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Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne P, Zador V. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (NY) 2018; 14:177-211. [PMID: 29735382 DOI: 10.1016/j.explore.2018.02.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
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Affiliation(s)
- Heather Tick
- Departments of Family Medicine, Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kenneth R Pelletier
- Department of Medicine, University of California School of Medicine, San Francisco, CA
| | - Robert Bonakdar
- Department of Pain Management, Scripps Center for Integrative Medicine, La Jolla, CA
| | | | - Ronald Glick
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Emily Ratner
- MedStar Health, Institute for Innovation, Integrative Medicine Initiatives, MedStar Montgomery Medical Center, Washington, DC
| | - Russell L Lemmon
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Veronica Zador
- Beaumont Hospital Integrative Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
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152
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Martin SR, Zeltzer LK. Prioritizing pediatric chronic pain and comprehensive pain treatment in the context of the opioid epidemic. Pain Manag 2018; 8:67-70. [PMID: 29451426 DOI: 10.2217/pmt-2017-0072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sarah R Martin
- Pediatric Pain & Palliative Care Program, Division of Pediatric Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA
| | - Lonnie K Zeltzer
- Pediatric Pain & Palliative Care Program, Division of Pediatric Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA
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153
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Richeimer SH. Perspective: Filling the Educational Void. PAIN MEDICINE 2018; 19:223-224. [DOI: 10.1093/pm/pnx215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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154
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Changing Prescribing Behavior in the United States: Moving Upstream in Opioid Prescription Education. Clin Pharmacol Ther 2018; 103:982-989. [DOI: 10.1002/cpt.1015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/08/2017] [Accepted: 01/04/2018] [Indexed: 11/07/2022]
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155
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Barreveld AM, Griswold T. A National Imperative: Multimodal Pain Education Reform in US Medical Schools. PAIN MEDICINE 2018; 19:415-416. [DOI: 10.1093/pm/pnx337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Antje M Barreveld
- Department of Anesthesiology, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Todd Griswold
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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156
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The effectiveness of online pain resources for health professionals: a systematic review with subset meta-analysis of educational intervention studies. Pain 2018; 159:631-643. [DOI: 10.1097/j.pain.0000000000001146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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157
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Murphy L, Lax L, Musa R, Langlois S, Kanofsky S, Hunter J, Kumbhare D, Promislow S, Oskarsson J, Davies R, Cockburn L, Barry M, Bjelajac Mejia A, Lanca J, Dao T, Watt-Watson J, Stevens B. Mapping of pain curricula across health professions programs at the University of Toronto. Can J Pain 2018; 2:182-190. [PMID: 35005378 PMCID: PMC8730574 DOI: 10.1080/24740527.2018.1479841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Laura Murphy
- Department of Pharmacy, University Health Network , Toronto, Ontario, Canada
| | - Leila Lax
- Biomedical Communications, Institute of Medical Science, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Renata Musa
- University of Toronto Centre for the Study of Pain, University of Toronto , Toronto, Ontario, Canada
| | - Sylvia Langlois
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Sharona Kanofsky
- Physician Assistant Program, University of Toronto , Toronto, Ontario, Canada
| | - Judith Hunter
- Department of Physical Therapy, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Dinesh Kumbhare
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto , Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network , Toronto, Ontario, Canada
| | - Sara Promislow
- University of Toronto Centre for the Study of Pain, University of Toronto , Toronto, Ontario, Canada
| | - Jon Oskarsson
- University of California San Francisco, Zuckerberg San Francisco General , San Francisco, California, USA
| | - Robyn Davies
- Department of Physical Therapy, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
- Bridgepoint Health, Sinai Health System , Toronto, Ontario, Canada
| | - Lynn Cockburn
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Maureen Barry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada
| | | | - Jose Lanca
- Faculty of Dentistry, University of Toronto , Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Thuan Dao
- Faculty of Dentistry, University of Toronto , Toronto, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada
| | - Bonnie Stevens
- University of Toronto Centre for the Study of Pain, University of Toronto , Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto , Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
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158
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Compton WM, Jones CM, Stein JB, Wargo EM. Promising roles for pharmacists in addressing the U.S. opioid crisis. Res Social Adm Pharm 2017; 15:910-916. [PMID: 29325708 DOI: 10.1016/j.sapharm.2017.12.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
Abstract
Overdoses of prescription or illicit opioids claimed the lives of 116 Americans each day in 2016, and the crisis continues to escalate. As healthcare systems evolve to address the crisis, the potential of pharmacists to make a positive difference is significant. In addition to utilizing available prescription drug monitoring programs to help prevent diversion of opioids, practicing pharmacists can be alert for signs of opioid misuse by patients (e.g., multiple prescriptions from different physicians) as well as inappropriate prescribing or hazardous drug combinations that physicians may not be aware of (e.g., opioid analgesics combined with benzodiazepines). They can also supply patients with information on risks of opioids, proper storage and disposal of medications, and the harms (and illegality) of sharing medications with other people. Increasingly, pharmacies are sites of distribution of the opioid antagonist naloxone, which has been shown to save lives when made available to opioid users and their families or other potential bystanders to an overdose; and pharmacists can provide guidance about its use and even legal protections for bystanders to an overdose that customers may not be aware of. Pharmacists can also recommend addiction treatment to patients and be a resource for information on addiction treatment options in the community. As addiction treatment becomes more integrated with general healthcare, pharmacies are also increasingly dispensing medications like buprenorphine and, in the future, possibly methadone. Pharmacists in private research labs and at universities are helping to develop the next generation of addiction treatments and safer, non-addictive pain medications; they can also play a role in implementation research to enhance the delivery of addiction interventions and medications in pharmacy settings. Meanwhile, pharmacists in educational settings can promote improved education about the neurobiology and management of pain and its links to opioid misuse and addiction.
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Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
| | - Christopher M Jones
- Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Jack B Stein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Eric M Wargo
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
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159
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Clauw DJ, D'Arcy Y, Gebke K, Semel D, Pauer L, Jones KD. Normalizing fibromyalgia as a chronic illness. Postgrad Med 2017; 130:9-18. [PMID: 29256764 DOI: 10.1080/00325481.2018.1411743] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.
