http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/ Tufts University Medical School en Copyright 2009 Thu, 19 Nov 2009 10:15:28 -0500 http://www.sixapart.com/movabletype/ http://blogs.law.harvard.edu/tech/rss 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. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/11/pain_and_dement.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/11/pain_and_dement.html Dementia Elderly Pain Tufts Thu, 19 Nov 2009 10:15:28 -0500 by Nancy Mitchell, MS-PREP/NESA student The non-profit organization, Human Rights Watch, is bringing attention to the lack of adequate pain care in many areas of the world. Human Rights Watch has recently published a 102-page report highlighting the current state of palliative pain care in India. To read more...click here. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/11/pain_controla_h.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/11/pain_controla_h.html Human Rights Human Rights Watch India NESA Pain Palliative Care PREP Mon, 09 Nov 2009 13:51:40 -0500 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. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/10/10_year_milesto.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/10/10_year_milesto.html masters degree NESA New England School of Acupuncture pain management patient rights PREP PREP program Tufts University School of Medicine Thu, 29 Oct 2009 14:24:18 -0500 by Jessica Gerber, M.Ac., Lic. Ac., MS-PREP Another article about acupuncture and low back pain...Though this one focuses on pregnant women. HealthDay News recently reported: "A week of continuous auricular acupuncture can reduce pain and disability in pregnant women with low back and posterior pelvic pain, according to a study published in the September issue of the American Journal of Obstetrics & Gynecology" "Shu-Ming Wang, M.D., of the Yale School of Medicine in New Haven, Conn., and colleagues conducted a randomized, controlled trial of 152 women at 25 to 38 weeks' gestation who had lower back pain, posterior pelvic pain or both, and were given either acupuncture or sham acupuncture, or put on a waiting list (control group). The subjects were then monitored for two weeks." "Compared with those in the sham acupuncture and control groups, women receiving auricular acupuncture reported the best results, the researchers discovered. At the seven-day mark, about 80 percent of the acupuncture group reported a clinically significant reduction in pain, whereas only 56 percent of the sham acupuncture group and 36 percent of those in the control group did. However, the authors note, for some of the participants, the benefits were not sustained." "Long-term efficacy of auricular acupuncture as a treatment for pregnancy-related low back and posterior pelvic pain is still inconclusive but clearly shows promise," Wang and colleagues conclude. "A future large-scale randomized control study is indicated to explore the characteristics of acupuncture responders versus non-responders [and] the optimal duration of treatment to achieve the sustained therapeutic effect." ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/10/acupuncture_app.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/10/acupuncture_app.html Acupuncture back pain pregnant PREP Shu-Ming Wang Tufts University School of Medicine Yale Wed, 14 Oct 2009 20:02:06 -0500 by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator A recent study based on analysis of data from the 2004 Health and Retirement Study suggests pain hastens the aging process with respect to functional limitations at a younger age. The study, published in the September issue of the Journal of the American Geriatrics Society, examined a sample of individuals age 50 and older living in the community. The mean age of the sample was 65. Participants who said they had significant pain -- 24% of the 18,531 people surveyed -- had functional limitations roughly equivalent to those of a person two to three decades older. One of the study's authors, Kenneth E. Covinsky, MD, MPH, University of California San Francisco, wrote, "So, a 50-year-old in pain functions on the level of a 70-year-old who does not have daily pain". The authors of the study stated that the cross-sectional design of the study did not allow them to determine if "pain is causing functional limitations or whether functional limitations are causing pain, but it seems likely that the relationship is bidirectional." But since the relationship appears to be powerful the study's authors concluded that taking a more unified approach to addressing pain and function in the community setting versus only in geriatric settings may prove beneficial. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/09/does_pain_make_1.