TxPAIN 09 Annual Report


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TxPAIN 09 Annual Report

  1. 1. annual 2009 ANNUAL REPORT Texas Pain Advocacy & Information Network
  2. 2. Inside front cover intentionally left blank. 2| 2009 TxPAIN Annual Report
  3. 3. A Word from the Chair Looking forward from where we have come and glancing back in the rearview mirror, the view is good. Our history of proactive collaboration in awareness, education, public policy, research and clinical care has enabled significant accomplishments by TxPAIN members and our partners, and set the stage for even greater progress ahead. Our greatest resource has been, and remains, our people, with bright minds and compassionate hearts for those people who live with and suffer from pain. TxPAIN demonstrates how a diverse group of people representing medicine, nursing, pharmacy, government, industry, academia and advocacy, can work together with a common agenda and purpose—helping other people. Our members have worked tirelessly across the state and the nation to raise awareness about the public health problem of inadequate pain treatment. Several have been interviewed Larry C. Driver, MD, TxPAIN Chair and quoted in local, regional and national publications and media outlets. We have written and published essays and articles in Professor, Department of Anesthesiology newspapers and magazines, as well as scholarly journals. We have and Pain Medicine, The University of Texas M.D. Anderson Cancer Center given testimony to the President’s Council on Bioethics, the Food and Houston Drug Administration, the Texas Legislature and the Texas Medical Board. We have been involved in crafting legislation to improve pain care for Texans, and continue to advocate for inclusion of pain issues in national health care agenda. Our members serve as leaders in the American Pain Foundation, Texas Pain Society, American Society for Pain Management Nursing, and Texas’s Nurse and Physician Oncology Education Programs. We contributed to the American Medical Association Pain Summit regarding the future of physician pain education and training, along with the National Pharmacy Pain Summit to improve pain education of pharmacists. Our members helped found the American Pain Society’s Special Interest Group on pain education, as well as the American Academy of Pain Medicine’s Subcommittee on Pain Education. We contribute to shaping and planning state and national meetings of the Texas Pain Society, Texas Medical Association, American Academy of Pain Medicine, and Alliance of State Pain Initiatives. Our affiliation with the Alliance of State Pain Initiatives, and active partnerships with the American Cancer Society and Lance Armstrong Foundation is a model for bringing together people from diverse backgrounds, organizations, interests and skills focused on a singular goal—helping people living with pain to have access to effective pain care. TxPAIN remains at the forefront to advocate, educate, and shape public policy about pain and its relief because of our people, and the people we are committed to serving. We have done much of which to be proud, but many opportunities remain ahead. Looking forward, to where we are going, the view is outstanding! 2009 TxPAIN Annual Report| 3
  4. 4. 2009 Steering Committee Krisha Cook. RN, BS, OCN Helen Ross Petty American Cancer Society Texas Network of Youth Services National Cancer Information Center Austin, TX Austin, TX Kris Robinson, PhD, FNP-bc, RN Krista Crockett University of Texas at El Paso Texas Pain Society School of Nursing Austin, TX El Paso, TX Larry Driver, MD, Chair Linda Schickedanz, RN, MSN, CNS leadership UT MD Anderson Cancer Center Weatherford, TX Houston, TX Beverly Shaw Kristi Dover, PharmD American Cancer Society Purdue Pharma L.P. National Cancer Information Center Colleyville, TX Austin, TX Gloria J. Duke, PhD, RN Daniel Still, PharmD, BCPP The University of Texas at Tyler Cephalon, Inc. College of Nursing & Health Sciences San Antonio, TX Tyler, TX Scott Strassels, PharmD, PhD, BCPS Stephanie Gonzalez, MHA University of Texas at Austin Physician Oncology Education Program College of Pharmacy Texas Medical Association Austin, TX Austin, TX Karen Torges Brian Howell, PharmD American Cancer Society Endo Pharmaceuticals Inc. High Plains Division Raleigh, NC Austin, TX Mary Beth Kean, DNP, RN-C, CNS Joni Watson, RN, MSN, OCN Central Texas Veterans Healthcare System Nurse Oncology Education Program Temple, TX Texas Nurses Association/Foundation Austin, TX Brenda McCoy, PhD University of North Texas College of Public Affairs & Community Advisors Service Denton, TX Alliance of State Pain Initiatives Andy Miller, MHSE, CHES June Dahl, PhD Lance Armstrong Foundation University of Wisconsin Austin, TX School of Medicine and Public Health Madison, WI Anne K. Moore, LMSW Texans for Compassionate Care American Pain Foundation Midland, TX Mary Bennett, MFA Baltimore, MD Dennis Pabis, PharmD, BCPP King Pharmaceuticals American Cancer Society San Antonio, TX Rebecca Kirch, JD National Government Relations Department Washington, DC 4| 2009 TxPAIN Annual Report
