By Richard Glickman-Simon, MD, Director, Programs in Pain Research, Educatin and Policy, Tufts University School of Medicine
Upcoming conference of interest: Effective Management of Chronic Pain and Addiction in Primary Care
Saturday May 8th, 2010, 9-4pm, Tufts University School of Medicine,
Sackler Building, 145 Harrison Ave. Boston
NO FEE TO ATTEND: sponsored by Greater Lawrence Family Health Center,
Tufts Family Medicine, Mass. League of Community Health Centers,
MassAHEC, and UMASS Medical School
Featuring practical interactive workshops on drug testing, patient
contracts and chronic pain, addiction treatment, and suboxone. SAM from
the ABFM on chronic pain (for family medicine recertification) offered
Fantastic speakers include Dr. Dan Alford (Medical Director,
Office-Based Opioid Treatment Program at BMC), Dr. Luis Sanchez
(Director of Physician Health Services/MMS), Dr. Alan Wartenberg
(Associate Medical Director of the DVA Providence Medical Center Opioid
Treatment Program), and Dr. Jeff Baxter (mentors providers on
addiction/pain treatment through the Physician Clinical Support System,
No fee to attend (breakfast, lunch and snacks included). Receive up to
4.5 hours in Category I credit towards the AMA Physician’s Recognition
April 1st, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
One of the aspects of the Pain Research Education and Policy program at Tufts University Medical School that I find so enriching is the diversity of the students, faculty and alumni. The interdisciplinary nature of the program, as well as the international mix of the students helps to create a global community of pain management experts and an ever expanding network of colleagues. I was able to use my Tufts PREP program connections recently by networking with MS-PREP alum Anne Colyn in Luxembourg where she is now living. We had an interesting discussion of the role of integrative modalities of pain management in Europe.
April 1st, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student, PREP-AIRED blog moderator
The Mayday Fund, a leading organziation dedicated to alleviating the incidence, degree and consequence of human physical pain has announced its recommendations for high-quality, cost-effective pain care in this country as we move forward in the decade. The Mayday Fund special Committee on Pain and the Practice of Medicine has recommended 12 action steps in their report entitled: A Call to Revolutionize Chronic Pain Care in America. The committee was made up of clinicians representing nursing, medicine, pharmacy and other healthcare professionals to provide comprehensive multidisciplinary strategies to move forward in addressing this widespread public health issue. According the Mayday Fund’s report, chronic pain affects as estimated 70 million Americans making the burden of chronic pain on society greater than diabetes, heart disease and cancer combined. To read the complete report, click here
March 7th, 2010
by Lisa Gualtieri, PhD, Adjunct Clinical Professor, Tufts University School of Medicine
Any woman who has had children knows that labor is painful. Psychologist Richard Stephens, at Keele University in England, was inspired by his wife’s “unsavory language during the throes of labor”. He questioned “whether swearing alters individuals’ experience of pain.”
Dr. Stephens conducted a study with 67 undergraduates as follows: They were asked to write down words that they might say after hitting their thumb with a hammer and words to describe a table. The students “then immersed a hand in frigid water for as long as they could bear, while either swearing or repeating an innocuous word. When people had a swear word for their mantra (popular choices: the s-word, the f-word, and two b-words), they were able to keep a hand in the cold water about 40 seconds longer. The people who swore also reported less pain after the fact. Swearing increased heart rate in participants, and researchers theorized that the increase might signal the beginning of a fight-or-flight response, which allows the body to tolerate or ignore pain.”
“Swearing increases your pain tolerance,” according to Dr. Stephens. Steven Pinker, a Harvard psychologist and author of The Stuff of Thought, an exploration of the psychology of language, said that “humans are hardwired to swear cathartically… Swearing probably comes from a very primitive reflex that evolved in animals.”
Diana Van Lancker Sidtis, a professor of speech language pathology and audiology at New York University, said that “in certain circumstances; either because we don’t bother to inhibit them or because the shock of pain or discomfort momentarily surpasses the safeguards; our impulse for obscenity takes over.”
Back to giving birth: Stephens’ study found that swearing reduced the perception of pain more strongly in women than in men. This may be because, according to Dr. Pinker, “men swear more than women,” thus “swearing retains more of an emotional punch [for women] because it has not been overused.
January 14th, 2010
By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
According to the Centers for Disease Control and Prevention, falls are the leading cause of injury deaths among older adults (2005). Falls are also the most common cause of non-fatal injuries and hospital admissions for trauma in elderly individuals. A new study suggests that persistent or chronic pain may be a risk factor for falls in the elderly. “No matter how it was assessed, seniors with chronic pain had a 1.5-fold increased risk of falling,” Suzanne G. Leveille, PhD, RN, of the University of Massachusetts in Boston, and colleagues reported in the November 25, 2009 Journal of the American Medical Association. Researchers conducted the longitudinal study of 749 older adults, ages 70 +, from 2005-2008. Study findings suggested that patients who had chronic pain had higher rates of falls during follow-up than those who were pain-free (P<0.05).