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/09/does_pain_make_1.html Aging Geriatrics Health and Retirement Study Pain PREP Thu, 24 Sep 2009 09:53:40 -0500 by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator The following article, about the Tufts University School of Medicine PREP programs, was published in the September issue of the Massacusetts Report on Nursing. We have included the full version below, to read the printed (edited for space) version, please click here (article appears on page 5) Boston's Hidden Gem: Pain Research, Education and Policy Programs at Tufts University By Pamela Katz Ressler, RN, BSN, HN-BC An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (medical definition) To hear about pain is doubt: To experience pain is certainty (patient definition) Pain is the number one reason that individuals seek medical care. As nurses, we are often faced with a lack of multidimensional pain strategies to support our patients and families living with pain. Pain has become the fifth vital sign in our assessments, but do we really have the tools and strategies to make a difference for our patients? Did you know that the only postgraduate multidisciplinary pain program in the United States is located in Boston, Massachusetts at the Tufts University School of Medicine? For me, and several other nurses who are enrolled in the Pain Research, Education and Policy Programs, it has been one of the best kept secrets around, a hidden gem in pain management education nestled in downtown Boston. Those of us involved in the Pain Research, Education and Policy Programs at Tufts University School of Medicine think it is time to raise awareness of the vital need for more pain management education taught across the disciplines and to share how our nursing practices have been enhanced by our better understanding of the many aspects of pain. The Pain Education, Research and Policy Programs at Tufts University School of Medicine were started in 1999, by an anthesiologist/internist, Dr. Daniel Carr, and a sociologist, Dr. Kathryn Lasch. The intent was to gather many voices in the developing multidimensional and multidisciplinary approaches to the complex nature of pain. The Master of Science in Pain Research Education and Policy (MS-PREP), a 48-credit graduate degree, became the first post-graduate multidisciplinary program in the United States a decade ago and remains so to this day. Seeing the need for advanced preparation in multidisciplary pain management by professionals who currently have advanced post graduate degrees, a 20 credit Certificate of Advanced Study in Pain Topics was subsequently added to the program. Certificate students take classes with the Master degree students but also declare one of three specializations in research, education or policy, which will inform their core courses and elective choices. In 2006, the New England School of Acupuncture and Tufts University School of Medicine launched a ground-breaking joint venture by allowing student to earn both a Master of Science in Pain, Research, Education and Policy from Tufts University Medical School, as well as a Master of Acupuncture degree from New England School of Acupuncture. The many models for learning have made the Tufts University Medical School’s programs in Pain Research Education and Policy attractive for mid-career health professionals seeking advanced knowledge in pain management. Richard Glickman-Simon, M.D. is the director of the Pain Research Education and Policy Programs at Tufts University School of Medicine, and also teaches courses on Complementary Medicine and Medical Acupuncture within the program. When asked to explain the rationale behind the unique Tufts University pain management programs, Dr. Glickman-Simon stated, “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. The Pain Research, Education and Policy Programs were 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 a 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.” A common feature I have found among fellow R.N. students in the Pain Research Education and Policy Programs (PREP) at Tufts University is the recognition of a knowledge gap in regard to advanced pain management strategies when confronted with particularly difficult professional or personal pain situations. While the specific pain situations we confront may differ due to our individual nursing practice environments, we have all sought out the programs because we firmly believe that we can and should be able to do better in addressing and relieving the many aspects of pain in our individual patients and larger society. I recently interviewed two current students; both experienced registered nurses, in the Pain Research Education and Policy Programs to get their perspectives on how these programs have benefited them professionally and personally. Sherry Brink is an RN working in the Day Surgical Recovery Room at Tufts University Medical Center, as well as a medical volunteer on several medical relief trips to Peru, the Philippines, and soon to China. The other student is well known to MARN members, Susan Krupnick, past president of MARN. Sherry is completing the Master of Science in Pain Education and Policy (MS-PREP) and Susan is currently enrolled in the Certificate of Advanced Study in Pain Topics What interested you in the Pain Research Education and Policy Programs (PREP)? Sherry Brink: “I was searching for a Masters Program that would interest me not long after finishing my RN to BSN/ BS at University of New Hampshire/Manchester. I didn’t have much luck finding a multidisciplinary program in the nursing field. When I saw PREP (Pain Research, Education and Policy Program) advertised in the hospital news, it immediately intrigued