  5. 5. Acknowledgements We gratefully acknowledge the following for their unflagging support of our work to re- duce the burden of unrelieved pain among Texans. To Dr. June Dahl for her service as a national and international leader in pain policy de- velopment, her leadership of the state pain initiative movement, her dedication to quality, and her tireless advocacy for the person in pain. To Dr. Larry Driver for faithfully leading TxPAIN toward achievement of our mission, his influence that has helped shape the pain policy agenda for this state, his dedication to educating the next generation of physicians, and his ability to engage others in our quest to ensure high quality pain management for all people. To the TxPAIN Steering Committee for their tireless efforts to implement our strategic plan. To Helen Ross Petty for her design and creative services. To Endo Pharmaceuticals and Cephalon, Inc. for funding support. Dedication We wish to dedicate this annual report to Tim Schickedanz, devoted son to Wayne and TxPAIN member, Linda Schickedanz, loving husband to Kate and father of four sons. He was diagnosed with terminal cancer at age 8, but sur- vived to adulthood and beyond. Tim was a dedicated emergency room nurse, volunteer firefighter and EMT, and a decorated veteran of the U.S. Army. Tim lost his second battle with cancer on October 1, 2009. Timothy Scott Schickedanz (1966-2009) 2009 TxPAIN Annual Report| 5
  6. 6. The Texas Pain Advocacy & Information Network The Texas Pain Advocacy and Information Network (TxPAIN) is an active multidisciplinary volunteer collaboration involving more than twenty members and organizations representing healthcare professionals, Texas Pain researchers, educators, and patient advocates. Our mission is to ensure high Advocacy & quality pain management for people of all communities & cultures in Texas Information through public policy initiatives, public awareness campaigns, & patient & Network provider education. For more information about TxPAIN: Visit online at www.cancer.org/texaspain An affiliate of the Alliance of State Pain Initiatives (ASPI), TxPAIN serves as the statewide initiative dedicated to improving pain management for all Texans. The TxPAIN Steering Committee develops strategies and identifies resources to implement its five-year strategic plan outlined in the Texas Action Plan to Relieve Pain. For more information about the Alliance of State Pain Initiatives: Call—(608) 265-4013, email aspi@mailplus.wisc.edu, or visit online at www:// aspi.wisc.edu TxPAIN is supported through the generosity of the American Cancer Society and its High Plains Division, an active member of TxPAIN. For more information about the American Cancer Society: Call toll free—1.800.ACS.2345 or visit online at www.cancer.org 6| 2009 TxPAIN Annual Report mission
  7. 7. The Texas Action Plan to Relieve Pain The Texas Action Plan to Relieve Pain is a five-year strategic plan that speaks to multiple issues and barriers to good pain management. The plan includes strategies and activities addressing public policy, education, advocacy, awareness, media outreach, relieve pain and collaboration. Notably, the plan addresses access to care, disparities in care, and support for implementation as crosscutting issues. TxPAIN’s activities fall within the following strategies. Special consideration is given to both access to care and disparities in care in all TxPAIN actions. I. Public Policy Initiatives for Consumer Protection II. Provider Education and Empowerment III. Advocacy for Better Patient Care IV. Public Awareness and Media Relations V. Law Enforcement and Regulatory Agency Collaboration and Education Details about the Texas Action Plan to Relieve Pain can be found in TxPAIN’s landmark report, ―The Politics of Pain: Balancing Vigilance and Compassion.‖ Single copies of the report are available through the American Cancer Society. Contact Karen Torges at (512) 919-1884 or email ktorges@cancer.org. This publication also is available for download at the following web locations. American Cancer Society—www.cancer.org/texaspain Facebook—http://www.facebook.com/pages/TxPAIN/116372608091 2009 TxPAIN Annual Report| 7
