Do Cortisone Injections Make Pain Worse?

cortisone injectionby Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator

A recent study published by The Lancet (to read the study abstract, click  here ) explores the question of efficacy and safety of corticosteroid injections for tendinopathy, both short-term and long-term. Using a systematic review of randomized control studies, researchers observed that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms.  

As this research indicates, there is a need for multidisciplinary pain management approaches in the treatment of chronic pain conditions.  What have been your experiences with using corticosteroid injections?

Add comment November 2nd, 2010

Can Changing How You Pay Attention Help Ease Pain?

Dissolving Pain by Fehmi and RobbinsThank you to our guest blogger, Dan Fields, for this informative and timely book review of Dissolving Pain: Simple Brain-Training Exercises for Overcoming Pain by Fehmi and Robbins. 

Can changing how you pay attention help to ease pain? Yes, suggest psychologist and biofeedback expert Les Fehmi, PhD, and science writer Jim Robbins in their new book, Dissolving Pain: Simple Brain-Training Exercises for Overcoming Chronic Pain (Trumpeter, 2010). The conventional understanding of pain is that it results from an injury to the body—such as a slipped disk, in the case of back pain. However, the authors contend that “pain, whatever its causes, resides principally in the brain and can therefore be treated by working with the mind in specific ways.”

Consider the phenomenon of phantom limb pain, in which pain persists in a limb after it has been removed. “Areas of the brain associated with the missing limb can still, mistakenly, generate pain, probably because they are [abnormally] sensitized,” according to Fehmi and Robbins.

You can reduce the intensity of any type of pain, the authors suggest, by expanding your focus of attention—like zooming out with a camera. “When you are narrow-focused on something, including pain, it represents 100 percent of your awareness. When you broaden your attention beyond the pain, the pain becomes a fraction of your total awareness,” they write.

And the quickest way to expand your focus is “to become aware of space,” say Fehmi and Robbins. The book and an accompanying CD include guided exercises that ask if you can imagine the distance between various parts of the body. These exercises supposedly encourage the brain “to produce more of the slower, more rhythmic brainwave frequencies associated with healing, balance, and well-being,” they write.

In contrast, a narrow focus of attention “increases the frequency of our EEG, tenses muscles, and generally makes us more sensitive to pain,” claim the authors.

The book includes many anecdotes of how the attention exercises have helped Fehmi’s patients with back, joint, or other types of pain. However, this reviewer is not aware of any solid research on this mind-body approach.  So it’s up to readers to try the exercises for themselves and see if they help.

Dan Fields is a freelance health writer and former editor in chief of Dr. Andrew Weil’s Self Healing newsletter.  He lives in the Boston area, and his email address is

1 comment October 10th, 2010

“Cough Trick” Reduces Pain From Immunizations

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Forcing a cough while receiving an immunization appears to decrease perceived pain a study published in the February 2010 issue of Pediatrics suggested. Dustin Wallace, PhD, one of the study authors states, “Pediatric immunizations are the most common painful procedures occurring in pediatric medical settings. Although a number of strategies are available to help reduce immunization pain, they often are not used because of time, effort, or cost associated with use.”
The goal of the study was to assess the efficacy of a “cough trick” technique on self-reported pain of children receiving routine pediatric immunizations. The “cough trick” technique consisted of a “warm-up” cough of moderate force, followed by a second cough at the time of needle puncture. Self-reported pain was decreased in the experimental group versus the control group. Limitations of the study included small sample size, refusal of some children to comply with intervention, and use of visual analog pain scale which has not be validated for use in young children.
“Belief in the value of pain management is relevant not only for patients but also for staff members,” the study authors conclude. “A significant barrier to the clinical implementation of any pain management strategy may be the perception of some that the pain associated with pediatric immunizations is not worth treating. In this study, however, nurses were observed to use a variety of strategies in the control condition to help children manage the pain, which suggests that the nurses were interested in helping to reduce immunization pain.”
To read more about this study, <a href="click here

