|
Acknowledgment:
|
|
New
Task Force Approved at APS November Board
Meeting The
board also discussed the report
from the corporate Another exciting year for APS is just around the corner! Watch for more information on the strategic plan process and the forthcoming initiatives.
Hospital Pain Control Evaluated in New England Journal of Medicine Article A team of Boston-based researchers representing the Harvard School of Public Health, the Brigham and Women's Hospital Division of General Medicine, and the Boston Veterans Affairs Healthcare System has analyzed the first national data on patients' experiences in hospital settings. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey found that while patients generally are satisfied with their care, they believe there is substantial room for improvement regarding pain management. The article, "Patients' Perception of Hospital Care in the United States," appeared in the October 30, 2008, issue of The New England Journal of Medicine (NEJM). The article highlights specific areas that need improvement, including pain control, nursing, medication-related communication, and hospital discharge instructions. Nearly one-third of surveyed patients did not give high ratings in the domain of pain control. The domains of patients' experiences were highly correlated overall (Cronbach's alpha 0.94), with a 0.84 correlation coefficient between communication with nurses and adequate pain control. Hospitals with high levels of patient satisfaction provided clinical care that was somewhat higher in quality for all conditions examined. The HCAHPS study findings received national attention and were picked up by a number of national publications.
APS Fundamentals of Pain Management: A Primer for Residents and Fellows© APS is pleased to again sponsor the APS resident's course, "Fundamentals of Pain Management: A Primer for Residents and Fellows.©" This intensive 2-day course for third- and fourth-year residents and fellows in anesthesiology, neurology, family practice, emergency medicine, and physical and rehabilitation medicine is planned by a program steering committee, chaired by Charles Argoff, and comprising pain management experts from across the United States. As in past years, a limited number of scholarships for nonmedicine trainees will be offered. The program combines didactic and interactive lectures and multidisciplinary breakout groups to present a diverse range of topics and experts in the field of pain. Participants will gain a foundation knowledge that—along with attendance at the 28th Annual Scientific Meeting in San Diego, CA—will offer a body of current and relevant information in pain management and research. Attendance at the program will be reserved for 100 scholarship awardees who gain access through a competitive selection process. The 2009 program will be held Tuesday, May 5, and Wednesday, May 6, 2009, prior to the APS Annual Scientific Meeting. Residents and fellows wishing to apply for a scholarship to attend the course should complete and submit the application no later than January 12, 2009. Scholarships cover the 2-day intensive training and registration for the APS 28th Annual Scientific Meeting, a complimentary 1-year APS membership, round-trip transportation costs, hotel accommodations, and a food stipend. If you are a third- or fourth-year resident in anesthesia, neurology, family medicine, emergency medicine, or physical/rehabilitation medicine, please click here for program information and to access the application. If you are a nonmedicine trainee with interest in this program, click here or contact Erica Boyer at erica@cmmglobal.com or 918/343-6005 for instructions regarding the application process. Only candidates who are interested in pursuing an academic career involving pain management and can commit to attending the full program May 5-9 should apply. APS is proud to sponsor this program as an important component in pain management education and is grateful for the initiative support provided by Endo Pharmaceuticals through an educational grant.
The
Journal of Pain Highlights Many women separated from abusive partners still experience high-disability chronic pain after nearly 2 years, according to Canadian researchers writing in The Journal of Pain. Despite ample evidence that chronic pain is a serious problem in women with a history of abuse, little is known about the severity and patterns of chronic pain in this population. The authors studied 292 abused women who had been separated for at least 20 months. They sought to describe patterns of chronic pain severity, define the relationship between chronic pain severity and disability, and document the pattern of use of select pain medications. In the study, 35% of the women who survived intimate partner violence (IPV) showed high disability chronic pain and experienced pain, on average, at three or more sites. Nearly half of those with chronic pain in the sample said they had swollen and painful joints. The authors noted that chronic stress caused by IPV may inhibit how the body naturally adapts to stress and cause imbalances in cortisol levels. Also, proinflammatory cytokines may lead to an increased autoimmune/inflammatory response and eventually cause chronic pain. Since IPV involves repeated trauma, many women sustain serial injuries before previous trauma can heal. Chronic pain also can be exacerbated by post-traumatic stress disorder (PTSD) and elevated anxiety that interferes with cognitive skills involved in managing pain. More than half of the women studied were unemployed, suggesting that chronic pain hampers the ability to maintain employment regardless of age or level of education. The authors reported that less than 25% of women with high-disability pain were taking opioids and, despite the prevalence of high-disability pain in this sample, opioid use in this group was the same as women in the general population. They concluded that these findings combined with high rates of unemployment and PTSD "raise questions about how well chronic pain is being managed" among victims of IPV.