  8. 8. 81st Regular Advocacy Initiatives Texas Legislative Session Summary TxPAIN actively advocates for people with pain to have optimal pain management. As a part of its mission, Senate Bill 904—Williams TxPAIN works to remove or minimize barriers that Authorizes a prescribing practitioner to issue multiple prevent people from receiving optimal care. Our prescriptions authorizing a patient to receive a total of up to studies corroborate national research conducted over a 90-day supply of a Schedule II controlled substance under the past four decades indicating that a primary barrier certain conditions. to optimal pain management in Texas is fear of Status: Signed into law. regulatory and law enforcement scrutiny by healthcare professionals who use controlled substances, in Senate Bill 911—Williams particular opioid medications, for the relief of pain. Establishes a pain management clinic certification and Such fear results in what is known as a ―chilling effect‖ specifies exemptions. Sets out procedures relating to or reluctance to provide state-of-the-science care. inspections, investigations, and certificate application, issuance, expiration, and renewal. Includes provisions Consequently, TxPAIN supports a public policy agenda relating to regulation of persons affiliated with a pain that promotes good pain management and opposes management clinic and to disciplinary action. policies that present barriers or that could have a Status: Signed into law. ―chilling effect‖ on the practitioner’s ability or willingness to use the full array of modalities available Senate Bill 912—Williams for treating pain. Related to the diversion of a controlled substance by those who have access to the substance by virtue of profession or The 81st Regular Texas Legislative Session saw more employment; providing penalties. new pain-related legislation than ever before. The sidebar at left summarizes key information. We Status: Did not pass this session. partner and collaborate with healthcare organizations Senate Bill 1281—Williams and professional associations to pursue public policies Related to fraudulently obtaining a controlled substance from on both the federal and state levels that are conducive a practitioner and providing a penalty. to the relief of pain. These include the American Status: Did not pass this session. Cancer Society, American Society for Pain Management Nursing, American Pain Foundation, House Bill 1107—Christian Lance Armstrong Foundation, Texas Medical Related to licensing advanced practice registered nurses and Association and Texas Pain Society. the authority of those nurses to prescribe certain controlled substances. Status: Did not pass this session. protect House Bill 2730—Kolkhorst Among other things, creates an interagency council to develop a plan to transfer controlled drugs prescription information from the Texas Department of Public Safety to the Board of Pharmacy. Status: Signed into law. 8| 2009 TxPAIN Annual Report
  9. 9. On the federal level, TxPAIN signed on and supported the passage of the National Pain Care Policy Act. The act will help people with pain in four ways; the act: 1. Authorizes an Institute of Medicine Conference on Pain Care; 2. Authorizes a Pain Consortium at the National Institutes of Health; 3. Provides comprehensive pain care education and training for health care professionals; and 4. Institutes a public awareness campaign on pain management. Concerned that recommendations about acetaminophen made by a Food and Drug Administration (FDA) Advisory Committee would have significant adverse effects on the quality of pain management in this country, TxPAIN filed formal comments urging the FDA to reject the following Advisory Committee recommendations:  Removal of opioid/acetaminophen combination products from the market;  Moving the 500mg and 650mg dosage strengths of acetaminophen from nonprescription to prescription only status; and,  Reducing the maximum total daily dose of acetaminophen from 4g to some lower amount, e.g., less than 3g. TxPAIN also is concerned about and is monitoring closely implementation of FDA- mandated Risk Evaluation and Mitigation Strategies (REMS) that are being required for patients, healthcare providers and the pharmaceutical industry. REMS are meant to minimize the risks associated with certain medications including some used to treat pain. While we acknowledge that certain medications used to treat pain have the potential for abuse and diversion for illicit purposes, we believe that the approaches mandated by the FDA have the potential to severely restrict patient access to these important pain relieving drugs. TxPAIN supports a comprehensive approach risk management, one that includes the following:  Pain management education for healthcare professionals beginning in school and perpetuating throughout their careers;  Standardized, generic patient education materials in multiple languages and in culturally appropriate ways;  Improve the ability of healthcare professionals to responsibly formulate, prescribe and provide, and manage indicated pain treatment regimens for their patients;  Beneficial, reasonable and achievable outcomes of access to adequate pain relief balanced with reduced risk of misuse, abuse, overdose and diversion;  Promote standardized public policy so that all Americans have equal access to appropriate and safe pain care based upon consistent statutes, regulations, standards and guidelines; and,  Promote adoption of uniform and universal All Schedules Prescription Electronic Reporting based on the national model. 2009 TxPAIN Annual Report| 9
