TxPAIN 2008 Annual Report

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TxPAIN 2008 Annual Report

  1. 1. Texas Pain Advocacy & Information Network Annual Report October 2008
  2. 2. Summary “Energy and persistence conquer all things.” -Benjamin Franklin (1706 - 1790) Two years ago, a group of committed individuals and organizations gathered in Austin at the Texas Pain Summit, an historic meeting dedicated to addressing legal regulatory barriers to pain management for the residents of this State. A major goal of the Summit was to foster dialog between healthcare professionals and the state’s licensing and regulatory bodies in order to create a “balanced” regulatory system. Such a system fosters the appropriate medical use of opioid analgesics and other controlled substances that are essential for Larry C. Driver, MD pain control while preventing their diversion and abuse for inappropriate, non- Chairman medical purposes. A year ago, the Texas Pain Summit issued its formal report, The Politics of Pain: Balancing Vigilance and Compassion. The report, containing survey results of Texas households and healthcare practitioners, supporting science and research, and policy-related perspectives, presented a five-year strategic plan for improving pain management for all Texans. The plan conveys strategies that address a full complement of issues and barriers to pain care. Today, the Texas Pain Advocacy and Information Network, also known as TxPAIN, has begun the work of implementing the Texas Action Plan to Relieve Pain. We are proud to present to you our first annual report detailing our progress, our triumphs, our successes, and, yes, even our frustrations over the past year. We also look forward to next, for each New Year brings us closer to our goal, a pain-free future for all Texans. 1 2008 Annual Report
  3. 3. About TxPAIN The Texas Pain Advocacy and Information Network (TxPAIN) is an active multidisciplinary volunteer collaboration Mission involving more than twenty members and organizations representing healthcare Ensure high quality pain management for professionals, researchers, educators, and people of all communities & cultures in Texas patient advocates. An affiliate of the Alliance through public policy initiatives, public of State Pain Initiatives (ASPI), TxPAIN serves awareness campaigns, & patient & provider as the statewide initiative dedicated to improving pain management for all Texans. education The TxPAIN Steering Committee develops strategies and identifies resources to Strategies implement its five-year strategic plan outlined I. Public Policy Initiatives for Consumer in the Texas Action Plan to Relieve Pain. Protection TxPAIN is supported through the generosity of the American Cancer Society High Plains II. Provider Education and Empowerment Division. The American Cancer Society High III. Advocacy for Better Patient Care Plains Division is an active member of TxPAIN. IV. Public Awareness and Media Relations V. Law Enforcement and Regulatory Agency Collaboration and Education Crosscutting Issues Access The Texas Action Plan to Disparities Relieve Pain The Texas Action Plan to Relieve Pain spans a Support full complement of issues and barriers to quality pain management. This multi-faceted, multi-year plan includes public policy initiatives, provider/professional education, advocacy, public awareness, media outreach, and collaboration with law enforcement and regulatory bodies. Importantly, the plan addresses access to care, disparities in care, and support for implementation as crosscutting issues. 2 2008 Annual Report
  4. 4. 2008 Steering Committee Larry C. Driver, MD, Committee Mary Beth Kean, MSN, RN-C, Linda Schickedanz, RN, MSN, Chair CRRN, CNS CNS Professor of Anesthesiology and Pain Clinical Nurse Specialist/Pain Chairman of the Board Medicine Management Texas Partnership for End-of-Life UT MD Anderson Cancer Center Baylor University Medical Center Care Houston Dallas Weatherford Krisha Cook, BS, RN, OCN Brenda McCoy, PhD Scott A. Strassels, PharmD, PhD, Oncology Nurse Information Assistant Professor, Department of BCPS Specialist Sociology Assistant Professor, Pharmacy American Cancer Society University of North Texas Practice National Cancer Information Center College of Public Affairs and University of Texas at Austin College Austin Community Service of Pharmacy Denton Austin Kristi Dover, PharmD Sr. Area Director, Medical Liaisons Andy Miller, MHSE, CHES Daniel Still, PharmD, BCPP Medical Liaison Alliance Outreach Vice President, Programs and Policy Medical Science Liaison Purdue Pharma L.P. Lance Armstrong Foundation Cephalon, Inc. Colleyville Austin San Antonio Gloria J. Duke, PhD, RN Anne K. Moore, LMSW Karen Torges Associate Dean Executive Director Director of Strategic Collaborations Office of Nursing Research & Texas Partnership for End-of-Life American Cancer Society High Plains Scholarship Care Division The University of Texas at Tyler Sugarland Austin College of Nursing & Health Sciences Tyler Kristynia Robinson, PhD, FNP- Joni Watson, RN, MSN, OCN bc, RN Program Director Michael Fitzpatrick, MD Associate Professor and Assistant Nurse Oncology Education Program Southwestern Medical Association Dean Graduate Education Texas Nurses Dallas University of Texas at El Paso School Association/Foundation of Nursing Austin Stephanie Gonzalez, MHA El Paso Program Director Matthew Wieman, MD Physician Oncology Education Helen Ross Petty Clinical Affairs Manager Program Principal Endo Pharmaceuticals Texas Medical Association MMIP & Associates Kingwood Austin Austin 3 2008 Annual Report