me. In my 30+ years of nursing when had I not encountered pain? Pain is found in every field of nursing practice. I was sure this Master of Science degree was something I could actually use no matter where I went.” Susan Krupnick: “During the time I was President of the Massachusetts Association of Registered Nurses (MARN) I was attending one of the MARN clinical conferences and met Jean Connolly (former PREP programs director) who was one of the exhibitors for the Tufts University PREP programs. I had always been interested in the area of pain as it intersects in the daily work that I do as a psychiatric clinical nurse specialist and addictions nurse practitioner. So, I had a discussion with her and took some of the information documents describing the programs. I knew that at some point I would need to pursue additional education related to pain, but at that time being president of MARN and working full time was keeping me very busy. The time was not right for me to pursue additional education, but I knew the time was coming soon and this area represented a gap in my knowledge, which I believed would interfere with my clinical practice.” Why did you decide either the MS-PREP or the Certificate program made sense for you and your nursing career? Sherry Brink: “I’m presently working in Day Surgical Recovery at Tufts University Medical Center and as the saying goes among my peers on this unit, “pain and puke are our lives”. I knew this program (MS-PREP) would help me be more proficient at treating pain and hopefully prevent nausea in my patients.” Susan Krupnick: “After I completed my two terms as President of MARN I still had an interest in pursuing further education in the area of pain. This turned quickly into a need to address a knowledge gap in my clinical practice very quickly. I changed my job and now was working as a psychiatric clinical nurse specialist and addictions nurse practitioner in the Emergency Department at Massachusetts General Hospital for about 18 months and, it was becoming ever apparent to me that approximately one third of the patients that I was assessing, referring and treating in the ED setting certainly had addictive illness, but also they experienced some form of pain, acute, chronic and most often neuropathic. I would work diligently to find an addiction program that could treat both their addictive illness while simultaneously treating their pain problem or at least maintain their pain medications and collaborating with their pain team members. I consistently was disappointed in the response that the patient would need to be detoxified off all their pain medications (even if they were not experiencing a problem with their prescription medication). I found this extremely disappointing and perplexing. So I turned to the literature and found no real answers there. At that time (2007) and to date there is a paucity of literature addressing the concrete issues of treating individuals with addictive illness and any form of pain, especially neuropathic pain. I had the privilege of attending a program titled Opioids, Pain and Addiction in 2007 hosted by NIDA (National Institute of Drug Abuse) and facilitated by Dr. Nora Volkow, the director of NIDA. During that program held in Bethesda, a few hundred researchers, educators and clinicians attended and heard of ongoing research, education and some future treatments that were primarily aimed at developing tamper resistant medications and novel delivery systems for opioids. Unfortunately, as the director pointed out to all of the audience that there was little research or novel programs being developed for individuals with concurrent pain and addiction and especially if treatment with an opioid might be one of the strategies to treat their pain disorder. Well I returned fueled to do something, but still knew that I had a learning curve due to my knowledge gap. Therefore, in the summer of 2008 I finally interviewed with Dr. Richard Glickman-Simon, Director of Programs for the Tufts University PREP programs to determine if my goal of knowledge acquisition about pain disorders and how best to integrate that into the care of patients with addictive illness could be met in their program. I had also searched the Internet for any other programs and found that the Tufts program was the only formally organized university level program in the United States. Fortunately for me, the Tufts program was only an hour and half away from where I live. It seemed like a good fit for my learning needs and I was impressed with the innovative nature of the programs and the discussion of the diversity of students.” Would you say something about the program you are enrolled in, your concentration, and perhaps any faculty members or courses that have particularly influenced you? Sherry Brink: “I’m going for the Master of Science in Pain Research Education and Policy degree (MS-PREP). In terms of inspirational faculty members, I’m still in awe of Dr Carr’s (program founder, Dr. Daniel Carr) knowledge on the subject. Respect for him and where he has taken this has inspired me. Susan Krupnick: “I started the Certificate of Advanced Pain Topics program at Tufts University in September 2008 and am focusing on the track related to education. I