by Pamela Katz Ressler, RN, MS-PREP, HN-BC, adjunct faculty Pain Research, Education and Policy Program, Tufts University School of Medicine, PREP-Aired blog moderator
On February 2, 2012, at sites around the world, a remarkable documentary will be premiered. LIFE Before Death seeks to raise awareness of the global issue of untreated and under-treated pain and the lack of adequate access to palliative care.
Dr. Dan Carr, director and founder of the Pain Research, Education and Policy Program (PREP) within Tufts Public Health recently commented on the selection of the Tufts’ PREP program as one of the U.S. movie screening locations, and global issue of pain relief as a human right. “PREP is honored to be one of the sites at which this remarkable film will be premiered worldwide. Sponsored by international pain relief and anti-cancer organizations, LIFE Before Death presents a moving, sobering and ultimately inspiring picture of courage amidst suffering. Tragically, much of the suffering at the end of life documented in this film in emerging economies is the unnecessary consequence of the unavailability of morphine and other inexpensive, effective medications. In first-world countries, patients are caught within health systems whose major goal is curbing prescription drug abuse. At a time when access to pain control is seen as a human right, this film appropriately pushes us out of our comfort zone”, stated Dr. Carr.
As emphasized by Dr. Carr, the issue of pain control in emerging global economies is immense. Global health organizations have estimated that more than 3.3 million individuals die with untreated moderate or severe pain form cancer and HIV each year (2009 WHO and UN Narcotics Control Board). Advocacy for adequate pain and palliative care is essential, concurred Carol Curtiss, MSN, RN-BC, a palliative care expert and adjunct faculty member of the PREP program. Ms. Curtiss stated, “Unrelieved pain and other distressing symptoms are challenges to quality of life, yet millions of people worldwide do not have access to expert care, basic pain medications and the other essential resources. Through viewing this film, LIFE Before Death, I hope participants will acquire or renew their passion to advocate for changes in policy, education and research that will make access to pain and palliative care a reality for people who experience life-threatening illnesses. For me, this film reaffirms what I’ve learned over the years by working with colleagues in developing countries and in clinical practice here – we have much more work to do to assure that individuals everywhere have the right to effective pain management and palliative care throughout their lives. In the U.S., we are facing difficult times dealing with misuse and diversion of medications. We MUST be sure that people with pain have access to evidence-based pain management and palliative care in the U.S. and around the world.”
Join together with clinicians, educators, policy makers, advocates and activists who believe that pain relief is a human right for the Tufts’ PREP screening of LIFE Before Death on Thursday, February 2 from 3:00-5:15 PM at the Wolff Auditorium at Tufts Medical Center. The Tufts’ screening will be introduced by nationally syndicated health columnist, Judy Foreman and followed by a panel discussion with pain and palliative care experts.
Click here for more information
LIFE Before Death Movie Trailer
January 30th, 2012
by Pamela Katz Ressler, MS-PREP, RN, HN-BC, adjunct faculty Pain Research, Education and Policy Program, Tufts University School of Medicine, PREP-Aired Blog moderator
Jessica Peck, MAc, LAc, MS-PREP candidate presented her capstone research project on December 9, 2011 to a group of students, faculty members and invited guests at the Tufts University School of Medicine. Jessica initiated an ambitious, ongoing study for her capstone project which is being conducted at the Maine Medical Center’s Palliative and Supportive Care Clinic. The focus of her pilot research study is the implementation and evaluation of the feasibility of using acupuncture plus standard care to treat pain and associated symptoms in cancer patients. Jessica will continue to work with her capstone preceptor, Dr. Lauren Michalakes, Director of Palliative Care at Maine Medical Center as her study progresses.
Congratulations, Jessica, for embracing the collaborative nature of the Pain Research, Education and Policy Program by creating a working partnership between eastern and western models of health care.
Jessica Peck and NESA's Amy Hull
January 6th, 2012
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
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
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 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
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.
June 17th, 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