  5. 5. TxPAIN: An Historical Perspective Where We Began & Three Back… History Repeats Itself 1989 – Texas passes first 2002 – Last Acts® rates Texas’ 2006 – PPSG issues 3rd policy Intractable Pain Treatment pain policies a “D” evaluation & 2nd progress Act in the nation 2003 – PPSG publishes 2nd policy report in September – Texas regulatory boards evaluation – Texas rates “C” - again update rules – PPSG issues 1st progress 1991 – Texas American Cancer report & compares state Building Momentum for Society (ACS) forms Pain “grades” for 2000 and Change Control Subcommittee 2003 2006 – Initiative polls Texas 1994 – UT M.D. Anderson – Texas rates “C” both households Cancer Center and the years 2006/7 – Texas Medical Board & Alliance of State Pain Texas Pain Society Initiatives (ASPI) Making History collaborate to revise rules collaborate with ACS to 2004 – The Federation of State 2007 – Initiative surveys Texas present the Role Model Medical Boards updates its pharmacists Program in Texas Model Policy for the Use – US Congress considers – The Texas Pain Initiative of Controlled Substances National Pain Care Policy formalized operations for the Treatment of Pain Act of 2007 under M.D. Anderson 2005 – Texas Comprehensive Cancer Center umbrella Cancer Control Coalition 1996 – Texas hosts ASPI Annual Making Lemonade revises the State Cancer Meeting 2007 – Texas Legislature passes Plan and includes pain SB1879 establishing all 2006 – National ACS adopts pain Two Steps Forward… schedules monitoring as a priority – ACS produces How You 1998 – Texas ACS adopts pain – ACS, Komen for the Cure, Measure Up report initiative as a program and the Lance Armstrong – PPSG issues 4th policy 2000 – The Pain & Policy Studies Foundation (LAF) award evaluation and 3rd Group (PPSG) publishes funding to PPSG to progress report first evaluation of state produce annual policy – Texas rates a “C” – again pain policies reports 2001 – Congress declares Decade 2006 – Texas conducts of Pain Control and knowledge, attitude and Springboard to the Future Research practice surveys of Texas 2007 – Initiative prepares findings – Joint Commission issues physicians & nurses & develops strategic plan pain management – The American Cancer – Holds stakeholders standards Society, Lance Armstrong meeting – Texas Board of Pharmacy Foundation, Texas Medical – Initiative renamed – Texas issues position statement Association, Texas Pain Pain Advocacy & on pain Society and Texas Information Network Partnership for End-of-Life – Publishes Pain Patient Bill Care host the Texas Pain of Rights Summit 4 2008 Annual Report
  6. 6. Stakeholders Meeting –- The Politics of Pain: Balancing Vigilance and Compassion Healthcare professionals from across Texas Department of Public Safety Narcotics Regulatory Program discussed representing all major disciplines, recent changes in statute, SB 1879. Texas Representative Ruth Jones academicians, regulators, legislators, and law McClendon shared how SB1879, establishing a Pain Study Committee was enforcement officers gathered in Austin on accomplished in the 80th Legislative Session in May. The American Cancer September 10, 2007 to address the central Society presented Rep. McClendon with an advocacy award for her efforts principle of balance in pain policy, regulation supporting this issue. and practice. TxPAIN leadership presented findings of the Texas Pain Summit with its formal report, The Politics of Pain: Balancing Vigilance and Compassion. The report contains survey results of Texas households and healthcare practitioners, supporting science and research, policy perspectives, and a five-year strategic plan for improving pain management for all Texans. A generous gift from the Lance Armstrong Foundation underwrote the cost of producing the report into a 4-color, 40-page bound book. The Lance Armstrong Foundation is an active participant in TxPAIN. This resource is posted on the Alliance of State Pain Initiatives website at http://www.aspi.wisc.edu/acstxpi/ and at the TxPAIN webpage at Media coverage included KVUE (ABC Affiliate), KTBC (FOX Affiliate), http://www.cancer.org/texaspain. News 8 (Austin Cable News Station), the TX State