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Affiliation(s)
- Daniel J Clauw
- a Department of Anesthesiology , University of Michigan , Ann Arbor , MI , USA
| | - Yvonne D'Arcy
- b Pain Management Nurse Practitioner , Ponte Vedra Beach , FL , USA
| | - Kevin Gebke
- c Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | | | | | - Kim D Jones
- f Schools of Nursing & Medicine , Oregon Health & Science University , Portland , OR , USA
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160
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Colleary G, O’Sullivan K, Griffin D, Ryan C, Martin D. Effect of pain neurophysiology education on physiotherapy students’ understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: a randomised controlled trial. Physiotherapy 2017; 103:423-429. [DOI: 10.1016/j.physio.2017.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/10/2017] [Indexed: 10/19/2022]
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161
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Young HW, Tyndall JA, Cottler LB. The current utilization and perceptions of prescription drug monitoring programs among emergency medicine providers in Florida. Int J Emerg Med 2017; 10:16. [PMID: 28421563 PMCID: PMC5395509 DOI: 10.1186/s12245-017-0140-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is among the most commonly treated symptoms in the emergency department, and opioids are commonly prescribed from the emergency department to treat moderate to severe pain. Prescription drug monitoring programs (PDMP) can be used to assist physicians identify individuals at increased risk to misuse or abuse opioids. While the use of the PDMP has been shown useful among clinicians, in the past, utilization of the PDMP has been less than optimal. The objective of this study was to assess the current utilization and perceptions of the prescription drug monitoring program among emergency medicine providers in Florida. METHODS A survey assessing the utilization and perception of Florida's prescription drug monitoring program was distributed to emergency medicine providers in Florida over a 5 week period. Attending physicians, physicians in training, and extenders from a variety of practice types were assessed. RESULTS A total of 88 surveys were completed. Over two thirds (67%) of the respondents were male. The majority of respondents were attending physicians (62%), 13 (14%) were residents, and 21 (23%) were extenders. Nearly all (99%) were aware of Electronic-Florida Online Reporting of Controlled Substance Evaluation Program (EFORCSE) and 84% had registered accounts. More than 2/3 (73%) reported feeling pressured to prescribe opioids, and 70% reported receiving no formal education on identifying individuals at increased risk of opioid misuse. Approximately half (51%) reported that they used EFORCSE only when they suspect the patient may misuse the medication, 21% reported that they rarely used EFORCSE, and only 3% reported using PDMP every time that they prescribed opioids. Residents used PDMP less frequently than extenders and attending physicians. The most common barriers associated with PDMP use were related to access. CONCLUSIONS Although most providers reported that they were aware of their states' PDMP, utilization of the PDMP among emergency medicine providers in Florida remains low. Low utilization was associated with barriers to access. If further enhancements to PDMPs can be made to improve accessibility, then rates of PDMP utilization may increase.
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Affiliation(s)
- Henry W. Young
- Department of Emergency Medicine, University of Florida, 1329 SW 16th Street, PO Box 100186, Gainesville, FL 32610-0186 USA
| | - Joseph A. Tyndall
- Department of Emergency Medicine, University of Florida, 1329 SW 16th Street, PO Box 100186, Gainesville, FL 32610-0186 USA
| | - Linda B. Cottler
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, PO Box 100231, Gainesville, FL 32610-0231 USA
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162
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Nooromid MJ, Mansukhani NA, Deschner BW, Moradian S, Issa N, Ho KJ, Stulberg JJ. Surgical interns: Preparedness for opioid prescribing before and after a training intervention. Am J Surg 2017; 215:238-242. [PMID: 29179909 DOI: 10.1016/j.amjsurg.2017.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/20/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Exposure to pain management curriculum in medical school is currently variable. This paper reports on formal prescribing education, self-perceived prescribing readiness, and prescribing practices among incoming surgical residents before and after a pain management training session. METHODS Pre-residency survey of thirty surgical interns at a single urban medical center, followed by a repeat survey after an educational session on prescription writing and opioid abuse. RESULTS Thirty-three percent of respondents had formal education on prescription writing in medical school. Median subjective preparedness to write an opioid prescription was 1.5 (range 1-10) on a 1-10 Likert scale. Ranges of morphine milligram equivalents (MME) prescribed varied from 420-2700 MME for 8 mock surgical scenarios. Post-training, median subjective preparedness increased to 3.5 (range 1-6) and prescription accuracy (the inclusion of a medication, dose, frequency, and duration) improved from 75% to 97% (p < 0.001). Overall, 90% of interns found the training session useful. CONCLUSION Most surgical interns were not trained in prescribing narcotics in medical school. Improved pain management curriculum is necessary to assure safe and consistent opioid prescriptions.
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Affiliation(s)
| | | | | | - Simon Moradian
- Department of Surgery, Northwestern University, Chicago, IL, USA.
| | - Nabil Issa
- Department of Surgery, Northwestern University, Chicago, IL, USA.
| | - Karen J Ho
- Department of Surgery, Northwestern University, Chicago, IL, USA.
| | - Jonah J Stulberg
- Department of Surgery, Northwestern University, Chicago, IL, USA.
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163
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Eaton LH, Langford DJ, Meins AR, Rue T, Tauben DJ, Doorenbos AZ. Use of Self-management Interventions for Chronic Pain Management: A Comparison between Rural and Nonrural Residents. Pain Manag Nurs 2017; 19:8-13. [PMID: 29153296 DOI: 10.1016/j.pmn.2017.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/27/2022]
Abstract
Individuals with chronic pain who live in rural communities often lack access to pain specialists and rely on primary care providers who may be less prepared. Research has indicated that rural residents with chronic pain are more likely to receive an opioid prescription than nonrural residents. Although self-management approaches are available for chronic pain management, it is unclear to what extent rural residents use these interventions. This study compares usage of self-management interventions and opioid-based analgesics for chronic pain management between rural and nonrural residents. This study is a secondary analysis of baseline data from a randomized controlled trial evaluating a telehealth intervention for chronic pain management. Participants, recruited from primary care clinics, were 65 rural residents and 144 nonrural residents with similar demographic characteristics. Differences in the use of self-management interventions, pain intensity, and opioid dose were evaluated between rural and nonrural residents. Rural residents (n = 50, 77%) were less likely to use self-management interventions compared with nonrural residents (n = 133, 92%) (p = .019). Opioids were taken for pain relief by 76% of the rural residents compared with 52% of the nonrural residents. A disparity exists in the use of self-management interventions for chronic pain management by rural residents compared with nonrural residents. Further study is needed to determine if this is related to the lack of access to specialists and/or pain management training of primary care providers. Nurses can play an essential role in addressing this disparity by educating patients about self-management interventions.
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Affiliation(s)
- Linda H Eaton
- School of Nursing, University of Washington, Seattle, Washington.
| | - Dale J Langford
- School of Medicine, University of Washington, Seattle, Washington
| | - Alexa R Meins
- School of Nursing, University of Washington, Seattle, Washington
| | - Tessa Rue
- School of Nursing, University of Washington, Seattle, Washington
| | - David J Tauben
- School of Medicine, University of Washington, Seattle, Washington
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164
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Abstract
America is in the midst of an opioid epidemic characterized by aggressive prescribing practices, highly prevalent opioid misuse, and rising rates of prescription and illicit opioid overdose-related deaths. Medical and lay public sentiment have become more cautious with respect to prescription opioid use in the past few years, but a comprehensive strategy to reduce our reliance on prescription opioids is lacking. Addressing this epidemic through reductions in unnecessary access to these drugs while implementing measures to reduce demand will be important components of any comprehensive solution. Key supply-side measures include avoiding overprescribing, reducing diversion, and discouraging misuse through changes in drug formulations. Important demand-side measures center around educating patients and clinicians regarding the pitfalls of opioid overuse and methods to avoid unnecessary exposure to these drugs. Anesthesiologists, by virtue of their expertise in the use of these drugs and their position in guiding opioid use around the time of surgery, have important roles to play in reducing patient exposure to opioids and providing education about appropriate use. Aside from the many immediate steps that can be taken, clinical and basic research directed at understanding the interaction between pain and opioid misuse is critical to identifying the optimal use of these powerful pain relievers in clinical practice.
