Military Leads the Way in Acupuncture for PTSD

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by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator
With an estimated 17 percent of U.S. miliary personnel returning from Iraq and Afghanistan with symptoms of PTSD or Post Traumatic Stress Disorder (Archives of General Psychiatry), the military is now leading the way in integration of western and eastern models of care into the healthcare system. Use of acupuncture, meditation, yoga, and tai chi are currently being utilized in conjuntion with allopathic medical and psychological care. A recent article in Statesman.com highlights these integrative efforts.
Click here to read the article.

1 comment June 24th, 2010

Acupuncture and Tension Headaches

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Thank you to 2010 MS-PREP alumna, Nancy Mitchell, for sending along a recent update to the Cochrane Library and the Cochrane Database of Systemic Reviews addressing acupuncture and tension-type headaches. In a previous Cochrane Review (2001), acupuncture was found to be inconclusive as a treatment for tension-type headaches. However an updated 2009 Cochrane Review on acupuncture and tension-type headaches, which included 11 randomly controlled trials, concluded that acupuncture may be a valuable treatment option for patients suffering from frequent tension-type headaches.
The Cochrane Review stated: “We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or ‘fake’ acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies. In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.”
Cochrane Reviews are an integral part of evidence based medicine. It is important to include both allopathic and integrative medicine studies in the rigorous review process to further our knowledge of effective strategies to treat and manage chronic pain conditions.

Add comment May 23rd, 2010

Massachuetts Pain Initiative Survey Finds Chronic Pain Affects 1 in 4 Adults in Massachusetts

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by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student, PREP-AIRED blog moderator
Thanks to Cyndie Rodman, MS-PREP ’09, for sending along the press release from the recent Massachusetts Pain Initiative Survey. Cyndie writes that “the survey not only quantified the incidence of chronic pain among the Massachusetts general population, but also the differences and disparities experienced by minorities versus non-minorities. This is the first Massachusetts study we are aware of to look at how pain is experienced by minorities compared to non-minorities.” Tufts University School of Medicine’s Pain Research, Education and Policy (PREP) faculty member, Carol Curtiss, RN, MSN, as well as PREP guest lecturer, Paul Arnstein, PhD, APRN-BC, played instrumental roles in the survey. Click here to read the Massachusetts Pain Initiative’s press release about the survey. For more information about the Massachusetts Pain Initative, click here.

2 comments May 10th, 2010

Effective Management of Chronic Pain and Addiction in Primary Care

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
Register Online
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
1:30-4pm.
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,
PCSSmentor.org).
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
Award.

1 comment April 1st, 2010

PREP Program International Networking

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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.

Add comment April 1st, 2010

Feeling the Pain: Addressing Pain Care in the United States

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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

1 comment March 7th, 2010

Pain Reduction through Swearing?

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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.

2 comments January 14th, 2010

Pain Increases Fall Risk in Elderly

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."

2 comments December 1st, 2009

Pain and Dementia

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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.

5 comments November 19th, 2009

Tufts PREP Faculty Speak at Mass PI Symposium

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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.

Add comment April 15th, 2009

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