Add comment February 2nd, 2010

10 Year Milestone for PREP Program at Tufts

By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
The Pain Research, Education and Policy Program at Tufts University has reached an important milestone by celebrating its first ten years of existence. In the Fall of 1999, the first two students were welcomed into the new master’s program, the first of its kind in the United States, founded by two prominent pain specialists, Daniel Carr, MD, an anthesthesiologist-internist, and sociologist Kathryn Lasch, PhD; and housed within the Tufts University School of Medicine. Recent MS-PREP alumna, Xu Cheng, discovered an archive edition of the Tufts Daily announcing the MS-PREP program’s launch on October 26, 1999.
Click here to view the Tufts Daily 1999 article
In 2009, the PREP program remains an innovative, multidisciplinary program that has grown and evolved since its launch a decade ago. As one of the foremost experts in the field of pain management, Dr. Daniel Carr continues to be a guiding presence in the growth and direction of the Pain Research Education and Policy program. On the occasion of the 10 year anniversary of the program, I asked Dr. Carr to share his reflections about the PREP program with the PREP-AIRED blog community. Dr. Carr’s remarks appear in the italicized text below:
“Ten years ago, a front page article in the Tufts Daily announced the launch of a new Masters of Science degree program in Pain Research, Education and Policy (“MSPREP”). Kathryn Lasch PhD, a medical sociologist now with an international outcomes research consultancy, and I were its co-founders. The inaugural class had 2 students. Shahnaz Turkistani, a physician, returned to her native Saudi Arabia after graduation and now treats women with pain. Ewan McNicol, a Tufts-based pharmacist now on the PREP faculty, is known internationally for systematic reviews of pain therapies with the Cochrane Collaboration and others.
The first of its kind in the United States, our program remains unique and has grown slowly and steadily since 1999. We now offer a shorter, certificate track in addition to the original MS track. We owe much to the Sackler family, whose initial and ongoing support has been indispensable, the Hermanson family for funding scholarships, and the Saltonstall family for supporting pain research in the Department of Anesthesia at Tufts Medical Center, the source of many PREP faculty. Jeanne Connolly-Horrigan combined a marketing background and passion for pain control to help us grow enrollment during the mid-2000s. Richard Glickman-Simon MD, now its Director, brought a career-long interest in complementary and alternative medicine and built a successful dual degree program between PREP and the New England School of Acupuncture.
Our faculty have taught students, treated patients, advised policymakers and professional organizations, and authored many articles and books. Our next book is a guide to pain treatment for busy clinicians practicing in the current era of health care reform. The editors of this volume are Ewan McNicol MSPREP, Carol Curtiss MSN RN BC, a distinguished nurse educator and PREP faculty member, and me; other contributors include Richard Glickman-Simon MD, Libby Bradshaw DO, MS, PREP’s Associate Director, and Steven Scrivani DDS PhD, another valued faculty member. We 6 faculty comprise PREP’s Steering Committee. Given pain’s burden upon public health, it is most appropriate that PREP is housed within the Department of Public Health and Community Medicine, capably led by Dean Harris Berman and more recently, Dean Aviva Must.
For me, the best thing about the first 10 years of PREP has been seeing our students succeed as they extend and enhance their careers, helping those with pain and becoming educational resources for their new colleagues. Students have come to PREP from across the US and from many countries, with diverse healthcare and non-healthcare backgrounds, and from other graduate programs at Tufts and affiliates. They have been MDs, RNs, DDSs, pharmacists, PTs, OTs, EMTs and others interested in pain, whether making a mid-career change from another field or beginning their graduate training immediately after college. One is the principal pain nurse educator in a large urban medical center. Another works with a world-famous outcomes research consultancy, on pain. Yet another accepted a high-profile advocacy position at a major pharmaceutical company. Another works in a hospice. Others have proceeded to medical or osteopathic school or to seek a PhD.
Our students are a very special group of altruistic people. We are proud of all they have achieved. We look forward to serving more and more students as society at large and the health professions increasingly understand how fundamentally important pain control is for quality of life, and accept pain control as a basic human right.”

Thank you to Dr. Carr and the PREP faculty for their vision and passion in the field of pain control, may the PREP program continue to blaze the trail for many years to come.

2 comments October 29th, 2009

Pain Management as a Fundamental Human Right

by Daniel Carr, M.D, FABPM, Founding Director PREP program Tufts University School of Medicine and Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
As the healthcare system has become more patient-centered, one sees increasing reference to patient rights to aspects of care, such as pain care. What does it mean for something — in particular, pain management
— to be a “human right”?
Do entitlements evolve into rights, or are rights something that have always existed but whose formal recognition may be slow to come? How is the human right to pain management operationalized within national legislative, judicial and regulatory systems, and healthcare policy? Dr Dan Carr, Founding Director of the PREP program, explores whether there is a fundamental human right to pain management in a comprehensive review available at Co-authored with two distinguished international authorities, this article was published in the official journal of the International Anesthesia Research Society along with an unprecedented four editorials including a very affirming one from the World Health Organization. Those with a deeper interest in this important topic may wish to read the white paper prepared by Human Rights Watch, available at .
What are your thoughts about pain managment as a fundamental human right? Please share your thoughts and comments.