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Affiliation(s)
- David J Clark
- From the *Department of Anesthesiology, Stanford University, Palo Alto, California; and †UCSF Department of Anesthesia and Perioperative Care, Division of Pain Medicine, San Francisco, California
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165
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Hoppe JA, McStay C, Sun BC, Capp R. Emergency Department Attending Physician Variation in Opioid Prescribing in Low Acuity Back Pain. West J Emerg Med 2017; 18:1135-1142. [PMID: 29085548 PMCID: PMC5654885 DOI: 10.5811/westjem.2017.7.33306] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Despite treatment guidelines suggesting alternatives, as well as evidence of a lack of benefit and evidence of poor long-term outcomes, opioid analgesics are commonly prescribed for back pain from the emergency department (ED). Variability in opioid prescribing suggests a lack of consensus and an opportunity to standardize and improve care. We evaluated the variation in attending emergency physician (EP) opioid prescribing for patients with uncomplicated, low acuity back pain (LABP). Methods This retrospective study evaluated the provider-specific proportion of LABP patients discharged from an urban academic ED over a seven-month period with a prescription for opioids. LABP was strictly defined as (1) back pain chief complaint, (2) discharged from ED with no interventions, and (3) predefined discharge diagnosis of back pain. We excluded providers if they had less than 25 LABP patients in the study period. The primary outcome was the physician-specific proportion of LABP patients discharged with an opioid analgesic prescription. We performed a descriptive analysis and then risk standardized prescribing proportion by adjusting for patient and clinical characteristics using hierarchical logistic regression. Results During the seven-month study period, 23 EPs treated and discharged at least 25 LABP patients and were included. Eight (34.8%) were female, and six (26.1%) were junior attendings (≤ 5 years after residency graduation). There were 943 LABP patients included in the analysis. Provider-specific proportions ranged from 3.7% to 88.1% (mean 58.4% [SD +/− 22.2]), and we found a 22-fold variation in prescribing proportions. There was a six-fold variation in the adjusted, risk-standardized prescribing proportion with a range from 12.0% to 78.2% [mean 50.4% (SD +/−16.4)]. Conclusion We found large variability in opioid prescribing practices for LABP that persisted after adjustment for patient and clinical characteristics. Our findings support the need to further standardize and improve adherence to treatment guidelines and evidence suggesting alternatives to opioids.
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Affiliation(s)
- Jason A Hoppe
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Christopher McStay
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
| | - Benjamin C Sun
- Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon
| | - Roberta Capp
- University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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166
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Comer L. Content analysis of chronic pain content at three undergraduate medical schools in Ontario. Can J Pain 2017; 1:75-83. [PMID: 35005343 PMCID: PMC8730565 DOI: 10.1080/24740527.2017.1337467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/23/2017] [Accepted: 05/30/2017] [Indexed: 11/02/2022]
Abstract
Background: It has been well documented that interdisciplinary, comprehensive pain education can foster positive pain beliefs among medical students, in addition to improving students' abilities to diagnose and treat pain. Though some work has been done to quantify the number of hours of pain education students receive, the content itself has received little attention. Aims: This study seeks to identify what medical students learn about chronic pain throughout an undergraduate medical degree program in Ontario. Methods: Three undergraduate medical schools in Ontario were selected on the basis of variety in curricular structure and instructional methods. Written documents comprising the formal curriculum were analyzed through qualitative and quantitative content analysis. These findings were compared with promising practices from the pain education literature. Results: The three curricula studied here dedicate the bulk of pain education to three topics: pain mechanisms, pain management, and opioids and addiction. The curricula vary considerably in organization of content and hours of pain training. All three curricula were found to contain negative pain beliefs that characterize pain patients as difficult, overwhelming, and unrewarding to work with. Two of the medical schools studied here do not have a pain curriculum. Conclusions: The results of this study indicate a need for medical schools to develop comprehensive, interdisciplinary pain curricula. Though increasing the number of hours of pain training is crucial, equally imperative is a consideration of what, and how, students learn about pain.
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167
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McCarberg B, D'Arcy Y, Parsons B, Sadosky A, Thorpe A, Behar R. Neuropathic pain: a narrative review of etiology, assessment, diagnosis, and treatment for primary care providers. Curr Med Res Opin 2017; 33:1361-1369. [PMID: 28422517 DOI: 10.1080/03007995.2017.1321532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neuropathic pain (NeP) is a distinct type of chronic pain that is a direct result of damage to the nervous system itself. Studies have shown that training on the topic of chronic pain in medical schools is lacking and many practitioners are not confident in their ability to effectively manage patients with such pain. AIMS The purpose of this narrative review is to provide a brief high-level overview of NeP for primary healthcare providers that includes a discussion of mechanisms, prevalence, burden, assessment, and treatment. The information provided here should help primary care providers better understand this type of chronic pain.
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Affiliation(s)
- Bill McCarberg
- a University of California San Diego , San Diego , CA , USA
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168
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Webster F, Bremner S, Oosenbrug E, Durant S, McCartney CJ, Katz J. From Opiophobia to Overprescribing: A Critical Scoping Review of Medical Education Training for Chronic Pain. PAIN MEDICINE (MALDEN, MASS.) 2017; 18:1467-1475. [PMID: 28371881 PMCID: PMC5914373 DOI: 10.1093/pm/pnw352] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic pain is a significant health problem strongly associated with a wide range of physical and mental health problems, including addiction. The widespread prevalence of pain and the increasing rate of opioid prescriptions have led to a focus on how physicians are educated about chronic pain. This critical scoping review describes the current literature in this important area, identifying gaps and suggesting avenues for further research starting from patients' standpoint. METHODS A search of the ERIC, MEDLINE, and Social Sciences Abstracts databases, as well as 10 journals related to medical education, was conducted to identify studies of the training of medical students, residents, and fellows in chronic noncancer pain. RESULTS The database and hand-searches identified 545 articles; of these, 39 articles met inclusion criteria and underwent full review. Findings were classified into four inter-related themes. We found that managing chronic pain has been described as stressful by trainees, but few studies have investigated implications for their well-being or ability to provide empathetic care. Even fewer studies have investigated how educational strategies impact patient care. We also note that the literature generally focuses on opioids and gives less attention to education in nonpharmacological approaches as well as nonopioid medications. DISCUSSION The findings highlight significant discrepancies between the prevalence of chronic pain in society and the low priority assigned to educating future physicians about the complexities of pain and the social context of those afflicted. This suggests the need for better pain education as well as attention to the "hidden curriculum."
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Affiliation(s)
- Fiona Webster
- Institute of Health Policy Management and Evaluation and Wilson Centre for Education Research, University of Toronto, Toronto, ON, Canada
| | - Samantha Bremner
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Oosenbrug
- Department of Psychology, York University, Toronto, ON, Canada
| | - Steve Durant
- Institute of Health Policy Management and Evaluation and Wilson Centre for Education Research, University of Toronto, Toronto, ON, Canada
| | | | - Joel Katz
- Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
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169
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Darnall BD, Carr DB, Schatman ME. Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility. PAIN MEDICINE (MALDEN, MASS.) 2017; 18:1413-1415. [PMID: 27425187 PMCID: PMC5914334 DOI: 10.1093/pm/pnw166] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Daniel B Carr
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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170
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Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain. Pain Res Manag 2017; 2017:1365910. [PMID: 28831278 PMCID: PMC5555017 DOI: 10.1155/2017/1365910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/02/2017] [Accepted: 05/24/2017] [Indexed: 11/18/2022]
Abstract
Aim To examine medical practices and training needs of Québec family physicians with respect to pain management and opioid prescription for chronic noncancer pain (CNCP). Methodology An online survey was carried out in 2016. Results Of 636 respondents (43.0% men; 54.3% ≥ 50 years old), 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly/somewhat agree), dependence (73.2%), and lack of support (75.4%) were the main barriers reported. Only 19.7% always/often screened their patients for risks of abuse and dependence using a screening tool. About two-thirds of participants (65.7%) had recently (last five years) taken part in continuing education programs on opioid use for CNCP and 73.4% on CNCP management. Patient evaluation and differential diagnoses of chronic pain syndromes were rated as a top priority for further training. Conclusions This study provides insights into Québec family physicians' concerns, practices, and needs with respect to the management of CNCP. Physicians' difficulties around the application of strategies to mitigate the problem of opioid abuse and addiction are worrying. The need to better train physicians in the field of pain and addiction cannot be emphasized enough.