  10. 10. Nurse Oncology Education Program www.noeptexas.org The Nurse Oncology Education Program (NOEP) is a project of the Texas Nurses Association/Foundation (TNA/F) funded by the Cancer Prevention and Research Institute of Texas. TNA/F is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. The Nurse Oncology Education Program is an active member of TxPAIN. NOEP’s statewide needs assessment conducted September – December 2008, revealed 50% of the 521 respondents stated they needed more pain management education. Nurses can earn 1.0 continuing education contact hours FREE through Nursing Principles of Pain Management, an independent study authored by Linda Schickedanz, RN, MSN, CNS, and developed by the Nurse Oncology Education Program (NOEP). The evidence-based study includes an overview on prevalence of pain in the cancer patient, defines and distinguishes acute and chronic pain, describes nursing assessment of pain, and discusses the pharmacologic and non-pharmacologic management of pain and barriers to pain management. Nurses can earn FREE contact hours through NOEP's new four-part slidecast Every Nurse's Guide to Pain Management. Topics include: an introduction to pain management and nursing assessment, pharmacological and nonpharmacological management of pain, pain management for culturally diverse, elderly, and substance abuse populations, and pain management at the end-of-life and ethics. These resources are available through NOEP at www.noeptexas.org. Mary Beth Kean, DNP, RN-C, CNS, presented Pain Management in Culturally Diverse Groups at the Alliance of State Pain Initiatives: Frontiers in Pain Management conference October 30 – November 1, 2008, in Austin. NOEP also worked collaboratively with Texans for Compassionate Care, TxPAIN, and the American Cancer Society to produce A Common Thread: Clinical and Practical Tools for Supporting Human Resilience, a conference for nurses and social workers with 13.75 contact hours of continuing education with a large portion focusing on pain management. 10| 2009 TxPAIN Annual Report educate
  11. 11. NOEP conducted four Pain Management & Palliative Care conferences with funding from the Lance Armstrong Foundation in Fredericksburg (November 8, 2008), Harlingen (January 17, 2009), Corpus Christi (March 7, 2009), and Lufkin (April 18, 2009). A total of 247 nurses were educated via the four conferences. As of October 6, 2009, NOEP has conducted outcome measurement follow-up with 158 nurses attending the latter three conferences to see if changes in their pain management practices occurred as a direct result of the conference education. 37 nurses, or 23%, responded to the outcome measurement survey sent three months post-conference, indicating they have shared the education with other colleagues formally and informally and have incorporated pieces of the education into their respective practices such as utilization of a pain assessment scale, knowledge of tolerance and dependence to provide appropriate pain management, and utilization of the equianalgesic chart for medication dosage conversion. Physician Oncology Education Program www.poep.org The Texas Medical Association (TMA) formed the Physician Oncology Education Program (POEP) in 1987 to carry out the recommendations of the Texas Cancer Plan regarding physician education. The POEP is funded in large part by the Cancer Prevention and Research Institute of Texas and is directed by a steering committee of experts interested in and knowledgeable about all facets of cancer prevention and control. The POEP has provided more than 100,000 Texas physicians and other professionals with cancer prevention and screening training since its creation. The Physician Oncology Education Program of the Texas Medical Association is an active member of TxPAIN. POEP hosts a Cancer Pain Resource Center for Physicians on its website. The July 2008 issue of Texas Medicine featured a pullout continuing medical education piece. Authored by TxPAIN Chair, Larry Driver, MD; Brian Bruel, MD; and Diane Novy, PhD, the Pain Primer for Primary Physicians: Essential Concepts is accredited for 1.5 AMA PRA Category 1 Credits™, including ethics. More than 220 physicians have completed this activity to date. The article assists physicians in outlining a systematic approach to pain assessment and evaluating outcomes, defines potential adverse outcome issues, summarizes physical and procedural interventions for managing pain, and identifies categories of medications useful for pain management. These resources are available at www.poep.org. 2009 TxPAIN Annual Report| 11