In adjusted models, each measure of chronic pain was independently associated with the increased occurrence of falls. Compared with those without pain or those in the lowest tertiles of pain scores, the greatest risk for falls was observed in those who:
•Had two or more pain sites (RR 1.53, 95% CI 1.17 to 1.99)
•Were in the highest tertiles of pain severity (RR 1.53, 95% CI 1.12 to 2.08)
•Had interference with activities (RR 1.53, 95% CI 1.15 to 2.05)
Dr. Leveille suggested that paying closer attention to assessment of pain in older adults could decrease the risk of falls, contribute to better health outcomes, and help people to continue living actively and independently in the community."
December 1st, 2009
by Lisa Gualtieri, Ph.D., Adjunct Clinical Professor, Tufts University School of Medicine
Having had a grandfather who had dementia, I was struck by Tara Parker-Pope’s New York Times article, “Treating Dementia, but Overlooking Its Physical Toll” about the impact of the lack of understanding families have about the physical toll of dementia. The article referred to a NEJM study that found that lack of understanding of dementia colored the decisions made by families and, further, “that pain control was often inadequate. One in four subjects were clearly suffering from pain, but that number may understate the problem, because the patients were unable to talk about their pain.”
It is years ago now, but I don’t remember anyone ever wondering, or asking his doctor, if my grandfather was in pain. I came across a Web site about understanding pain and dementia (http://www.painanddementia.ualberta.ca ) developed to help family members to address the problem of undiagnosed and under-treated pain in the elderly. While it is too late for my grandfather, it is wonderful this issue is being specifically addressed by this and other resources.
November 19th, 2009
Congratulations to the Massachusetts Pain Initiative for an excellent educational symposium on Friday, April 3. Familiar faces from the Tufts Pain Research, Education and Policy faculty served as expert speakers at the event: Dr. Dan Carr delivered the keynote, while Dr. Kate Faulkner, Carol Curtiss, RN, MSN, and guest lecturer, Dr. Edgar Ross, engaged and encouraged the audience to work towards a new paradigm of pain care.
April 15th, 2009
by Pamela Ressler, RN, BSN, HN-BC, MS-PREP student and PREP blog moderator
Thanks to all who participated in the Name Our Blog contest. The entries we received were exceptionally creative and clever, and made choosing a winner extremely difficult for the selection committee. The winning entry, PREP-AIRED was submitted by PREP student Eileen Dube. When asked how she came up with the blog name PREP-AIRED, Eileen stated,
“Basically I thought that the name PREP-AIRED conveyed the idea that in the Pain Research Education and Policy program we are airing our ideas. By airing them we are better prepared to answer questions of others, to think more deeply about things, to see things from a different perspective, and to act. And I love a good play on words any day.”
Here are some of the other great entries we received:
Melzack’s Echo: To recognize Melzack’s pioneering efforts towards pain research, as well the residual echo of its impact
Polemos on Poena: The Greek word for war and the Latin word for pain, preparing us to do battle with pain in our collective work
PPP/Triple P (Pain Program Posting): Recognizing the interactive nature of postings on the blog
Painless: Acknowledging our desire to mitigate pain
We were struck by the thought and creativity, as well as the relevance to the unique PREP program, that went into each of the name submissions. Thank you to all who participated.
Over the next week you will see a new blog heading graphic with the new name: PREP-AIRED, and you will continue to see new content added. The beauty of a blog is the collaborative nature of interaction with others; we welcome and depend on your continued comments and ideas. I am happy to help you post your thoughts or give you suggestions on topics that may be of interest. Feel free to email me at email@example.com
March 29th, 2009
by Marie Belle Francia, M.D., M.S.
As an Internist and future Oncologist, pain assessment and management will play a vital role in my practice. That said, one issue I’ve come to realize based on personal experience and discussions with other practitioners is that the field of pain management often receives a disproportionately lower emphasis and share of investment in training programs. This issue is magnified in developing countries (like the Philippines where I will be practicing long term) where latest treatment may sometimes not be available or patients may not be able to afford. This is one of the primary reasons why I pursued the Master of Science in Pain Education, Research and Policy (MS-PREP) at Tufts University School of Medicine.
MS-PREP is a pioneering program that provides students with a solid foundation on the multi-faceted nature of pain. The multidisciplinary nature of the program encourages healthcare professionals to view pain from a broader perspective, seeing pain not as disease but as an illness where quality of life can be a therapeutic goal. The program equips students with knowledge on the molecular mechanism of pain to strategies in enabling changes in society. It has inspired me and my fellow students to search for gaps in knowledge and further contribute to the broader research agenda.
March 8th, 2009
by Richard Glickman-Simon, MD, Program Director, Pain Research, Education & Policy Programs, Tufts University School of Medicine
Welcome to the Programs in Pain Research, Education and Policy at Tufts University School of Medicine! Our multidisciplinary masters program is the only one of its kind in the United States, and our joint program with the New England School of Acupuncture is the only one in the world. This blog serves as a useful and engaging resource, not just for information about our program, but for timely articles on the latest developments in the field of pain and its management. Contributors include our faculty, alumni and students.
Who are we?