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171
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Helmerhorst GTT, Teunis T, Janssen SJ, Ring D. An epidemic of the use, misuse and overdose of opioids and deaths due to overdose, in the United States and Canada. Bone Joint J 2017; 99-B:856-864. [DOI: 10.1302/0301-620x.99b7.bjj-2016-1350.r1] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/15/2017] [Indexed: 11/05/2022]
Abstract
The United States and Canada are in the midst of an epidemic of the use, misuse and overdose of opioids, and deaths related to overdose. This is the direct result of overstatement of the benefits and understatement of the risks of using opioids by advocates and pharmaceutical companies. Massive amounts of prescription opioids entered the community and were often diverted and misused. Most other parts of the world achieve comparable pain relief using fewer opioids. The misconceptions about opioids that created this epidemic are finding their way around the world. There is particular evidence of the increased prescription of strong opioids in Europe. Opioids are addictive and dangerous. Evidence is mounting that the best pain relief is obtained through resilience. Opioids are often prescribed when treatments to increase resilience would be more effective. Cite this article: Bone Joint J 2017;99-B:856–64.
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Affiliation(s)
| | - T. Teunis
- University Medical Center Utrecht, Heidelberglaan
100, 3584 CX Utrecht, The
Netherlands
| | - S. J. Janssen
- Onze Lieve Vrouwe Gasthuis, Oosterpark
9, 1091 AC Amsterdam, The
Netherlands
| | - D. Ring
- The University of Texas at Austin, 1912
Speedway, Austin, Texas, 78712, USA
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172
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Hadi MA, Alldred DP, Briggs M, Marczewski K, Closs SJ. 'Treated as a number, not treated as a person': a qualitative exploration of the perceived barriers to effective pain management of patients with chronic pain. BMJ Open 2017; 7:e016454. [PMID: 28606909 PMCID: PMC5541634 DOI: 10.1136/bmjopen-2017-016454] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify barriers to effective pain management encountered by patients with chronic pain within the UK's National Health Service (NHS). DESIGN Secondary analysis of face-to-face, semistructured qualitative interviews using thematic analysis. SETTING A community-based chronic pain clinic jointly managed by a nurse and pharmacist located in the North of England. PARTICIPANTS Nineteen adult (>18 years) patients with chronic pain discharged from a pain clinic, with the ability to understand and speak the English language. RESULTS In general, patients were highly disappointed with the quality of pain management services provided both within primary and secondary care, and consequently were willing to seek private medical care. Barriers to effective pain management were divided into two main themes: healthcare professional-related and health systems-related. Three subthemes emerged under healthcare professionals-related barriers, namely (1) healthcare professionals' lack of interest and empathy, (2) general practitioners' (GP) lack of specialised knowledge in pain management and (3) lack of communication between healthcare professionals. Three subthemes emerged under health system-related barriers: (1) long waiting time for appointments in secondary care, (2) short consultation times with GPs and (3) lack of an integrated multidisciplinary approach. CONCLUSIONS The patients expressed a clear desire for the improved provision and quality of chronic pain management services within the NHS to overcome barriers identified in this study. An integrated holistic approach based on a biopsychosocial model is required to effectively manage pain and improve patient satisfaction. Future research should explore the feasibility, effectiveness and cost-effectiveness of integrated care delivery models for chronic pain management within primary care.
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Affiliation(s)
| | | | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK
- Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
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173
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Hanley K, Zabar S, Altshuler L, Lee H, Ross J, Rivera N, Marvilli C, Gillespie C. Opioid vs nonopioid prescribers: Variations in care for a standardized acute back pain case. Subst Abus 2017; 38:324-329. [DOI: 10.1080/08897077.2017.1319894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kathleen Hanley
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Sondra Zabar
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Lisa Altshuler
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Hillary Lee
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Jasmine Ross
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Nicomedes Rivera
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Christian Marvilli
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
| | - Colleen Gillespie
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, New York, USA
- Research on Medical Education Outcomes (ROMEO) Unit, Program for Medical Education Innovation and Research (PrMEIR), NYU School of Medicine, New York, New York, USA
- Institute for Innovations in Medical Education, NYU School of Medicine, New York, New York, USA
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174
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Bradshaw YS, Patel Wacks N, Perez-Tamayo A, Myers B, Obionwu C, Lee RA, Carr DB. Deconstructing One Medical School’s Pain Curriculum: II. Partnering with Medical Students on an Evidence-Guided Redesign. PAIN MEDICINE 2017; 18:664-679. [DOI: 10.1093/pm/pnw340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bradshaw YS, Patel Wacks N, Perez-Tamayo A, Myers B, Obionwu C, Lee RA, Carr DB. Deconstructing One Medical School's Pain Curriculum: I. Content Analysis. PAIN MEDICINE 2017; 18:655-663. [PMID: 28122938 DOI: 10.1093/pm/pnw293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Inventory one medical school's first- and second-year pain-related curriculum in order to explore opportunities to teach about pain both as a social, population-based process and as a neuron-centered phenomenon. Design Deconstruction of pain-related curricular content through a detailed content inventory and analysis by students and faculty. Setting and Subjects University-affiliated US medical school. Methods Detailed inventory and content analysis of first- and second-year curricular materials. Results The inventory of pain content showed fragmentation, mostly presenting it as a symptom without an underlying framework. Conclusion Analysis of one medical school's pain-related curricular materials reveals opportunities for a more unified perspective that includes pain as a widespread disease state (not merely a symptom) and to provide an emphasis in the curriculum consistent with pain's public health burden.