have discovered that the program is very much a multidisciplinary program. During my first semester course of Neuroanatomy, Neurophysiology and Pharmacotherapy, my class colleagues were quite diverse, which was very exciting. The class participants included three nurses, a massage therapist, two physicians, and a student who had degree in genetics, individuals also from the business world. We also had students that were enrolled in the NESA program (New England School of Acupuncture). This tapestry of students made for robust and diverse discussions that exposed me to different models and theories of treating pain. This diversity has been an enriching experience for me. I am completing my second semester and have traveled along with the same students from the first semester, which has allowed me, as a student to build some relationships that I believe will last after I complete the post master’s certificate program. I have been impressed by the expertise of all the faculty members as they have done their presentations. The faculty and presenters in this program are the individuals who have done much of the groundbreaking research in their specific area of pain. I have been pleasantly surprised at their willingness to be active participants in our learning process and their enthusiasm for their research and practice is often infectious.” How has being a student in the PREP programs influenced your nursing practice or career? Sherry Brink: “The MS-PREP program has already affected the choices I make every day. Which pain medication to use, when, and how often. Most recovery room RN’s have a lot of leeway for making these choices. I see decisions made based on outdated information or “feelings”; not a lot of evidence based practice. There are some colleagues who will come to me for suggestions. It’s not my job to change everyone’s practice but I would like to think I have had some influence. I also have a better report with the anesthesiologists now that we discuss the different techniques in pain control. Sharing articles I have read for classes or research are of interest to the MDs. I can see they have an increased respect for me since I have started the PREP program. I have also expanded my nursing practice to include international medical mission work. I was introduced to the Medical Missions for Children by the staff from Tufts University Medical Center who had attended other missions. There was a cancellation May 08 and I was asked to join. A large group of us ended up in Lima, Peru and went to Cusco from there. It was great to see so many families waiting to be helped, some of whom received the first stage of cleft repair the previous year. I ended up being the only recovery room nurse on the trip. I used my knowledge of pain treatment for the post-op children and some adults, enough to impress the entire staff and gain some independence. We all worked hard and it was very rewarding. The Peruvian volunteers and staff were wonderful. I will return in May 2009 and see the families and staff who were such a great part of the experience. In October 2008 I was able to travel on another international medical mission trip to Leyte in the Philippines. The conditions were rudimentary but again the team pulled together and the families were so appreciative. I'm hoping my luck continues and every year I can visit another country and gain new perspective on international healthcare, especially methods of pain management. A new site is opening in China and I have asked to be part of the team. I am considering that my capstone project for the MS-PREP degree could have something to do with teaching the Peruvian hospital staff more about pain and methods of control. Susan Krupnick: “I have already developed a more comprehensive assessment in my own practice with patients that I am consulted on an inpatient addictions unit and also in my psychiatric consultation liaison practice in an acute care hospital. I also have been discussing with leaders of institutions the idea of a research based inpatient unit that will develop an innovative program that will be multidisciplinary and the focus will be the care of the complex pain patient who also has an addictive illness. That is my ultimate goal to improve the care to this particularly challenging and often disenfranchised group of patients. “ What advice would you give to nurses who may be interested in the PREP programs? Sherry Brink: “You have to be interested in the subject to start because it is so focused. Just spend a week making a mental note of how often you assist a patient with pain issues. If you could do it better wouldn’t you want to? Can I tell you how satisfying it is to effectively treat a patient’s pain, to see relief wash over them? It’s great! It’s part of why I stay with nursing.” Susan Krupnick: “I would encourage any nurse who is considering further education to identify their own knowledge gaps and if the area of pain assessment and treatment is an area that they need to acquire knowledge do consider this program. The classes are diverse and that is the reality of the clinical world we work in today. I have been impressed by this program so far and believe that will continue. The faculty and leadership of the program solicit