  12. 12. In addition to the Pain Primer for Primary Physicians: Essential Concepts, the POEP Speakers’ Bureau also had three lectures on pain. Greg Guzley, MD, of San Antonio spoke to 90 healthcare professionals on Cancer Pain Control and Management to the University of Texas Health Science Center San Antonio – Laredo Campus Extension. Dr. Guzley also spoke on the Barriers to Effective Pain Management to twenty-one members of the clinical staff at Texas Health Presbyterian Hospital in Plano, Texas. During POEP’s 11th Annual Symposia: ―What Primary Care Physicians Need to Know,‖ Dr. Larry Driver of MD Anderson and Scott Strassels, PharmD of the University of Texas at Austin presented a panel discussion on Pain Management to 126 physicians. Through this active collaboration with the Texas Medical Association and the POEP, TxPAIN is able to extend its reach and message to more than 45,000 physicians across Texas. American Society for Pain Management Nursing Texas Chapters: Alamo Area-San Antonio, North Texas-Dallas/Fort Worth, Houston Area, and Ciudad del Sol-El Paso http://www.aspmn.org The ASPMN was founded in 1990 nurses specializing in pain management. The society’s mission is to advance and promote optimal nursing care for people affected by pain by promoting best nursing practice. This is accomplished through education, standards, advocacy, and research. The organization’s goals address the following critical areas: 1) Access to quality care; 2) Public awareness, 3) Professional resources; 4) Education; and, 5) Professional recognition. In 2009, the ASPMN actively advocated for passage of the National Pain Care Policy Act of 2009, endorsed The Mayday Fund’s A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care, and urged Congress enact and fund a comprehensive set of initiatives to address the national nursing shortage. partnership 12| 2009 TxPAIN Annual Report
  13. 13. There are four ASPMN chapters in Texas—Alamo Area-San Antonio, North Texas-Dallas/ Fort Worth, Houston Area, and Ciudad del Sol-El Paso. Local chapters engage nurses in all fields of practice and create collegial relationships in which individuals can share ideas and concerns. Chapters offer continuing education for nurses and often serve as speakers for programs geared towards patients and families as well as the general public. Texas Pain Society www.texaspain.org Established in 1989 in Houston, the Texas Pain Society (TPS) is dedicated to improving the quality of life of patients in Texas Texas Pain Society who suffer from pain. The society’s mission is to be the organization of pain medicine practitioners in the State of Texas that represents the interests of patients, the public, physicians, and others involved in the care of Texans who suffer from pain. More than 300 pain practitioners are involved in acute and chronic pain management and TPS represents the practice of pain medicine in Texas with a seat on the Texas Medical Association’s House of Delegates. TPS advances the art and science of pain medicine by:  Promoting and maintaining the highest standards of professional practice through education and research in pain;  Aiding and encouraging the education of trainees and practitioners in pain medicine and practitioners in all areas of medicine;  Supporting a scientific pain medicine journal; and,  Legislative and regulatory efforts to advocate patients’ access to care and third party payment for pain treatment and related services. The Texas Pain Society enjoys a close alliance with the Texas Medical Association, American Pain Society, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians and the Texas Pain Advocacy and Information Network. The TPS is also an active co-sponsor of Pain Practice (a quarterly scientific journal dealing with the multidisciplinary aspects of pain) and the Texas Tech University Health Sciences Center Annual Pain Symposium. In 2009, the Texas Pain Society hosted educational symposia and workshops across the state including the following:  Annual half day pain symposium in conjunction with the Texas Medical Association  Annual pain symposium in conjunction with Texas Tech University Health Science Center—Lubbock 2009 TxPAIN Annual Report| 13