A review of more than 4 million insured patients with private coverage and Medicaid showed that rates of opioid use did not differ widely between noncancer pain conditions but there were higher rates of opioid use among Medicaid patients. In this study, researchers examined general trends in prescription opioid use in patients covered by HealthCore private insurance and Arkansas Medicaid. They sought to determine if increases in opioid use are limited to particular noncancer pain (NCP) conditions and how patterns of use differ between NCP conditions and among those with multiple pain conditions. Trends reported in the study suggest an increased tendency to prescribe long-term opioid therapy for those with multiple pain conditions, which also have been associated with greater psychopathology than single pain conditions. The presence of a comorbid mental disorder may predict opioid use among individuals with chronic pain. The authors concluded that higher rates of opioid use in Arkansas Medicaid patients likely reflects the greater disability and disease burden of this population and added it is also possible this disadvantaged population has less access to nonopioid rehabilitative therapy for NCP compared with privately insured individuals.
Flexible dosing of the antidepressant pregabalin was shown to be effective for treating postherpetic neuralgia (PHN), as evidenced by alleviating allodynia, which can be very disabling and is commonly associated with PHN. Patients with PHN reporting moderate to severe allodynia have more intense overall pain and often are activity—restricted due to pain from physical contact—even from wearing clothing. Researchers at Oregon Health and Sciences University evaluated 269 patients with PHN in a 4-week randomized trial. They compared flexibly dosed pregabalin with a fixed dose of the drug (330 mg/d) and placebo. The trial was designed to prospectively evaluate the time to onset of pain relief in the three groups of patients with PHN. The study results showed the median times to onset of pain relief were 3.5 days for flexible-dose pregabalin and 1.5 days for the fixed dose. A median time to relief for the placebo group could not be calculated because only 31% of the patients in this group met the predefined pain relief criterion during the study treatment time of 28 days. The researchers concluded that the trial results confirm previous studies showing that pregabalin administered twice a day is highly effective and well tolerated. With flexible dosing from 150 to 600 mg per day, the clinician can adjust doses for optimal efficacy and tolerability according to individual patient needs.
Pain
Medicine Highlights This study was conducted to provide physicians with a better understanding of painful diabetes and neuropathy (PDN) and its treatment. Diabetes is one of the main causes of peripheral neuropathy. Patients often have both diabetes and painful neuropathy, but diabetes does not always cause neuropathy. This review set out to help physicians correctly distinguish between PDN and diabetic peripheral neuropathy (DPN). Searches were performed in the Medline database to find well-designed, controlled PDN-related studies published between 1966-2007. Based on the studies examined, pain was found in 10%-20% of patients with diabetes and 40%-50% of peripheral neuropathy. One study found there was significantly less pain in both the upper and lower extremities of patients with type 1 diabetes compared to higher rates of pain in those with type 2 diabetes. Evidence suggests that neuropathy can be connected to impaired glucose tolerance (IGT); consequently, the study notes that screening and early evaluation of nerve function can play an important role in preventing PDN. Additionally, practitioners can determine who should be evaluated for IGT or diabetes based on the results of neuropathic pain. The authors acknowledge that there are limited treatment options for PDN, but say maintaining glucose levels is an important step in any treatment plan. Benefits of controlling glucose levels include reducing the risk of diabetic neuropathy, preventing an increase in neuropathy, and avoiding an influx in concentrations that might negatively affect pain. Ideally, therapy should be aimed at prevention and symptom improvement. After this has been achieved, treatment plans should be based on the individual patient. With limited treatment options, the study concludes that physicians must first have a solid understanding of PDN and its causes and treatments.