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Affiliation(s)
- Ylisabyth S Bradshaw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Neha Patel Wacks
- Department of Family Medicine and Community Health, University of Massachusetts, Amherst, Massachusetts, USA
| | - Alejandra Perez-Tamayo
- Department of Surgery, University of Vermont School of Medicine, Burlington, Vermont, USA
| | - Brenden Myers
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA
| | - Chukwueloka Obionwu
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rebecca A Lee
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Daniel B Carr
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Barth KS, Guille C, McCauley J, Brady KT. Targeting practitioners: A review of guidelines, training, and policy in pain management. Drug Alcohol Depend 2017; 173 Suppl 1:S22-S30. [PMID: 28363316 PMCID: PMC5555357 DOI: 10.1016/j.drugalcdep.2016.08.641] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 01/03/2023]
Abstract
This paper reviews the current literature on clinical guidelines, practitioner training, and government/payer policies that have come forth in response to the national rise in prescription opioid overdoses. A review of clinical opioid prescribing guidelines highlights the need for more research on safe and effective treatment options for chronic pain, improved guidance for the best management of post-operative pain, and evaluation of the implementation and impact of guideline recommendations on patient risk and outcomes. Although there is increasing attention to training in pain management in medical schools and medical residency programs, educational opportunities remain highly variable, and the need for additional clinician training in the recognition and treatment of pain as well as opioid use disorder has been recognized. Mandated use of private, federal and state educational and clinical initiatives such as Risk Evaluation and Mitigation Strategies (REMS) and Prescription Drug Monitoring Programs (PDMPs) generally increase utilization of these initiatives, but more research is needed to determine the impact of these initiatives on provider behaviors, treatment access, and patient outcomes. Finally, there is an acute need for more research on safe and effective treatments for chronic pain as well as an increased multi-level focus on improving training and access to evidence-based treatment for opioid use disorder as well as non-pharmacologic and non-interventional chronic pain treatments, so that these guideline-recommended interventions can become mainstream, accessible, first-line interventions for chronic pain and/or opioid use disorders.
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Affiliation(s)
- Kelly S Barth
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Jenna McCauley
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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178
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Loeser JD, Schatman ME. Chronic pain management in medical education: a disastrous omission. Postgrad Med 2017; 129:332-335. [PMID: 28276788 DOI: 10.1080/00325481.2017.1297668] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- John D Loeser
- a Department of Neurological Surgery , University of Washington , Seattle , WA , USA
| | - Michael E Schatman
- b Department of Public Health and Community Medicine , Tufts School of Medicine , Boston , MA , USA
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179
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Alvarez AG, Dal Sasso GTM, Iyengar MS. Persuasive technology in teaching acute pain assessment in nursing: Results in learning based on pre and post-testing. NURSE EDUCATION TODAY 2017; 50:109-114. [PMID: 28039801 DOI: 10.1016/j.nedt.2016.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/13/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Thousands of patients seek health services every day with complaints of pain. However, adequate pain assessment is still flawed, a fact that is partly related to gaps in professional learning on this topic. Innovative strategies such as the use of a virtual learning object mediated by persuasive technology in the learning of undergraduate nursing students can help to fill these gaps and to provide different ways of learning to learn. OBJECTIVE To evaluate the results in learning among undergraduate nursing students about assessment of acute pain in adults and newborns, before and after an online educational intervention. DESIGN This is a quasi-experimental, non-equivalent study using pre-and post-testing. SETTING Federal University of Santa Catarina, Brazil. PARTICIPANTS 75 undergraduate nursing students. METHODS Our study was conducted in three steps (pre-test, education intervention, post-test). Data were collected from November 2013 to February 2014. The educational intervention was performed using online access to virtual learning object about acute pain assessment, which students accessed on their mobile devices. CONCLUSION A significant difference was seen in student learning (p<0.001) in the post-test compared with the pre-test results. The students understood the importance of the topic, and were satisfied and motivated by the technology and method applied. The use of persuasive technology such as small mobile devices as mediators of online educational interventions broadens learning spaces in an innovative, flexible, motivational, and promising manner.
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Affiliation(s)
- Ana Graziela Alvarez
- Federal University of Santa Catarina, Postal Box: 5057, 88040-900 Florianópolis, SC, Brazil.
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180
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Abstract
The introduction of pain medicine (cross-sectional subject 14, QF 14) into the Human Medicine study program is a great opportunity. A knowledge gap concerning the treatment of pain patients outside of specialized pain centers has been recognized for many years. This gap might be closed or at least reduced by a compulsory curriculum in pain medicine. If implementation of new lessons for QF 14 is not possible, pain medicine could be represented by labelled elements in the existing curriculum, in order to highlight the field. The core curriculum must now be converted into appropriate teaching and test formats. Due to the autonomy and heterogeneity of German medical faculties, no uniform solution will be achieved. In contrast, this diversity and the entirely new implementation of the cross-sectional subject will allow structured evaluation of different teaching and examination formats with respect to teaching outcome in benchmarking investigations in the coming semesters. Practically experienced lecturers and theory-driven medical educationalists are called upon to get involved with the development, implementation, and evaluation of pain medicine in undergraduate education in Germany. Teaching enthusiasts are encouraged to dedicate themselves to the strenuous, but stimulating task of implementing QF 14. The Deutsche Schmerzgesellschaft (German Pain Society) will offer support for this.
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Affiliation(s)
- A Kopf
- Klinik für Anästhesiologie mit Schwerpunkt Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12202, Berlin, Deutschland.
| | - M Dusch
- Klinik für Anästhesiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, Hannover, 30625, Deutschland
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181
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Stanos S, Brodsky M, Argoff C, Clauw DJ, D'Arcy Y, Donevan S, Gebke KB, Jensen MP, Lewis Clark E, McCarberg B, Park PW, Turk DC, Watt S. Rethinking chronic pain in a primary care setting. Postgrad Med 2017; 128:502-15. [PMID: 27166559 DOI: 10.1080/00325481.2016.1188319] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings.
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Affiliation(s)
- Steven Stanos
- a Swedish Pain Services , Swedish Health System , Seattle , WA , USA
| | - Marina Brodsky
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
| | - Charles Argoff
- c Department of Neurology , Albany Medical Center , Albany , NY , USA
| | - Daniel J Clauw
- d Department of Anesthesiology , The University of Michigan , Ann Arbor , MI , USA
| | | | - Sean Donevan
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
| | - Kevin B Gebke
- f Department of Family Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Mark P Jensen
- g Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Evelyn Lewis Clark
- h Warrior Centric Health, LLC , Rutgers Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Bill McCarberg
- i University of California San Diego , San Diego , CA , USA
| | - Peter W Park
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
| | - Dennis C Turk
- j Department of Anesthesiology and Pain Medicine , University of Washington , Seattle , WA , USA
| | - Stephen Watt
- b Global Medical Affairs , Pfizer Inc ., New York , NY , USA
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182
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Ruan X, Labrie-Brown C, Kaye AD. Are transdermal opioids contraindicated in patients at risk of suicide? Eur J Anaesthesiol 2017; 34:39-40. [PMID: 27164017 DOI: 10.1097/eja.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Xiulu Ruan
- From the Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, Louisiana, USA
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183
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Midgley M. Mitigating the prescription drug abuse epidemic. J Healthc Risk Manag 2017; 36:16-20. [PMID: 28099791 DOI: 10.1002/jhrm.21265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Focused attention on the prescription drug abuse epidemic needs to include evidence-based training for clinicians who manage patients with pain to facilitate accurate screening with consideration of comorbid conditions, diagnosis, selection of the appropriate treatment regimen, and focused monitoring of adherence to the established course of therapy. DEA licensure requirements need to be amended to mandate targeted training focused on pain medication upon initial application and renewal of license. A nationwide mandated real-time dispenser database that requires verification every time a clinician prescribes opioids and other key controlled substances should be a top priority.
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184
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Alford DP, Zisblatt L, Ng P, Hayes SM, Peloquin S, Hardesty I, White JL. SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program. PAIN MEDICINE 2016; 17:52-63. [PMID: 26304703 PMCID: PMC4718419 DOI: 10.1111/pme.12878] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. METHOD Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. SUBJECTS The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. RESULTS Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. CONCLUSIONS The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain.