  14. 14.  Pain Awareness Month—Partnered with St. David’s Hospital to promote pain awareness to physicians and other medical staff at St. David’s through a grand rounds lecture  Presented a half day pain-related lecture at the Texas Society of Anesthesiology annual meeting  Launched public sale and distribution of the TPS 1st Edition Controlled Substance Record Book. The TPS worked with the Drug Enforcement Agency, Texas Department of Public Safety and Texas Medical Board for approval of the book.  Numerous local chapter and community dinner meetings to discuss pain A landmark for the Texas Pain Society in 2009 included hosting its 1st Annual Scientific Meeting in San Antonio with more than 115 physicians in attendance. In 2009, the Texas Pain Society advocated for the rights of pain patients to have access to quality care by becoming a signatory medical society in the RICO settlement against a major insurance carrier for denials of Sacroiliac joint injections for pain patients. Additionally, the TPS actively engaged the Texas Department of Insurance Division of Workers Compensation (TDIWC) stakeholders meeting providing input on the new proposed closed formulary and the effects it will have on the pain patient community. TPS continues to work closely with elected officials and the Commissioner of Health to rectify these problems. collaboration 14| 2009 TxPAIN Annual Report
  15. 15. Consumer Awareness TxPAIN member, Gloria Duke, PhD, RN, reached out to the Asian-American community in Houston giving presentations about advance directives, end of life care and pain management to The Asian-American Health Coalition and to the Vietnamese group at The Boat People SOS. Since 2006, TxPAIN member Kris Robinson, PhD, FNP-bc, RN, has served as a state leader for the American Pain Foundation’s (APF) Power Over Pain Action Network, a grassroots network of volunteers who are people with pain, caregivers, and healthcare providers. In February 2009, Dr. Robinson was a featured speaker for the APF’s PainAid Chat, an online forum for people with pain and their caregivers. Her presentation focused on Care for the Caregiver. Dr. Robinson also is a regular on an El Paso radio talk show at KTEP and has created and published a YouTube video about her experience as a caregiver of someone with unrelenting chronic pain. advocacy TxPAIN Member, Scott Strassels, PharmD, PhD, BCPS, provided an op-ed published in the Austin American Statesman commenting on the lack of pain management provided to a dying inmate with sickle cell pain. 2009 TxPAIN Annual Report| 15
  16. 16. By the Numbers Attendance/ Activity Audience Location Readership/ Viewership, etc. Austin American Statesman Commentary by TxPAIN General Public Austin 350,000 Member Scott Strassels on Sickle Cell Pain KTEP Radio Show with TxPAIN Member Kris Robinson General Public El Paso 50,000 YouTube Caring for the Person with Chronic Pain by General Public El Paso 270 TxPAIN Member Kris Robinson The Asian-American Health Coalition Presentation by General Public Houston 20 TxPAIN Member Gloria Duke The Boat People SOS Presentation by TxPAIN Member General Public Houston 20 Gloria Duke APF Caring for the Caregiver Live Online Chat w/ Patient/Caregiver Nationwide 30,000 TxPAIN Member Kris Robinson Texas Legislative Appointments by TxPAIN Members Legislators Austin 6 NOEP Online Pain CNE Modules Nurses Statewide 1,010 Fredericksburg, NOEP Pain and Palliative Care Conferences Nurses 247 Harlingen, Corpus NOEP In the Know with NOEP E-News Article—Barriers Nurses Statewide 7,756 to Effective Pain Management at the End of Life UTEP Alternative Methods for Managing Pain Class by Nursing Students El Paso 26 TxPAIN Member Kris Robinson ASPMN-Alamo Chapter Program—Addiction & Pain Nurses San Antonio 16 ASPMN-Alamo Chapter Program—Current Trends in Nurses San Antonio 18 Drug Diversion ASPMN-Alamo Chapter Program—Hypnosis & Pain Nurses San Antonio 14 ASPMN-Alamo Chapter Program—Regional Nerve Nurses San Antonio 9 Blocks 16| 2009 TxPAIN Annual Report
  17. 17. Attendance/ Activity Audience Location Readership/ Viewership, etc. UT Austin College of Pharmacy Interdisciplinary Pain Pharmacy Students Austin 20 and Palliative Care Class El Paso Pain Society Presentations by TxPAIN Member Physicians El Paso 27 Kris Robinson Texas Pain Society (TPS) 1st Annual Scientific Meeting Physicians San Antonio 115 Texas Medicine Journal CME--Pain Primer for Primary Physicians: Essential Concepts authored by TxPAIN Physicians Statewide 220 Member Larry Driver and Others TPS/TMA Annual Half Day Pain Symposium Physicians Austin 100 TPS/Texas Tech University Health Science Center Physicians Lubbock 100 Annual Pain Symposium TPS/St. David's Hospital Grand Rounds Physicians Austin 35 TPS/Texas Society of Anesthesiologists Annual Meeting Physicians San Antonio 50 Lecture POEP/UTHSC San Antonio--Cancer Pain Control and Physicians Laredo 90 Management Presentation POEP 11th Annual Symposia: ―What Primary Care Physicians Need to Know‖ Pain Management Panel Physicians Austin 126 Presentation NCI Office of International Affairs Distribution of Texas Multidisciplinary International 10 Pain Report Interlink Healthcare Communications Shared TxPAIN Multidisciplinary Nationwide Unk. Posters POEP/Texas Health Presbyterian Hospital--Barriers to Multidisciplinary Plano 21 Effective Pain Management Presentation 2009 TxPAIN Annual Report| 17