The mission of the Programs in Pain Research Education and Policy (PREP) is to equip our graduates with the knowledge and skills necessary to meaningfully improve the lives of people anywhere suffering from chronic or recurrent pain. Most of our students and recent graduates fall into one of two categories:
• Clinicians working with patients suffering from chronic pain (e.g., nurses, physical therapists, physicians, psychologists) who wish to be more effective on their behalf
• Students training to practice in a field that frequently serves patients in pain (e.g., acupuncture occupational therapy).
However, PREP is also well suited for those engaged in a variety of other professions including clinical research, dentistry, public health, health communication, grass-roots advocacy, legislation and the pharmaceutical industry. Recent college graduates have also enrolled in our program in preparation for medical school or other related fields.
For more information about our two masters programs and certificate program, please visit our program website.
Why do we exist?
PREP was created ten years ago in response to a number of disquieting trends in the world of pain that continue to this day. Mounting research from the biomedical and social sciences clearly demonstrate that, despite their superficial similarities, acute and chronic pain share little in common. Clinicians who manage their chronic pain patients with the same methods they use for acute pain inevitably fail their patients. Acute pain results from tissue damage or other causes of inflammation as a signal to the sufferer that something is amiss and needs attention. Chronic and recurrent pain, however, often occur in the absence of any identifiably persistent cause. (See Is Pain a Disease or Symptom article in this blog.) In fact, it is hard to imagine how such pain could be construed as beneficial in any way. Simply treating chronic pain with long-standing doses of anti-inflammatory (e.g., ibuprofen), narcotic (e.g., morphine) or other analgesic medications may provide a modicum of short-term relief. However, this approach does not address the underlying problem, which is far too complex and multifaceted for any medication (or equally simplistic treatment) to manage alone.
We now know that the experience of chronic pain involves far more than the persistent transmission of noxious stimuli through the nervous system. It is the culmination of a highly elaborate and dynamic process inextricably tied to the sufferer’s cognitive, psychological, social and cultural history. Standard analgesic treatments that downplay or ignore these dimensions of suffering should not be expected to adequately serve anyone in chronic pain. A far more sophisticated approach is required if these patients are to find adequate and sustainable relief. Fortunately, this is now possible. But does it happen?
Modern medicine is quite capable of ameliorating many, if not most, acute problems, including pain. It is can also effectively manage a variety of chronic or recurrent conditions like heart disease, diabetes and peptic ulcers, largely though the use of medications and invasive procedures (e.g., surgery). It is not surprising, therefore, that most clinicians are sufficiently trained to successfully take on these common illnesses. However, for patients presenting in chronic pain, for which there is often no identifiable cause, standard methods are often not up to the task, particularly the kinds of expedient treatments emphasized in clinical training and practice. Under these circumstances, otherwise highly competent clinicians are forced to settle for symptomatic interventions that serve as stopgap measures rather than actual solutions. Many chronic pain patients, therefore, continue to suffer despite their clinician’s best efforts.
• According to data from the National Health and Nutrition Survey conducted from 1999 to 2002, 26% of Americans reported being in pain for more than 24 hours during the prior month, 42% of whom had been suffering with their pain for a year or more.
• In a 2004 survey, 27% of respondents reported low back pain, 15% reported severe headache or migraine, another 15% reported neck pain, and 4.3% reported face or temperomandibular joint (TMJ) pain in the previous three months.
• Also in 2004, 31% of adults reported joint pain (other than neck, back or TMJ) in the past 30 days; among those over 65, the proportion rose to 52%, with 17% of respondents in this age category characterizing the pain as severe.
• In 2003-04, narcotic analgesics were prescribed or provided during 23% of all emergency room visits, and for the period 1999-2002, 4.2% of adults reported using narcotic drugs in the previous month
(Data from Health, United States, 2006 from the Centers for Disease Control and Prevention)
Of course, many of these patients are benefiting from the services they receive from the physicians, nurses, physical therapist, acupuncturists and numerous other professionals providing high quality care. And, the numbers would certainly be even worse without their efforts. But what these and other troubling statistics strongly suggest is that we as a society have a long way to go before the formidable public health problem of persistent pain is brought under control.
Like any social or health problem, additional research has the potential to reduce the enormous burden of suffering from chronic pain. Even the most remarkable advances in research, however, will help no one unless they are translated into action by clinicians, educators, advocates and policymakers. It has become abundantly clear that an overly simplistic, one-dimensional strategy is no match for the complexity and tenacity of chronic pain. Pharmacologic and surgical interventions are often essential, but they are rarely sufficient. What chronic pain sufferers require is a sophisticated, multidimensional strategy worthy of the challenge.
PREP was created for precisely this reason. Our programs encourage students to take on the problem of pain from every conceivable angle: biological, psychological, sociological, cultural, spiritual, ethical and legal. Our graduates emerge with an perspective and expertise few of their colleagues possess. More than anyone else, they have the capacity to meaningfully change the lives of people suffering from chronic pain.
Again, welcome. I hope you find our blog to be an interesting, provocative and enlightening gateway into the rapidly progressing and widely divergent field of pain and its management. I look forward to your comments, suggestions and contributions.
March 1st, 2009