1 comment July 29th, 2009

FDA Advisory Committee Recommends Restrictions on Acetaminophen

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP Student, and PREP-AIRED blog moderator
On June 30, a Food and Drug Administration (FDA) advisory committee voted to recommend restrictions on both over the counter and prescription acetaminophen and acetaminophen combination products. Citing the danger of acute liver failure due to overuse of acetaminophen containing products by consumers, the committee voted to recommend reducing the maximum single adult dose of acetaminophen to 650 milligrams from 1000 milligrams. The advisory committee also recommended removing from the market frequently prescribed combination prescription pain relievers, such as Percocet (oxycodone and acetaminophen) and Vicoden (hydroocodone and acetaminophen).
How does this recommendation affect patients, healthcare providers and pain management specialists? If patients switch to other non-steroidal anti-inflammatory drugs (NSAIDs) because of fear of liver failure, are they setting themselves up for increased complications related to gastric bleeding, cardiovascular or kidney function? The American Association of Family Physicians published an interesting review of the recommendation by David Mitchell (click here to read).
What are your thoughts about the FDA advisory committee’s recommendation?

Add comment July 2nd, 2009

Low Back Pain and Complementary & Alternative Medicine

by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
The current issue of the NIH National Center for Complementary and Alternative Medicine’s (NCCAM) newsletter focuses on low-back pain: research and care. Since 4 out of 5 individuals will experience low-back pain in their lives, most healthcare practitioners will be asked to treat this condition at some point. Patients, as well as healthcare practitioners are often frustrated with treatment options for low-back pain. Understanding types of complementary strategies patients may be utilizing and may not be disclosing to their physicians is helpful in exploring the full context of low-back pain.

3 comments June 22nd, 2009

Tracking Pain With Twitter

by Lisa Neal Gualtieri, Ph.D., Adjunct Clinical Professor, Tufts University School of Medicine
I teach Online Consumer Health and Web Strategies for Health Communication in the Health Communication Program . While this doesn’t have to do with pain per se, the Web is an important way people learn about pain and seek peer support. The Web also is used for tracking pain. I first thought about this when speaking to a Rheumatoid Arthritis group at Brigham and Women’s Hospital, when it struck me how much information about the fluctuations in pain were not available for a physician during the patients’ visits. At the same time, input challenges are presented when a patient’s pain prevents him or her from using a computer.
Twitter, which has been recently popularized by Oprah, allows “microblogging”: writing 140 character or less messages. Twitter has been used for health applications, including the charmingly-named Qwitter . Twitter is now being promoted for pain tracking as well, and a blog post provides five easy-to-follow steps for someone new to Twitter to use it for this purpose. It has the advantages of ease of use and being free; there are tools specifically designed for pain tracking but they may have a steeper learning curve. Of course, the real question is if it provides benefits to the patient through peer support or tracking.

1 comment June 9th, 2009

PREP-AIRED named Link of the Month

We are honored to be named “link of the month” by the Mayday Pain Project. The Mayday Pain Project was begun in 1994 with a grant from the Mayday Fund in New York as an international educational resource with a goal of empowering people in pain and those who care for them. The Mayday Pain Project website provides accessible, user friendly and professionally authoritative information about pain issues for patients, medical professionals and caregivers.
Thank you to the Mayday Pain Project for recognizing the important role that Tufts University’s Pain Research Education and Policy Programs play in educating tomorrow’s leaders in pain management.

Add comment May 24th, 2009

From Pain to Palliative Care

Thank you to MS-PREP/NESA student, Nancy MItchell for sending along the link to a thought provoking documentary series that recently aired on WBUR in Boston. The documentary entitled: Quality of Death: End of Life Care in America, raises many questions about the type of care and medical interventions our current health care system promotes at the end of life. The documentary challeges those of us involved in health care to consider how we can make the end of life more compassionate and meet the needs of our patients and their families more effectively and humanely. You will find it well worth your time to listen to the documentary and check out the website for more information and further discussion about Quality of Death: End of Life Care in America. Feel free to post your comments on this blog for a focused discussion on pain and palliative care.

Add comment May 10th, 2009

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