  18. 18. Contributing to the Body of Knowledge* *Body of knowledge—All that is known… the information, facts, truths and principles learned through time The generation, dissemination, and preservation of knowledge through scholarly research is a noble pursuit. Following are brief summaries of TxPAIN members’ efforts to contribute to the generation of new knowledge about pain, advance professional practice, and further understanding of the barriers presented to people in pain and those who care for them. Nursing Research Duke, et al. (in review). Pain knowledge and attitudes in Baccalaureate nursing students and faculty. Pain Management Nursing. This study emphasized the significant need for not only pain education, but to explore and test different approaches to education that would impact practice. The study reflected that improving knowledge does not translate into effective practice, and also found that having pain knowledge in a curriculum does not equate with having knowledge. Moreover, there were no correlates between personal experiences with pain Gloria Duke, PhD, RN Associate Dean, Office of Nursing Research and knowledge/practice. & Scholarship, The University of Texas at Tyler College of Nursing & Health Sciences 18| 2009 TxPAIN Annual Report research
  19. 19. Kean, M. B. (2009). A comparison of barriers encountered by pain management advance practice nurses in states with and without practice restrictions. (Doctoral dissertation, Texas Christian University). Advance Practice Registered Nurses (APRNs) specializing in pain management face multiple practice barriers. Some of these barriers are common across healthcare disciplines and some are unique to APRNs. This includes state specific scope of practice restrictions particularly related to controlled substance prescriptive authority. This study compares barriers encountered Mary Beth Kean, DNP, RN-BC, CRRN, CNS Clinical Nurse Specialist in Pain Management by pain management APRNs in states with practice restrictions to Central Texas Veterans Healthcare System those in states without restrictions. Study participants were Temple recruited from among APRNs participating on the American Society for Pain Management Nursing (ASPMN) list serv. APRNs from states with practice restrictions identified the lack of prescriptive authority for schedule II-V medications as the most significant barrier, while those in states with fewer restrictions identified lack of time to collect practice outcomes as the number one barrier. Interestingly, lack of pain management education accountability in healthcare providers was the second greatest barrier for both groups. Lack of physician and administrator understanding of APRN scope of practice regulations was third in states with practice restrictions. However, those in states without restrictions did not identify this as one of their top barriers, rather citing the lack of mental health providers to co-manage substance abuse disorders as third (5th among respondents in restrictive states.) Both groups identified reimbursement issues or lack of financial rewards among the top five. Robinson, K., & Monsivais, J. J. (in press). Malingering? No evidence in a primarily Hispanic worker's compensation population. Pain Management Nursing. The purpose of this archival study is to identify malingering in a predominantly Hispanic, worker's compensation population seeking treatment for pain. We used a correlational, archival research design to collect data from the medical records of 91 patients treated over a ten-year period in a specialty clinic. The study sample reflects the ethnicity, educational level, and socioeconomic status of the larger US-Mexico border community. The majority (93%) had worker's compensation and about one- Kris Robinson, PhD, FNP-bc, RN third had active litigation. No one was diagnosed with Associate Professor, Assistant Dean for malingering or pain disorder with primarily psychological Graduate Nursing, Director of Advanced origins. Depression coexisted with chronic pain and patients Practice Programs, The University of Texas at reported serious impairment in physical, occupational, and El Paso School of Nursing social function an average of 5 years after the onset of chronic pain. However, the vast majority of patients returned to work. In our experience, there is no place for the labeling and resultant stigma of malingering in chronic pain sufferers. 2009 TxPAIN Annual Report| 19