Moral intuition may not necessarily be enough to guide a physician to the best possible decision. Instead, reasoning tools based on theory may best equip physicians with the ability to make tough decisions. At the center of this survey was a tough ethical question for medical professionals: "Would you give a blood transfusion to a young, ASA I, Jehovah's Witness who clearly refused transfusion in a case of life-threatening bleeding?" With voluntary participation, 29 anesthesiologists, 41 surgeons, 21 surgical nurses, and 33 nurse anesthetists were surveyed as to whether or not they would give the Jehovah's Witness the transfusion against her wishes, and also were asked to describe the ethical principles they used to reach their answer. Multiple-choice options for ethical principles were respect of autonomy (RA), nonmaleficience (NM), beneficience (B), justice, or other. Overall, anesthesiologists were most likely to transfuse blood despite a clear patient wish to not do so (59% said they would), compared to about one-third across other groups (surgeons, 30%; nurse anesthetists, 36%; and surgical nurses, 29%). Among those who would do the transfusion, anesthesiologists and nurse anesthetists most often used the principles of B and NM to arrive at their decision, surgeons used NM, and surgical nurses used B to reach their decision. Most who said they would not do the transfusion used the RA principle to reach their conclusion. After being surveyed, participants were given a 1-hour tutorial on ethical decision making and then took the survey again. Nine participants changed their response after the tutorial. It was hypothesized that anesthesiologists may have decided to perform the transfusion because they, more than surgeons or surgical nurses, understand the increased risk of death patients face without transfusion. The survey creators attempted to present principle-based ethical theory information to help provide a foundation for more consistent decisions in ethical situations.
PAIN
Highlights Researchers have long known that chronic pain often occurs with posttraumatic stress disorder (PTSD). However, it has not been understood how often or from what mechanisms it results. The authors of this article studied 32 outpatients with PTSD, with a mean age of 44 ± 10 years. To diagnose PTSD, criteria were taken from the DSM-IV-TR. Medicines administered included benzodiazepines, SSRIs, tricyclic antidepressants, and anticonvulsant mood regulators. Questionnaires were administered to gauge the intensity of patients' pain, and testing was conducted with the use of thermal stimuli from a Peltier-based thermal stimulator. Chronic pain was found in 25 of the 32 study subjects (83.3%), a rate five to eight times higher than in the general population. Interestingly, when administered with suprathreshold noxious heat and mechanical stimuli, PTSD rated higher; at the same time, PTSD subjects were less sensitive to pain than the other groups studied (anxiety subjects and healthy controls). The authors considered two explanatory theories: This is how PTSD subjects emotionally interpret/respond to pain stimuli, or, these results reflect "altered sensory processing."
Knowing that anxiety and depression often have a significant effect on patients with chronic pain, the authors decided to study anxiety and depression in women with arthritis. The study included 170 elderly women presenting with either rheumatoid arthritis (82) or osteoarthritis (88). Before the study, the authors hypothesized that both anxiety and depression would be related to weekly pain elevations. Patients were between the ages of 42 and 76 years of age and all were postmenopausal, to limit variables related to hormonal issues. Patients were assessed at the beginning of the study for anxiety and depression, and for pain every week for 11 weeks. They completed an initial questionnaire and were interviewed weekly via telephone. Patients assessed their own pain on scales for stress, depression, anxiety, and pain. Their stress level was determined by their answers to questions related to their relationships with work, family, significant other, and coworkers. The results of the study showed no significant correlation between functional disability and anxiety or depression, but a strong correlation between anxiety and depression and pain. Interestingly, anxiety had a greater impact on pain than depression, with nearly double the impact. Additionally, the effects of depression were almost nonexistent after anxiety was controlled. Stress did not predict next week's pain, suggesting that anxiety is a stronger predictor of arthritis pain levels. The authors acknowledged a few limitations to their study in that all patients were female, fairly well-educated, and from the same demographic group.
Can
Your Program Be an APS 2009 CCOE Award
Recipient? The Clinical Centers of Excellence (CCOE) in Pain Management Awards Program annually awards U.S.-based multidisciplinary pain programs that provide the most distinguished and comprehensive pain care. Since 2007, 12 forward-thinking teams of healthcare professionals have been recognized as CCOE award recipients. Among meeting other award criteria, CCOE award recipients must demonstrate the ways in which their care is patient-centered, evidence-based, and safe; provide appropriate access to multidisciplinary and multimodal care; employ various therapeutic modalities; act as a local champion to improve pain management in systems of care; demonstrate innovation and serve as a model of excellence; and show a commitment to advancing the scientific knowledge related to pain. To learn more about the awards program and to submit an online application, visit http://www.ampainsoc.org/awards/ccoe.htm.
Interstitial
Cystitis Association Announces ICA Pilot
Research Program Awards
Click here for more information about the grant program. Incentive
Grants for Serving Patients with Pain
Management Central-Nervous-System
Intersections of Drug Addiction, Chronic
Pain, and Analgesia Research topics of interest include but are not limited to
For
more information, visit Exploratory
Studies in the Neurobiology of Pain in
Sickle Cell Disease (R01)
The following are examples of research that might be proposed under this program. The following are examples and this list is not meant to be inclusive:
For
more information, visit http://grants.nih.gov/grants/guide/rfa-files/RFA-HL-09-008.html
Save
the Date for an Exciting 2009 Meeting
in San Diego!