feedback from students on a regular basis, and do respond to recommendations in a prompt manner. This is truly a student-focused program and I am very satisfied with my decision to pursue this education, my practice has already been enhanced and in the long run that benefits both the patients and the staff that I consult to on a daily basis.” For more information about this “hidden gem” of a multidisciplinary pain program nestled in downtown Boston, contact Dr. Richard Glickman-Simon, program director of the Pain Research, Education and Policy Programs at Tufts University School of Medicine (richard.glickman-simon@tufts.edu) The Pain Research Education and Policy Programs now hosts an interactive blog (PREP-AIRED) available at http:// gotufts.edu/prep. You are welcome to join in the discussion with faculty, students and alumni working together to treat pain more effectively, efficiently, and compassionately. Resources on Pain Management: Tufts University Pain Research, Education and Policy (www.tufts.edu/med/education/phpd/msprep/index.html) Massachusetts Pain Initiative (www.masspaininitiative.org) International Association for the Study of Pain (www.iasp-pain.org) PainEDU (www.painEDU.org) American Society of Pain Management Nursing (www.aspmn.org) References: International Association for the Study of Pain: http://www.iasp-pain.org Scarry, Elaine: The Body in Pain, Making and Unmaking of the World, Oxford University Press, 1987. National Institute of Arthritis and Musculoskeletal and Skin Diseases NIH Guide: “New Directions in Pain Research,” NIH Web site.http://www.niams.nih.gov/rtac/funding/grants/pa/pa_98_102.pdf.New England School of Acupuncture http://nesa.edu/pain_management_pm_2.html ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/09/bostons_hidden.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/09/bostons_hidden.html Tue, 15 Sep 2009 14:10:12 -0500 By Marcin Chwistek, MD, Attending Physician, Pain and Palliative Care Program, Supportive Oncology Care, Fox Chase Cancer Center, Philadelphia, PA I joined Twitter around the last elections, fascinated by social media’s power in inducing a societal change. The optimism and the real sense that we can change things for better were palpable. I had not felt anything of that magnitude since I witnessed, as a college student, the first democratic election in my native Poland in the early 1980’s. I stuck with Twitter since then, and have been primarily using it to tweet about issues related to cancer pain and palliative medicine. Over time, my community on Twitter has evolved into a fascinating mix of people: patients, medical librarians, consultants, physicians, head hunters, nurses, community organizers, news organizations, social workers and cancer advocates to name a few. And although many of them are interested in issues concerning pain management and cancer care in general, it would be incredibly naïve to think we all have common goal or even agree on things. Our backgrounds, life experiences, geography could not be more diverse. And yet, I have a sense that as a group we have a new responsibility. Clay Shirky, who has been writing about social media for a while, said this during his recent TED talk: “Old Media: professionals broadcasting messages to amateurs are increasingly slipping away. In a world where former audience are now increasingly full participants, it is less and less about crafting a single message to be consumed by individuals, it is more about environment for convening and supporting groups…. How can we best use it? " Traditionally, it was the pain physicians or researchers broadcasting to the community of pain patients. They might have written books on the subject, speak at a conference or for a TV program. Now it is pain patients (and again there is this amazing variety within the group - cancer pain, fibromyalgia pain, back pain etc), pain advocates, pain physicians, pain educators, pain researches organizing their own groups on Twitter, MySpace or Facebook. The groups may function as a support group, as a place to exchange ideas or perhaps as a resource. The Internet makes those goals incredibly easy. Without however committing the groups to bigger goals, more ambitious goals, goals that would affect lives of many people I am afraid we are not using the power we were given. Pema Chodron in her new book,"Taking the Leap", writes, about “three basic qualities that have always been with us but perhaps have gotten buried and been almost forgotten” … natural intelligence, natural warmth, natural openness. I would argue that these qualities apply to groups too. There is a natural intelligence that is bigger than the sum of our individual minds, natural intelligence of the groups or “the wisdom of crowds” as James Surowiecki names it. We need to engage it as it would point naturally to what needs to be done. Natural warmth is our empathy. But hearing the stories, which being a part of online community enables, our empathy increases and we all are moved to action. Empathy is a seed of compassion, and compassion is an urge to act on behalf of those who suffer. We can choose to be moved by the stories we hear and act on them. Empathy has the power to focus our attention on issues we may have otherwise