to become well-informed advocates for pain issues.  After about a month in this role, I see two challenges to the PREP programs that I would like to positively impact.  One challenge is getting more and more people in the greater Boston area to know about this great set of programs and to become students in the program.  I happen to know one graduate of the program, Hallie Greenberg, a nurse from the Brigham & Women’s Hospital, and know that there are so many others that would be really inspired to become proficient in this area.  The other challenge is understanding and communicating to others clear linkages between getting one of the certificates and/or the master’s degree and a specific career enhancement.  There seems to be a certain pioneering element to encouraging students to go for the certificates or the degree as a natural next step in career growth.

What are your hopes and vision for the PREP program?

I hope that PREP grows steadily, both in numbers and in innovative educational initiatives, and sustainably with input from all communities of interest: students and alumni and staff and our steering committee and faculty and leaders in pain issues globally.  I would love to speak with students and alumni and gain their insights on how we can best lead the way in pain research, education and policy.  I welcome calls, 617 636-0815, emails wendy.williams@tufts.edu, or simply stop by my office in the M&V building, Room 142A. I’d love to meet you.

Add comment November 15th, 2010

Love Induced Pain Relief

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIREDLove Induced Pain Relief blog moderator

Thank you to Tufts University School of Medicine, MS-PREP alumna Nancy Mitchell for forwarding this intriguing study from Stanford University School of Medicine on love induced pain relief.  In their study, Dr. Sean Mackey and colleagues suggest that intense, passionate feelings of love can alter the perception of pain. 

“When people are in this passionate, all-consuming phase of love, there are significant alterations in their mood that are impacting their experience of pain,” said Sean Mackey, MD, PhD, chief of the Division of Pain Management, associate professor of anesthesia and senior author of the study. “We’re beginning to tease apart some of these reward systems in the brain and how they influence pain. These are very deep, old systems in our brain that involve dopamine — a primary neurotransmitter that influences mood, reward and motivation.”

While love is not the only answer to relieving pain, it appears that similar areas of the brain are activated by intense love and also by pain relieving pharmaceuticals.  Further study of the neural reward pathways  that are triggered by intense feelings of passion could lead to a more complete undertanding of the neural mechanisms involved in the pain experience.

Click here to read the complete study

Add comment November 9th, 2010

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