by Pamela Katz Ressler, MS-PREP, RN, HN-BC, adjunct faculty Pain Research, Education and Policy Program, Tufts University School of Medicine and PREP-Aired blog moderator
As has been discussed previously in this blog, the under-treatment of chronic or persistent pain places an enormous burden on individuals, the health care system, the economy and our society. In June 2011, the Institute of Medicine reported that there are an estimated 116 million individuals in the United states who report chronic pain, at an economic cost of $635 billion per year. According to a recent article by Matthew Brady in the magazine of the site, Angie’s List, (which reviews numerous categories of service and health care providers;) “health care providers in the pain management category garner negative reviews at twice the average of other Angie’s List categories” Additionally, Angie’s List members reported that their “health care provider didn’t take their problem with pain seriously”.
While reports of patient dissatisfaction with chronic pain management are disturbing, they are understandable when one recognizes the paucity of training most clinicians receive in chronic pain management. According to the Association of American Medical Colleges less than 1 in 4 of the 133 accredited medical schools in the country teach students about chronic pain management and most students receive less than 11 hours of pain management training in their entire 4 years of medical school.
Addressing the systemic lack of comprehensive pain education is a key mission of the Tufts University School of Medicine’s Pain Research, Education and Policy Program (PREP). The founding director of the PREP program, Dr. Dan Carr, states that the high level of dissatisfaction and complaints among patients seeking effective chronic pain management may reflect the traditional training of clinicians to focus only on objective measures and procedures to alleviate pain, without regard to the social and psychological aspects of persistent pain. “There is an enormous social component to pain,” states Dr. Carr. “Patients will be more satisfied if they feel they have been cared for. That has more to do with their satisfaction with pain control than the actual intensity of their pain.”
While there are no easy answers to chronic pain management; patients, clinicians, educators and health care stakeholders all agree that our current approach to pain management is inadequate and needs to be addressed as we prepare to meet the increasing health needs of an aging baby-boomer population.
What are your thoughts on how we can create a more comprehensive model of chronic pain management?
December 8th, 2011
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 Pamela Katz Ressler, MS-PREP, RN, HN-BC, Adjunct Faculty, PREP Program, Tufts University School of Medicine, PREP-Aired blog administrator and moderator
The Pain Research Education and Policy Program at Tufts University School of Medicine educates thought leaders in the multidisciplinary area of pain. This is evident by the efforts of two PREP program graduates, one a current Tufts PREP program faculty member and the other a practicing acupuncturist, through their collaborative research concerning endometrial pain and acupuncture. PREP graduates, Ewan McNichol and Kindreth Hamilton, along with co-author Xiaoshu Zhu, recently published a systematic intervention review; Acupuncture for Pain in Endometriosis in the Cochrane Library. In this systematic review, twenty-four studies were identified that involved acupuncture for endometriosis. One trial, enrolling 67 participants, met all the inclusion criteria. The authors concluded: “The evidence to support the effectiveness of acupuncture for pain in endometriosis is limited, based on the results of only a single study that was included in this review. This review highlights the necessity for developing future studies that are well-designed, double-blinded, randomized controlled trials that assess various types of acupuncture in comparison to conventional therapies.”
The PREP program applauds our graduates for their continued thought leadership surrounding the global issues of pain research, education and policy.
September 21st, 2011
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
Holly Roche, BS, LMT: Finding Insight, Exploring pain education for LMTs Preceptor: Steven Scrivani, DDS, DMSc
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.
July 18th, 2011
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”.
July 5th, 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 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
May 16th, 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.
March 27th, 2011