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Affiliation(s)
- Daniel P. Alford
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Lara Zisblatt
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Pamela Ng
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Sean M. Hayes
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Sophie Peloquin
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Ilana Hardesty
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Julie L. White
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
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185
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Coyne KS, Currie BM, Donevan S, Cappelleri JC, Hegeman-Dingle R, Abraham L, Thompson C, Sadosky A, Brodsky M. Discriminating between neuropathic pain and sensory hypersensitivity using the Chronic Pain Questions (CPQ). Postgrad Med 2016; 129:22-31. [DOI: 10.1080/00325481.2017.1267538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Sean Donevan
- Global Medical Affairs, Pfizer Inc, New York, NY, USA
| | | | | | - Lucy Abraham
- Outcomes & Evidence, Global Health & Value, Pfizer Ltd, Tadworth, UK
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186
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Anderson DR, Zlateva I, Coman EN, Khatri K, Tian T, Kerns RD. Improving pain care through implementation of the Stepped Care Model at a multisite community health center. J Pain Res 2016; 9:1021-1029. [PMID: 27881926 PMCID: PMC5115680 DOI: 10.2147/jpr.s117885] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Treating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center. METHODS The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention) cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. RESULTS Providers' pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009). There was no significant change in opioid prescribing. CONCLUSION Implementation of the SCM-PM resulted in clinically significant improvements in several quality of pain care outcomes. These findings, if sustained, may translate into improved patient outcomes.
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Affiliation(s)
| | - Ianita Zlateva
- Weitzman Institute, Community Health Center, Inc., Middletown
| | - Emil N Coman
- UCONN Health Disparities Institute, University of Connecticut, Farmington
| | - Khushbu Khatri
- Weitzman Institute, Community Health Center, Inc., Middletown
| | - Terrence Tian
- Weitzman Institute, Community Health Center, Inc., Middletown
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Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners. Pain 2016; 158:278-288. [DOI: 10.1097/j.pain.0000000000000755] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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188
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Barry DT, Cutter CJ, Beitel M, Kerns RD, Liong C, Schottenfeld RS. Psychiatric Disorders Among Patients Seeking Treatment for Co-Occurring Chronic Pain and Opioid Use Disorder. J Clin Psychiatry 2016; 77:1413-1419. [PMID: 27574837 PMCID: PMC6296217 DOI: 10.4088/jcp.15m09963] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 12/01/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Psychiatric comorbidities complicate treatment of patients with chronic pain and opioid use disorder, but the prevalence of specific comorbid psychiatric disorders in this population has not been systematically investigated. METHODS 170 consecutive participants entering a treatment research program for co-occurring chronic pain and opioid use disorder between March 2009 and July 2013 were evaluated with the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/P) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). RESULTS The prevalence of any lifetime (and current) comorbid Axis I disorder was 91% (75%); 52% met criteria for lifetime anxiety disorder (48% current), 57% for lifetime mood disorder (48% current), and 78% for lifetime nonopioid substance use disorder (34% current). Common current anxiety diagnoses were posttraumatic stress disorder (21%), generalized anxiety disorder (16%), and panic disorder without agoraphobia (16%). Common current mood diagnoses were major depressive disorder (40%) and dysthymia (11%). A majority of patients had a personality disorder (52%). CONCLUSIONS High rates and persistence of co-occurring psychiatric disorders, including anxiety or mood disorders, may explain in part the difficulty providers have treating patients with co-occurring opioid use disorder and chronic pain and suggest possible targets for improving treatment. TRIAL REGISTRATION ClinicalTrials.gov identifiers: buprenorphine/naloxone treatment (NCT00634803), opioid treatment program-based methadone maintenance treatment (NCT00727675).
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Affiliation(s)
- Declan T. Barry
- Yale University School of Medicine, New Haven, CT 06519 USA,The APT Foundation Pain Treatment Services, New Haven, CT 06519 USA
| | - Christopher J. Cutter
- Yale University School of Medicine, New Haven, CT 06519 USA,The APT Foundation Pain Treatment Services, New Haven, CT 06519 USA
| | - Mark Beitel
- Yale University School of Medicine, New Haven, CT 06519 USA,The APT Foundation Pain Treatment Services, New Haven, CT 06519 USA
| | - Robert D. Kerns
- Yale University School of Medicine, New Haven, CT 06519 USA,VA Connecticut Healthcare System, West Haven, CT 06516 USA
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189
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Madaus SM, Lim LS. Teaching Pain Management in Interprofessional Medical Education: A Review of Three Portal of Geriatric Online Education Modules. J Am Geriatr Soc 2016; 64:2122-2125. [PMID: 27590678 DOI: 10.1111/jgs.14309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic pain is an international healthcare crisis that affects an estimated 1.5 billion individuals worldwide, but pain management is not emphasized in the medical school curriculum, and thus supplemental education is essential. The Portal of Geriatric Online Education (POGOe) is a free repository of teaching modules for use by geriatric educators and learners. This article highlights three teaching modules available on this site: It's My Old Back Again: An Approach to Diagnosing and Managing Back Pain in the Older Adult (POGOe ID: 21670), Computer Based Learning Workbook, Third Edition module on Pain Management (POGOe ID: 21036), and Aging Q3 Curriculum on Pain Management of Older Adult Patients (POGOe ID: 21187). These modules were chosen based on their ability to address the major topics that the International Association for the Study of Pain proposes should be included in medical school curricula: mulitdimensional nature of pain, pain assessment and measurement, management of pain, and clinical conditions resulting in pain in older adults. They were also selected for their ability to be adapted for interprofessional education and how well they integrate basic science and clinical principles.
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Affiliation(s)
- Stacy M Madaus
- University of Medicine and Health Sciences, New York, New York
| | - Lionel S Lim
- Department of Internal Medicine, Griffin Hospital, Derby, Connecticut. .,Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut. .,Department of Medicine, School of Medicine, Quinnipiac University, North Haven, Connecticut.
