By Pamela Katz Ressler, MS, RN, HN-BC, Faculty, Pain Research, Education and Policy (PREP) Tufts University School of Medicine
The Pain Research, Education and Policy Program is looking forward to welcoming guest lecturer, Dr. Beth Murinson, Director of Pain Education at Johns Hopkins School of Medicine and Co-Chief of the Chronic Pain Program at the Veterans Administration Medical Center, Washington, DC on Wednesday, April 8, from 4-5 PM (DuBlois Auditorium, Sackler Building, 145 Harrison Ave, Boston, MA). Dr. Murinson, a distinguished thought leader in the area of pain education, will be speaking on the topic of “Expertise, Skillfulness and Professional Comportmant: Preparing Trainees for Clinical Effectiveness in Pain Care”.
I recently had the pleasure of interviewing Dr. Murinson about her thoughts on the need for creation of robust interdisciplinary models of pain education.
Pamela Ressler (PR): “What are we doing well and what might be improved in educating new clinicians in treating pain?”
Dr. Beth Murinson (BM): “Educating new clinicians in treating pain starts with the fundamentals of clinical assessment but needs to be augmented with several important concepts, including the multi-dimensional impact of pain, e.g. social, functional, sleep quality, etc.; the importance of assessing and re-assessing for efficacy; developing capacity as a clinician to deliver care that is attuned to the natural history of specific pain-associated conditions, e.g. recognizing and anticipating the difference between ligamentous strain and nerve injury; as well as consistently providing care that is compassionate and patient-centered, e.g. responding to patient’s report of pain with the utmost seriousness and empathy while not being incapacitated or hardened by high levels of self-reported pain; and finally demanding of ourselves and others the development of comprehensive, multi-modal treatment plans for those devastated by treatment-resistant chronic pain.”
PR: “How can the interdisciplinary nature of pain management be brought into medical education?”
BM: “The interdisciplinary and interprofessional nature of pain management brings several opportunities for advances in step with recent developments in medical education: development of teaching teams that are interprofessional, the creation of curricular innovations that bring together students from different health professions programs, and the exposure of trainees to clinical settings where physicians of different disciplines as well as different types of health professionals are working together collaboratively. Although the current mantra is ‘assessment drives learning’, the reality is that the most enduring lessons that most of us absorb are those of the enlightening example: both positive and negative role models, as well as especially insightful teachers give us the most important and durable guidance in our careers.”
PR: “How can we be change agents in pain education?”
BM: “The study of change is a field in itself and merits study by those of us wishing to foment a positive revolution. Perhaps Gandhi said it best: “We must be the change we wish to see in the world.” But change is most often the result of sustained, positive effort. Few people realize that Charles Darwin’s grandfather Erasmus actually had a well-developed theory of neuroembryologic phylogeny. In recent years he has been acknowledged as the founder of evolutionary biology popularly credited to his grandson Charles. In short, we must demand of ourselves a long-range vision, but maintain nimble readiness to innovate and insert curricula at a moments notice. Consistently reflective, eloquent advocacy with policy makers, institutional and national leadership is also essential. Know what you need to say and be ready to say it: ‘Why do you need time in the curriculum?’ ‘How will this improve care?’ and ‘Are you updated on trends in general medical education and prepared to deliver curriculum that is timely and effective?’”
The conversation is happening in this field, will you be a part of it? Please join us on Wednesday, April 8, 4-5 PM at the DuBlois Auditorium to continue the dialogue with Dr. Murinson and the PREP program students, alumni and faculty.
April 7th, 2015
By Pamela Katz Ressler, MS, RN, HN-BC, Pain Research, Education and Policy Program, Tufts University School of Medicine
As the burden of pain continues to weigh heavily on our public health and health care system, development of innovative ways of safe and effective pain management methods is imperative. The Pain Research, Education and Policy Program (PREP) is honored to have William Schmidt, PhD present the 2013 Sackler Lecture, entitled Building a Better Aspirin: The Frontiers of Pain Medicine Development on Tuesday, September 24 from 4-5 PM at the Tufts University Medical Campus, 145 Harrison Ave (Sackler Building) room 114. Dr. Schmidt is the past president of the Eastern Pain Association and an internationally-recognized expert on pain research and therapeutics. Of particular interest to Dr. Schmidt is the evolution of safer, more effective pharmaceuticals for the treatment of persistent or chronic pain. The Pain Research Forum interviewed Dr. Schmidt recently on his vision of the future of pain medicine development (click here for a link to the interview).
We hope you will be able to join us on Tuesday, September 24 for Dr. Schmidt’s lecture followed by audience discussion with Dr. Schmidt and members of the PREP program.
September 12th, 2013
Among MS-PREP alumni/ae, Hallie Greenberg is redesigning templates for patient-controlled IV and epidural analgesia at the Brigham and Women’s Hospital to enhance quality and safety of pain relief. Gretchen Kindstedt is working with the Massachusetts Pain Initiative in its legislative outreach, and is on track to earn a second Master’s degree from our department – an MPH — in 2014. Ian Koebner is employed at the Pain Treatment Center at University of California at Davis, dividing his time between clinical acupuncture and interprofessional pain education. Jessica Peck is growing her acupuncture practice in Maine. Along with her MS-PREP Capstone preceptor, Jessica will teach at the 7th Annual Palliative Care Conference at Maine Medical Center in Portland in June. Heather Thomson, working in Health Outcomes and Pharmacoeconomics at Endo, recently conducted a claims analysis with collaborators in New Mexico on the prevalence of chronic pain in patients with pulmonary disease, and will report the findings in 3 abstracts and 2 papers.
