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2| 2009 TxPAIN Annual Report
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
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
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
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
UT MD Anderson Cancer Center Weatherford, TX
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
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
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
Brenda McCoy, PhD
University of North Texas
College of Public Affairs & Community Advisors
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
Anne K. Moore, LMSW
Texans for Compassionate Care American Pain Foundation
Midland, TX Mary Bennett, MFA
Dennis Pabis, PharmD, BCPP
King Pharmaceuticals American Cancer Society
San Antonio, TX Rebecca Kirch, JD
National Government Relations Department
4| 2009 TxPAIN Annual Report
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
To Helen Ross Petty for her design and creative services.
To Endo Pharmaceuticals and Cephalon, Inc. for funding support.
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
2009 TxPAIN Annual Report| 5
The Texas Pain Advocacy & Information
The Texas Pain Advocacy and Information Network (TxPAIN) is an active
multidisciplinary volunteer collaboration involving more than twenty
members and organizations representing healthcare professionals,
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
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
For more information about the Alliance of State Pain Initiatives:
Call—(608) 265-4013, email email@example.com, or visit online at www://
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
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
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 firstname.lastname@example.org. This publication also is
available for download at the following web locations.
American Cancer Society—www.cancer.org/texaspain
2009 TxPAIN Annual Report| 7
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
Status: Did not pass this session.
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
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
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
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
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
Nurse Oncology Education Program
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
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
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
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
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
These resources are available at www.poep.org.
2009 TxPAIN Annual Report| 11
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
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
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.
12| 2009 TxPAIN Annual Report
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
Texas Pain Society
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
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
Annual pain symposium in conjunction with Texas Tech University Health
2009 TxPAIN Annual Report| 13
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
Presented a half day pain-related lecture at the Texas Society of Anesthesiology
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
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.
14| 2009 TxPAIN Annual Report
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.
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
By the Numbers
Activity Audience Location Readership/
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
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
NOEP Pain and Palliative Care Conferences Nurses 247
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
ASPMN-Alamo Chapter Program—Hypnosis & Pain Nurses San Antonio 14
ASPMN-Alamo Chapter Program—Regional Nerve
Nurses San Antonio 9
16| 2009 TxPAIN Annual Report
Activity Audience Location Readership/
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
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
POEP/UTHSC San Antonio--Cancer Pain Control and
Physicians Laredo 90
POEP 11th Annual Symposia: ―What Primary Care
Physicians Need to Know‖ Pain Management Panel Physicians Austin 126
NCI Office of International Affairs Distribution of Texas
Multidisciplinary International 10
Interlink Healthcare Communications Shared TxPAIN
Multidisciplinary Nationwide Unk.
POEP/Texas Health Presbyterian Hospital--Barriers to
Multidisciplinary Plano 21
Effective Pain Management Presentation
2009 TxPAIN Annual Report| 17
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.
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
& Scholarship, The University of Texas at
Tyler College of Nursing & Health Sciences
18| 2009 TxPAIN Annual Report
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
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
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
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/
20| 2009 TxPAIN Annual Report
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
Mayday Pain & Society
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.
Senior Vice President, Federation of State Medical
Boards, Dallas, Texas
Scott Strassels, PharmD, PhD, BCPS
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
Inside back cover intentionally left blank.
2009 TxPAIN Annual Report| 23
Contact Karen Torges
P.O. Box 149054
Austin, Texas 78714-9054
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