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190
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Schoneboom BA, Perry SM, Barnhill WK, Giordano NA, Wiltse Nicely KL, Polomano RC. Answering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health. Nurs Outlook 2016; 64:459-84. [DOI: 10.1016/j.outlook.2016.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/23/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
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191
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Carr EC, Watt-Watson J, McGillion M, Huizinga A. The quest of pain education leaders in Canada and the United States: a qualitative study. J Adv Nurs 2016; 72:2728-2737. [DOI: 10.1111/jan.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Judy Watt-Watson
- Faculty of Nursing (Lawrence S. Bloomberg); University of Toronto; Ontario Canada
| | - Michael McGillion
- Heart and Stroke Foundation/Michael G. DeGroote Chair in Cardiovascular Nursing; School of Nursing; McMaster University; Hamilton Ontario Canada
| | - Anne Huizinga
- Faculty of Nursing; University of Calgary; Alberta Canada
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192
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Alford DP, Carney BL, Brett B, Parish SJ, Jackson AH. Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination. J Grad Med Educ 2016; 8:390-7. [PMID: 27413443 PMCID: PMC4936858 DOI: 10.4300/jgme-d-15-00273.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/22/2015] [Accepted: 01/18/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing. OBJECTIVE To describe a safe opioid prescribing education program utilizing an objective structured clinical examination (OSCE) and report the resulting impact on residents' knowledge, confidence, and self-reported practices. METHODS Using a quasi-experimental design, 39 internal medicine residents from an urban academic medical center were assigned to 1 of 4 groups: 1-hour lecture only, lecture followed by immediate OSCE, lecture followed by 4-month delayed OSCE, and control. Safe opioid prescribing knowledge, confidence, and self-reported practices were assessed at baseline and at 8 months. RESULTS At 8 months, knowledge, confidence, and self-reported practices improved in the control and in all 3 intervention groups. The immediate OSCE group had the greatest improvements in combined confidence scores within group (0.74, P = .01) compared to controls (0.52, P = .05), using a 5-point scale. This group also had the greatest improvement in self-reported practice changes (1.04, P = .04), while other groups showed nonsignificant improvements-delayed OSCE (0.43, P = .44), lecture only (0.66, P = .24), and control (0.43, P = .19). CONCLUSIONS Safe opioid prescribing education that includes a lecture immediately followed by an OSCE had an impact on residents' confidence and self-reported practices greater than those for delayed OSCE or lecture only groups. There was no difference in knowledge improvement among the groups. Lecture followed by an OSCE was highly regarded by residents, but required additional resources.
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Affiliation(s)
- Daniel P. Alford
- Corresponding author: Daniel P. Alford, MD, MPH, Boston University School of Medicine, Clinical Addiction Research and Education Unit, Department of Medicine, Section of General Internal Medicine, 2nd Floor, 801 Massachusetts Avenue, Boston, MA 02118-2393, 617.414.3747, fax 617.414.4676,
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193
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Poon SJ, Nelson LS, Hoppe JA, Perrone J, Sande MK, Yealy DM, Beeson MS, Todd KH, Motov SM, Weiner SG. Consensus-Based Recommendations for an Emergency Medicine Pain Management Curriculum. J Emerg Med 2016; 51:147-54. [PMID: 27369855 DOI: 10.1016/j.jemermed.2016.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/28/2015] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Increased prescribing of opioid pain medications has paralleled the subsequent rise of prescription medication-related overdoses and deaths. We sought to define key aspects of a pain management curriculum for emergency medicine (EM) residents that achieve the balance between adequate pain control, limiting side effects, and not contributing to the current public health opioid crisis. METHODS We convened a symposium to discuss pain management education in EM and define the needs and objectives of an EM-specific pain management curriculum. Multiple pertinent topics were identified a priori and presented before consensus work. Subgroups then sought to define perceived gaps and needs, to set a future direction for development of a focused curriculum, and to prioritize the research needed to evaluate and measure the impact of a new curriculum. RESULTS The group determined that an EM pain management curriculum should include education on both opioid and nonopioid analgesics as well as nonpharmacologic pain strategies. A broad survey is needed to better define current knowledge gaps and needs. To optimize the impact of any curriculum, a modular, multimodal, and primarily case-based approach linked to achieving milestones is best. Subsequent research should focus on the impact of curricular reform on learner knowledge and patient outcomes, not just prescribing changes. CONCLUSIONS This consensus group offers a path forward to enhance the evidence, knowledge, and practice transformation needed to improve emergency analgesia.
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Affiliation(s)
- Sabrina J Poon
- Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lewis S Nelson
- New York University School of Medicine, New York, New York
| | - Jason A Hoppe
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret K Sande
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael S Beeson
- Department of Emergency Medicine, Akron General Medical Center, Akron, Ohio
| | - Knox H Todd
- Department of Emergency Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Sergey M Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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194
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Erickson JM, Brashers V, Owen J, Marks JR, Thomas SM. Effectiveness of an interprofessional workshop on pain management for medical and nursing students. J Interprof Care 2016; 30:466-74. [PMID: 27268513 DOI: 10.3109/13561820.2016.1159185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Interprofessional (IP) care is critical for effective pain management, but evidence is lacking about the best way to teach pain management skills to medical and nursing students using IP strategies. In 2013 and 2014, 307 medical and 169 nursing students participated in an IP case-based pain management workshop. The aims of this study were to determine (1) if students who participate in IP case-based learning groups will have improved pain management skills compared to students who participate in uniprofessional case-based learning groups, and (2) if students mentored by faculty with IP training will have improved pain management skills compared to students who are not mentored by IP-trained faculty. Student learning was assessed and compared using scored checklists for each group's pain management plans. Findings show that IP mentorship and IP group participation improved medical students' pain management skills but did not have the same effect on nursing student performance. Continued work is needed to develop, refine, and integrate innovative and tailored IP strategies into the curricula of medical and nursing schools to advance the pain management competencies of students before they enter clinical practice.
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Affiliation(s)
- Jeanne M Erickson
- a College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | - Valentina Brashers
- b Schools of Medicine and Nursing , University of Virginia , Charlottesville , Virginia , USA
| | - John Owen
- b Schools of Medicine and Nursing , University of Virginia , Charlottesville , Virginia , USA
| | - Jennifer R Marks
- c Keck School of Medicine , University of Southern California , Los Angeles , California , USA
| | - Shannon M Thomas
- b Schools of Medicine and Nursing , University of Virginia , Charlottesville , Virginia , USA
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195
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Davis CS, Carr D. Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug Alcohol Depend 2016; 163:100-7. [PMID: 27137406 DOI: 10.1016/j.drugalcdep.2016.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The opioid overdose epidemic in the United States is driven in large part by inappropriate opioid prescribing. Although most American physicians receive little or no training during medical school regarding evidence-based prescribing, substance use disorders, and pain management, some states require continuing medical education (CME) on these topics. We report the results of a systematic legal analysis of such requirements, together with recommendations for improved physician training. METHODS To determine the presence and characteristics of CME requirements in the United States, we systematically collected, reviewed, and coded all laws that require such education as a condition of obtaining or renewing a license to practice medicine. Laws or regulations that mandate one-time or ongoing training in topics designed to reduce overdose risk were further characterized using an iterative protocol RESULTS Only five states require all or nearly all physicians to obtain CME on topics such as pain management and controlled substance prescribing, and fewer than half require any physicians to obtain such training. CONCLUSIONS While not a replacement for improved education in medical school and post-graduate clinical training, evidence-based CME can help improve provider knowledge and practice. Requiring physicians to obtain CME that accurately presents evidence regarding opioid prescribing and related topics may help reduce opioid-related morbidity and mortality. States and the federal government should also strongly consider requiring such training in medical school and residency.
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Affiliation(s)
- Corey S Davis
- Network for Public Health Law-Southeastern Region, 101 E. Weaver St. #G-7, Carrboro, NC 27510, United States.
| | - Derek Carr
- Network for Public Health Law-Southeastern Region, 101 E. Weaver St. #G-7, Carrboro, NC 27510, United States.