Among Certificate alumni/ae, Elizabeth Carpino is now Program Coordinator for ChildKind International. Based at Boston Children’s Hospital and led by Neil Schechter (whose PREP lecture on ChildKind is viewable at our website), this program improves pediatric pain management worldwide by certifying healthcare institutions according to process and quality measures. Kathleen Norris is pursuing further studies to be credentialed as both an Adult and a Geriatric Nurse Practitioner, with the goal of positively impacting long-term care pain management practices and policies.
Among PREP faculty, Academic Director Libby Bradshaw has now overseen conversion of 4 PREP courses to a blended onsite/online format. Kudos to Libby, the Course Directors (Richard Glickman-Simon, Ewan McNicol, Pam Ressler and Steve Scrivani), their excellent TAs (Ali Carter, Kelly Murphy and Phuong Nguyen) and the students embarking on this new approach. Dan Carr recently testified on behalf of the American Society of Anesthesiologists at an FDA workshop on possible relabeling of opioid package inserts, and was elected VP for Scientific Affairs of the American Academy of Pain Medicine. Srdjan Nedeljkoviccontinues work on the BOLD (Back Pain Longitudinal Data) study evaluating outcomes of management of elderly patients with back pain. As Director of the Brigham and Women’s Pain Medicine fellowship, Serge will accept the Fellowship Excellence Award from the American Academy of Pain Medicine at its annual meeting in April. Pam Ressler attended the Narrative Medicine Workshop at Columbia University, led by Rita Charon, a national figure and pioneer in this area. Pam looks forward to using tools of narrative medicine to engage her students next summer in PREP232 (Ethical and Sociocultural Aspects of Pain).
February 14th, 2013
by Pamela Katz Ressler, MS, RN, HN-BC, adjunct faculty, Pain Research, Education and Policy program,Tufts University School of Medicine
Congratulations to Pain Research, Education and Policy Program (PREP) student, Amy Vaz for an innovative and informative capstone project and presentation, Chronic Pain: The Good Day Diary.
As a nurse and through her studies within the PREP program, Amy saw an unmet need for those living with chronic pain. For her capstone, Amy envisioned a Smartphone application that would enable individuals with chronic pain to chronicle and track their “good” days. Amy explained that there are currently a number of products on the market that track pain and negative symptoms for chronic pain patients, but none that focus on good days or days with less pain. Amy plans to take her capstone project to the next level, by pursuing market research and product development.
Stay tuned for more from Amy Vaz.
January 15th, 2013
When one thinks of chronic or persistent pain one often thinks in terms of the biologic pathways of pain perception. However, an important component of pain involves of the psychosocial aspects of coping with a chronic illness. Disciplines across the health professions, including medicine, nursing, psychology, social work, and sociology, are actively engaged in understanding the psychosocial and emotional consequences of chronic pain and illness: Yet few studies have addressed the use of web-based tools, such as blogs, in the patient experience of living with chronic pain or illness.
Four Tufts University School of Medicine faculty members, Pamela Katz Ressler (Pain Research, Education and Policy Program), Libby Bradshaw (Pain Research, Education and Policy Program), Lisa Gualtieri (Health Communications Program), and Kenneth Chui (Public Health and Community Medicine) from the Tufts University School of Medicine in the Department of Public Health and Community Medicine recently published the results from a formative research study, Communicating the Experience of Chronic Pain and Illness through Blogging, in the Journal of Medical Internet Research.
The goal of this research was to explore the use of patient illness blogs as a means of communicating the experience of chronic pain and illness and to articulate the unique set of benefits and barriers of blogging. Qualitative data from 230 current illness bloggers were collected and analyzed to better understand the self-perceived psychosocial and health effects associated with the blogging activity. Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. While the authors’ acknowledge the study limitations, they are hopeful that further research will be conducted to explore the observed associations between communicating the experience of chronic pain through blogging and patients’ coping and self-efficacy when living with chronic pain or illness.
To read the full paper, Ressler, PK; Bradshaw, YS; Gualtieri, L ; Chui, KKH: Communicating the Experience of Chronic Pain and Illness through Blogging, in the Journal of Medical Internet Research, please click here.
December 11th, 2012
The Pain Research, Education & Policy (PREP) program at Tufts University School of Medicine is GOING THE DISTANCE!
Since 1999 Tufts has had a unique program that trains leaders in pain research, education and policy. Our graduates have included nurses, physicians, dentists, physical therapists, nurse practitioners, physician’s assistants, pharmacists, researchers, holistic health practitioners, occupational therapists, massage therapists, social workers, hospice workers, health policy advocates, and other health care professionals.
Your input is valuable to us as we plan our move from Boston only-based classroom learning to distance/online learning — please take this brief, 21 item educational needs survey. It should take 10 minutes or less to complete.
TAKE SURVEY NOW
SURVEY EXTENDED TO APRIL 30th TO ALLOW A BROADER RANGE OF OPINIONS TO BE ADDED. COMPLETE THE SURVEY BY APRIL 30, 2012 TO BE ELIGIBLE FOR THE PRIZES BELOW!
If you wish to be eligible to win
- The new (March 2012) iPad (1st prize)
- 1 OF 2 iPOD SHUFFLES (2nd Prize)
- 1 OF 25 iTUNEs $10 GIFT CARDS (3rd Prize)
Just leave your name and email address as directed at the end of the survey.
April 19th, 2012
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 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
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