not known about. And finally, there is natural openness that Pema Chodron describes as the spaciousness of our sky-like minds. It is a beautiful metaphor, and when I think about social media, this metaphor seems to be even more powerful - Individuals working in their own seemingly separate environments, but connected on the net. It is literally "minds connecting in the sky". Pema contrasts this attitude of openness with a fear based view “where everyone is either an enemy or a friend, a threat or an ally, someone to like, dislike or ignore.” And as anyone who has experienced it first hand, as a patient or a clinician knows, medicine is riddled with fear. There is fear of misdiagnosing the disease, fear of not being good enough, fear of not being in control, fear of being in pan, fear of not regaining ones health, fear of relationship etc. Fear seems to be in a way of most of what we do. As Parker Palmer says in one of his essays:”Fear is not just an emotion, but a central feature of the culture that surrounds us”. Being in a group, feeling a strong sense of community united to improve wellbeing of others, could be one of the best antidotes to fear. And it comes to generating a change in how medicine is practiced today; it may turn out to be our biggest asset. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/09/social_media_ho.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/09/social_media_ho.html Cancer Clay Shirky Pain Palliative Parker Palmer Pema Chodron Social Media Support Twitter Wed, 02 Sep 2009 21:16:19 -0500 by Daniel Carr, M.D., FABPM, Founding Director of the Pain Research, Education and Policy Program, Tufts University School of Medicine, and Pamela Katz Ressler, RN, BSN, HNC, MS-PREP student and PREP-AIRED blog moderator Every academic field has a handful of texts that are classic, definitive reference works. For pain medicine and regional anesthesia the textbook first prepared by Michael Cousins and Philip Bridenbaugh in 1988, Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine, has enjoyed worldwide success as one of the most, if not the most, comprehensive and authoritative monographs on these topics. Professor Cousins has pioneered in the development of pain research and treatment in Australia, and is a Past President of the International Association for the Study of Pain. During his tenure as IASP President he formed a Task Force on Pain Curricula whose recommendations have influenced pain education around the world -- including Tufts' PREP program. Dr Bridenbaugh is Past President of the American Society of Anesthesiologists and also the American Society of Regional Anesthesia. About five years ago Professors Cousins and Bridenbaugh approached Dr Dan Carr, Founding Director of the PREP program, and Professor Terese Horlocker of the Mayo Clinic to join them as co-editors for the fourth edition of this text. Dr Carr is happy to report that the text has now been published! Compared to the prior edition, the number of chapters has expanded from 34 to 51, and the total number of authors from 52 representing 9 countries to 90 (including 68 new ones) representing 15 countries. Of note for those with an interest in acupuncture, it is the first text on regional anesthesia to include a chapter on the effects of needle insertion per se, by two Western physicians who studied acupuncture with Professor Han in Beijing. The book also includes chapters on placebo, psychological aspects of pain, and pain mechanisms. The very first user review on Amazon's website states "This edition has been almost rewritten and [a] larger portion is dedicated to pain management and basic pain mechanisms. Indispensable reference!" ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/08/4th_edition_of.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/08/4th_edition_of.html Acupuncture Anesthesia Daniel Carr IASP Michael Cousins Neural Blockade Pain Medicine Philip Bridenbaugh PREP program Terese Horlocker Tue, 18 Aug 2009 20:40:31 -0500 by Lisa Gualtieri, PhD, Adjunct Clinical Professor, Tufts University School of Medicine "Nothing is certain but death and taxes," said Benjamin Franklin. Celine Dion's version is, "Rain, Tax (It's Inevitable)." My version is "Technological Innovation (It's Inevitable)" when I see yet another announcement about a new social networking site or upgrade to an existing one. Plaxo, the poor stepchild to LinkedIn, had today's innovation, with the addition of groups that members can set up and invite other members to join. This makes sense when people are congregating around common professional interests. But health issues? I looked at the profile of someone who had connected to me in Plaxo and learned that he is member of "Living in Pain". The group's page provided the following description: "Anyone who has pain from any source, or a caregiver is welcome here. RSD, CRPS, RA, LUPUS , Fibromyalgia or any other condition. We are here to gather support and have fun at the same time." Support can have a huge impact on how someone copes with disease. Pain is particularly difficult because there might be no outward manifestation of it, such as with Rheumatoid Arthritis, as I learned from Diane Aronson, the past president of the Roadback Foundation. But what I questioned here was not the existence of an online support group, but having one for people "living in pain" as part of a professional network. I was surprised people were comfortable being open about their health issues in this way and I wondered if it leads to better support, or the ability to connect online with peers in a more meaningful way than in a less professional setting. Possibly they even discuss how to cope with pain in the workplace. But I am concerned about the stigma of disease in the workplace and if playing membership in such a group in a professional profile is, using the acronym common to the online world, TMI (too much information). ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/08/technological_i_1.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/08/technological_i_1.html LinkedIn Living in Pain Plaxo Tue, 11 Aug 2009 15:16:12 -0500 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 http://www.anesthesia-analgesia.com/cgi/reprint/105/1/205. 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 http://www.hrw.org/sites/default/files/reports/health0309web_1.pdf . What are your thoughts about pain managment as a fundamental human right? Please share your thoughts and comments. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/as_the_healthca.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/as_the_healthca.html Daniel Carr Human Right Pain management PREP program Tufts University School of Medicine Wed, 29 Jul 2009 11:26:09 -0500 by Lisa Neal Gualtieri, PhD, Adjunct Clinical Professor, Tufts University School of Medicine and Pamela Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator We went to the Massachusetts Technology Leadership Council meeting in June on Healthcare & Social Media: Don't Do It Alone - How to Leverage Social Media to Power Behavior Change . It was a fascinating session that included an excellent presentation by Dan Pallestant, MD, founder and CEO of Sermo, the best known physician online community. But the point here is not the seminar itself, but that there any many conferences and seminars in Boston on healthcare and attending them takes a committment of both time and money. The time issue comes down to a determination of how beneficial the content or the networking will be. The cost issue is one where there is help. Stay In MA is designed to support students' attending local conferences and seminars and the application process has a quick turnaround. We recommend you try it the next time you see an announcement.]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/attending_local.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/attending_local.html Healthcare Massachusetts Sermo Social Media Technology Sun, 19 Jul 2009 21:56:30 -0500 by Lisa Neal Gualtieri, PhD, Adjunct Clinical Professor, Tufts University School of Medicine We just celebrated Independence Day and can easily see how, in the US, we have rights that we often take for granted until we compare our lives with those of people in other countries. However what are the rights of patients? Loosely modeled after the Declaration of Independence, is a new Declaration of Health Data Rights which states: In an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people: 1. Have the right to our own health data 2. Have the right to know the source of each health data element 3. Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form 4. Have the right to share our health data with others as we see fit These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights. This was created by patient advocates, caregivers, health care professionals, technology and policy experts, and entrepreneurs. It is both controversial and timely given government initiatives and the wealth of technology available, as well as recently announced initiatives, such as Beth Israel Deaconess Medical Center's,pilot program to allow patients to see notes written about them by their doctors. What do you think about the Declaration of Health Data Rights and the potential impact? ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/declaration_of.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/declaration_of.html health data information patient rights Tue, 07 Jul 2009 19:52:12 -0500 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? ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/fda_advisory_co.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/07/fda_advisory_co.html Acetaminophen FDA Pain Pain Management Tylenol Thu, 02 Jul 2009 21:34:10 -0500 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. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/06/low_back_pain_a.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/06/low_back_pain_a.html low-back pain National Center for Complementary and Alternative Medicine NCCAM NIH Pain Pain Management Mon, 22 Jun 2009 09:41:12 -0500 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. ]]> http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/06/tracking_pain_w.html http://blogs.uit.tufts.edu/tuftsuniversitymspainresearcheducationandpolicy/2009/06/tracking_pain_w.html Chronic Illness Health Health Communication Microblog Pain Pain Log Pain Management Qwitter Twitter Web 2.0 Web Strategies Tue, 09 Jun 2009 11:07:21 -0500