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Katzman JG, Fore C, Bhatt S, Greenberg N, Griffin Salvador J, Comerci GC, Camarata C, Marr L, Monette R, Arora S, Bradford A, Taylor D, Dillow J, Karol S. Evaluation of American Indian Health Service Training in Pain Management and Opioid Substance Use Disorder. Am J Public Health 2016; 106:1427-9. [PMID: 27196642 DOI: 10.2105/ajph.2016.303193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined the benefits of a collaboration between the Indian Health Service and an academic medical center to address the high rates of unintentional drug overdose in American Indians/Alaska Natives. In January 2015, the Indian Health Service became the first federal agency to mandate training in pain and opioid substance use disorder for all prescribing clinicians. More than 1300 Indian Health Service clinicians were trained in 7 possible 5-hour courses specific to pain and addiction. We noted positive changes in pre- and postcourse knowledge, self-efficacy, and attitudes as well as thematic responses showing the trainings to be comprehensive, interactive, and convenient.
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Affiliation(s)
- Joanna G Katzman
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Chris Fore
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Snehal Bhatt
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Nina Greenberg
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Julie Griffin Salvador
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - George C Comerci
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Christopher Camarata
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Lisa Marr
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Rebecca Monette
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Sanjeev Arora
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Andrea Bradford
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Denise Taylor
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Jenny Dillow
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
| | - Susan Karol
- Joanna G. Katzman is with the Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque. Christopher Fore is with the Indian Health Service (IHS), Telebehavioral Health Center of Excellence, Albuquerque, NM. Snehal Bhatt and Julie Griffin Salvador are with the Department of Psychiatry, UNM School of Medicine. Nina Greenberg is with the Mathematics and Statistics Department, UNM. George C. Comerci and Lisa Marr are with the Department of Internal Medicine, UNM School of Medicine. Christopher Camarata is with the Department of Family Medicine, UNM School of Medicine. Rebecca Monette, Sanjeev Arora, and Andrea Bradford are with Project ECHO (Extension for Community Healthcare Outcomes), UNM School of Medicine. Denise Taylor is with the Department of Pediatrics, UNM School of Medicine. Jenny Dillow is with the Department of Anesthesia, UNM School of Medicine. Susan Karol is with IHS, US Health and Human Services, Rockville, MD
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Kolber BJ, Janjic JM, Pollock JA, Tidgewell KJ. Summer undergraduate research: A new pipeline for pain clinical practice and research. BMC MEDICAL EDUCATION 2016; 16:135. [PMID: 27142616 DOI: 10.1186/s12909-016
-0648-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/20/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Most medical schools fail to provide adequate training of clinicians in the treatment of pain. Similarly, despite the fact that over 1/3 of Americans suffer from chronic pain, National Institutes of Health (NIH) funding for pain represents only ~1% of the NIH budget. These issues may dissuade students from pursing pain in their clinical and research careers. To address these gaps in training and funding, we argue that exposing students to pain science early in their careers, at the undergraduate level, may be an effective method to develop a pipeline for future pain clinicians and scientists. To highlight our argument, we will describe our recent successful implementation of a cross-disciplinary and community-engaged biomedical summer research program. The Pain Undergraduate Research Experience (PURE) summer program involved both off-site and on-site experiences to expose undergraduate students to the range of careers in the pain field from basic science to clinical practice. The objective of the 10-week long PURE program was to evaluate whether a combination of basic science research, clinical practice visits, and patient interactions would increase student understanding of and exposure to the underlying science of pain. METHODS A pre-post cohort study was used without a comparison group. Entry and exit surveys were used to evaluate students' perceptions about pain clinical practice and research, student interest in pain, and student confidence about communicating about pain and doing basic science pain research. RESULTS Students reported significant increases to a number of questions in the survey. Questions were scored on 5 point Likert scales and there was significant increases in student understanding of what life is like with chronic pain (2.6 vs 4.3 post survey), their confidence in explaining pain to a patient (2.8 vs 4.1) or researcher (2.8 vs 4), and their comfort with pain terminology(2.8 vs 3.9). CONCLUSIONS With the PURE program, we wanted to entice top undergraduates to consider pain as a future area of study, practice, and/or research. We present a model that can be easily implemented at research universities throughout the United States.
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Affiliation(s)
- Benedict J Kolber
- Department of Biological Sciences, Bayer School of Natural and Environmental Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
| | - Jelena M Janjic
- Graduate School of Pharmaceutical Sciences, Mylan School of Pharmacy, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
| | - John A Pollock
- Department of Biological Sciences, Bayer School of Natural and Environmental Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
| | - Kevin J Tidgewell
- Graduate School of Pharmaceutical Sciences, Mylan School of Pharmacy, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
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198
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Kolber BJ, Janjic JM, Pollock JA, Tidgewell KJ. Summer undergraduate research: A new pipeline for pain clinical practice and research. BMC MEDICAL EDUCATION 2016; 16:135. [PMID: 27142616 PMCID: PMC4855323 DOI: 10.1186/s12909-016-0648-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/20/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Most medical schools fail to provide adequate training of clinicians in the treatment of pain. Similarly, despite the fact that over 1/3 of Americans suffer from chronic pain, National Institutes of Health (NIH) funding for pain represents only ~1% of the NIH budget. These issues may dissuade students from pursing pain in their clinical and research careers. To address these gaps in training and funding, we argue that exposing students to pain science early in their careers, at the undergraduate level, may be an effective method to develop a pipeline for future pain clinicians and scientists. To highlight our argument, we will describe our recent successful implementation of a cross-disciplinary and community-engaged biomedical summer research program. The Pain Undergraduate Research Experience (PURE) summer program involved both off-site and on-site experiences to expose undergraduate students to the range of careers in the pain field from basic science to clinical practice. The objective of the 10-week long PURE program was to evaluate whether a combination of basic science research, clinical practice visits, and patient interactions would increase student understanding of and exposure to the underlying science of pain. METHODS A pre-post cohort study was used without a comparison group. Entry and exit surveys were used to evaluate students' perceptions about pain clinical practice and research, student interest in pain, and student confidence about communicating about pain and doing basic science pain research. RESULTS Students reported significant increases to a number of questions in the survey. Questions were scored on 5 point Likert scales and there was significant increases in student understanding of what life is like with chronic pain (2.6 vs 4.3 post survey), their confidence in explaining pain to a patient (2.8 vs 4.1) or researcher (2.8 vs 4), and their comfort with pain terminology(2.8 vs 3.9). CONCLUSIONS With the PURE program, we wanted to entice top undergraduates to consider pain as a future area of study, practice, and/or research. We present a model that can be easily implemented at research universities throughout the United States.
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Affiliation(s)
- Benedict J Kolber
- Department of Biological Sciences, Bayer School of Natural and Environmental Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
| | - Jelena M Janjic
- Graduate School of Pharmaceutical Sciences, Mylan School of Pharmacy, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
| | - John A Pollock
- Department of Biological Sciences, Bayer School of Natural and Environmental Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA
| | - Kevin J Tidgewell
- Graduate School of Pharmaceutical Sciences, Mylan School of Pharmacy, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
- Chronic Pain Research Consortium, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15219, USA.
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199
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Lynch M. The Opioid Pendulum and the Need for Better Pain Care. PAIN MEDICINE 2016; 17:1215-1219. [PMID: 27142390 DOI: 10.1093/pm/pnw085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary Lynch
- Department of Anesthesia, Pain Medicine, Perioperative Care and Psychiatry and Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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200
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Grigson PS. Addiction: A preclinical and clinical analysis. Brain Res Bull 2016; 123:1-4. [PMID: 27005437 PMCID: PMC5676458 DOI: 10.1016/j.brainresbull.2016.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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