Plan
ahead to attend the APS 28th Annual Meeting
May 7-9, 2009, in San
Diego also offers an array of world-class
family attractions such as Register early and save! Click here for more meeting details as they become available. For more information about San Diego, visit the San Diego Convention and Visitors Bureau Web site at www.sandiego.org, or call 619/236-1212.
New
APS Paperless Membership Directory In addition to the online directory, APS has traditionally published a printed directory. This year, in APS's continuing efforts to be environmentally and fiscally responsible, we have created a print-optional directory, which is posted online. The print-optional directory is a searchable PDF, which is located in the members-only section of the APS Web site. The PDF allows you to access member information in several ways. The alphabetical section of the membership directory lists the preferred mailing addresses, e-mail addresses, and phone numbers of members. Members also can be located by professional discipline/medical specialty and geographical location. You then can refer to the alphabetical listing for complete information about a specific member. The directory includes important APS information, such as officer, board, committee, and staff listings. It also features details about special interest groups (SIGS) and regional sections. In addition, you will find contact information and profiles for our 30 corporate members. If having a printed directory is useful to you, you can simply choose to print this PDF document by clicking on "Print" once you're inside the file. This valuable tool is perfect for locating fellow healthcare professionals and specialists who are committed to advancing pain-related research, education, treatment, and professional practice. Its purpose is to encourage networking among members. Please note that the PDF document features data that were pulled in July 2008. Only the "live" directory reflects the most up-to-date membership information. To login in to the members-only section of the APS Web site, please enter your Web ID and password. For first-time visitors, use your member number and last name to login. If you need help logging on, contact APS member services at 847/375-4715. We hope that you will access both directories for your needs.
A new link on the APS Web site allows you to easily e-mail colleagues and friends with information about the benefits of APS membership. Take this opportunity to help us grow! As APS grows, so does its effectiveness at influencing perceptions on pain and pain management and its ability to continue to provide an outstanding array of benefits. You'll be able to add as many e-mail addresses as you wish and can customize the message for your colleagues. Tell them why you're an APS member-and why they should be, too. Recipients will receive information and links to the Web site and a reminder about the 2009 Annual Scientific Meeting, to be held May 7-9, 2009, in San Diego. You can access this option by going to the APS home page and clicking on the "Tell a Colleague About APS" link on the bottom left-hand side. Thank you for your input!
Mayo
Clinics Says Smoking, Gender Have Impact
On Pain Therapy Troops
Reportedly Popping More Painkillers American
Academy of Orthopedic Surgeons Issues
New Treatment Guidelines for Carpal Tunnel
Syndrome End-of-Life
Discussions With Physicians May Have Benefits
For Patients and Caregivers Click here to read more pain-related news in the media. |
November
to continue the process of implementing
the strategic plan. The board reviewed
goals and 2009 priorities in the areas
of research, education, treatment, and
advocacy. To achieve those priorities,
the board approved the purchase of tools
to bolster grassroots advocacy efforts
and member engagement. The charge for
the APS Membership Task Force was approved;
the task force will review critical elements
of membership including benefits, communication,
recruitment, and retention.
members'
advisory meeting. Bob Saner summarized
the efforts of the Pain Care Coalition
in Washington and talked about the future
of legislative initiatives under a new
administration. Jerry Gebhart presented
The Journal of Pain editor's and
publisher's reports. The board also approved
the formation of a research advocacy task
force to study pain research issues at
the National Institutes of Health, Department
of Defense, and Veterans 
Administration.
2008
(volume 9, number 11).
Early
Diagnosis, and Treatment Options
Implications
for the Mechanism of the Coexistance Between
PTSD and Chronic Pain 
beautiful
temperate San Diego, CA. With its 70 miles
of beaches, championship golf courses,
deal-laden shopping outlets, and award-winning
restaurants, San Diego is the ideal location
to network with colleagues after garnering
current information about pain diagnosis,
treatment, and management from cutting-edge
researchers and clinicians.
the
San Diego Zoo and Wild Animal Park, Sea
World San Diego, and LEGOLAND California.
|
American
Pain Society
| 4700 W. Lake Avenue | Glenview, IL 60025-1485
847/375-4715 | Fax: 877/734-8758 | info@ampainsoc.org |