  20. 20. Cancer Survivor Study Actively engaging cancer survivors with pain, the American Cancer Society implemented a Pain Education & Empowerment Project through its National Cancer Information Center (NCIC) located in Austin, Texas. From November 2008 through January 2009, Cancer Information Specialists at the NCIC proactively queried callers as to their experience with pain in an attempt to quantify the scope and scale of unresolved pain experienced by survivors. Among the NCIC leadership involved were two TxPAIN members, Beverly Shaw and Krisha Cook, RN, BS, OCN. Key findings of the study from a total of 360 callers from 38 states include the following. 1  65% were experiencing cancer-related pain at Beverly Shaw time of their call, with nearly two-thirds rating Director of Mission Delivery their pain intensity on the 0-10 scale as moderate American Cancer Society (27% rated pain 4-6) or severe (36% rated pain 7 National Cancer Information Center -10). Austin  Of the people who reported moderate or severe pain scores, 53% had either the same or higher levels of pain currently, as compared to 3 days before.  76% of callers said they told their health care team about their pain, but nearly two-thirds of those callers still rated their current pain intensity as moderate (29% rated pain 4-6) or severe (35% rated pain 7-10).  58% of callers who reported pain said the were regularly asked about their pain in clinic visits, but only 55% had ever been asked to describe or rate pain intensity using any type of scale. Krisha Cook, RN, BS, OCN Oncology Nurse Information Specialist American Cancer Society National Cancer Information Center Austin 1 Brawley, O. W., Smith, D. E., & Kirch, R. A. (2009). Taking action to ease suffering: Advancing cancer pain control as a health care priority. CA Cancer J Clin, 59, 285-289. Available online at http://caonline.amcancersoc.org:80/ cgi/content/full/59/5/285 20| 2009 TxPAIN Annual Report
  21. 21. State Pain Initiatives Study The Alliance of State Pain Initiatives (ASPI) endorsed a Masters Degree research project of the state pain initiative movement of Cynthia W. Rodman, a student at the Tufts University School of Medicine in Pain Research, Education and Policy. The study explored insights and perspectives into leadership experiences in a state pain initiative. In-depth qualitative interviews were conducted among a select group of initiative leaders, including members of the ASPI Advisory Council, the ASPI staff and two of our TxPAIN members, Karen Torges and Helen Ross Petty. Findings and recommendations include strengthening the The service you do ASPI as a whole, reinforcing supports for state initiatives, developing or enhancing the for others is the rent right partnerships and providing communications conduits between and among the ASPI you pay for the time and its affiliates. you spend on earth. Mohammed Ali National Pharmacy Pain Summit (1942- ) http://www.siue.edu/pharmacy/pain TxPAIN member, Scott Strassels, PharmD, PhD, BCPS, served as faculty for the Strategic Planning Summit for the Advancement of Pain and Palliative Care Pharmacy held in October at the Southern Illinois University at Edwardsville. Funded by the Mayday Fund, the summit’s ultimate purpose is to improve upon the education of pharmacists and pharmacy students on pain and palliative care across the continuum of a pharmacist's professional life. Dr. Strassels facilitated a working group tasked with identifying key concepts of pain and palliative care education for pharmacists as it relates to the following practice sites: community, long term care, institutional, and ambulatory care. service 2009 TxPAIN Annual Report| 21
  22. 22. Mayday Pain & Society Fellowships Established in 2004 by the Mayday Fund, The Mayday Pain & Society Fellowship is a five-year initiative intended 2005-06 Fellow to increase the pool of experts healthcare professionals, scientists, and legal scholars in the pain management Larry C. Driver, MD community who communicate about pain—the research, Professor in the Department of Anesthesiology and the problems and the solutions. Pain Medicine at The University of Texas M.D. Anderson Cancer Center, Houston, Texas Fellows receive intensive training and five months of coaching in media, policy and leadership. The fellows also have the opportunity to work one-on-one with communications professionals to develop a communications strategy for a goal they choose. Only six fellowships are awarded each year, and TxPAIN is proud to count three of a total of thirty fellows among our most active participants. 2008-09 Fellow Lisa Robin Senior Vice President, Federation of State Medical Boards, Dallas, Texas 2008-09 Fellow Scott Strassels, PharmD, PhD, BCPS honor Assistant Professor of Pharmacy Practice, University of Texas at Austin College of Pharmacy and Adjunct Assistant Professor of Public Health, University of Texas School of Public Health, Austin Regional Campus, Austin, Texas 22| 2009 TxPAIN Annual Report
  23. 23. Inside back cover intentionally left blank. 2009 TxPAIN Annual Report| 23
  24. 24. Texas Pain Advocacy & Information Network Contact Karen Torges P.O. Box 149054 Austin, Texas 78714-9054 (512) 919-1884 ktorges@cancer.org www.cancer.org/texaspain Find us on Facebook http://www.facebook.com/pages/TxPAIN/116372608091