Radio Network, and Meeting participants received updates on how the Long News Service. Interviews were conducted with the following: Texas compares to the nation, regulatory and Larry C. Driver, MD, Summit Chair, 2006 Mayday Pain Fellow law enforcement issues, a report on the 80th Regular Texas Legislative Session, and Allen W. Burton, MD, President-Elect, Texas Pain Society discussed next steps for implementing the Samuel Hassenbusch, MD, PhD, Past President, Texas Pain Society, plan. Past President, American Academy of Pain Medicine Donald W. Patrick, MD, JD, Executive Scott A. Strassels, PharmD, PhD, BCPS, Co-Chair, American Pain Director of the Texas Medical Board, Society Pharmacotherapy Special Interest Group reviewed revisions to Chapter 170, the Regina Fabian, 35-year-old mother of five, diagnosed with Stage IV Medical Board Rules on pain management. breast cancer in 2003, suffering with chronic pain due to B.C. Lyon from the Texas metastasis to the spine for the past four years Nationally recognized pain expert, June Dahl, PhD, Senior Advisor to the Alliance of State Pain Initiatives, in Madison, WI commented, “This is a landmark report…that serves as the first of its kind in the nation.” 5 2008 Annual Report
  7. 7. Empowering Healthcare Professionals through Continuing Education and Curriculum Development Physician Education 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 which can be accessed at www.poep.org. 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 170 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. This resource is available at www.poep.org. Through this active collaboration with the Texas Medical Association and the POEP, TxPAIN is able to extend its reach and message to more than 26,000 physicians across Texas. 6 2008 Annual Report
  8. 8. Nursing Education 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. 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. This resource is available through NOEP at www.noep.org/ce/onlinece.asp. 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. This resource is available at www.noep.org/ce/onlinece.asp. NOEP offers continuing education programs at the community level on a variety of topics for nurses. Pain Management and Palliative Care, a one-day workshop is being presented by Hill Country Memorial Hospital System and NOEP on November 8, 2008 at the Hampton Inn, Fredericksburg. Nurses who attend will earn 4.25 contact hours through the Texas Nurses Association/ Foundation provider unit. Speakers include two nurse members of the TxPAIN Steering Committee. For more information, or to register go to ACTEVA online registration at: www.acteva.com/go/noeptexas or call 866- 462-2838. 7 2008 Annual Report
  9. 9. Multidisciplinary Approaches The Texas Partnership for End-of-Life Care (Texans for Compassionate Care) in collaboration with the American Cancer Society and the Nurse Oncology Education Program will host its fifth annual continuing education Texas Partnership conference, A Common Thread 2008: Clinical and Practical Tools for for End-of-Life Care Supporting Human Resilience at the Westin DFW Hotel in Dallas, December 5-6, 2008. A Common Thread has become the premiere palliative and end-of-life The Texas Partnership for End-of-Life Care care conference synonymous with quality educational experience for the (Texans for Compassionate Care) advocates estimated 200 health professionals expected to attend. Its innovative for quality healthcare and works to remove content focuses on current information about palliative and end-of-life barriers. The Partnership’s pacesetting Let’s care, pain management and oncology. Talk, Texas! campaign, funded through a Continuing education credits are offered for nurses, social workers and generous grant from the Aetna Foundation, licensed professional counselors. For additional information, contact the will revolutionize advance care planning in Texas Partnership for End-of-Life Care (Texans for Compassionate Care) Texas. The Partnership educates consumers, at www.txpec.org or call (512) 453-9600. healthcare professionals and systems about healthcare choices, pain/symptom management, ethical decision-making, and compassionate communication. Its website, www.txpec.org, is cited as the Texas authority on advance care planning. The Texas Partnership for End-of-Life Care (Texans for Compassionate Care) is an active member of TxPAIN. 8 2008 Annual Report
  10. 10. Contributing to the Body of Knowledge about Pain Professional Publications Patient Studies Four poster abstracts were accepted for the 27th Annual Scientific The American Cancer Society’s (ACS) Meeting of the American Pain Society in May 2008 where more than National Cancer Information Center (NCIC) 1,300 professionals attended. Three of the abstracts address results of conducted a two month nationwide pain pilot Texas-specific surveys of physicians, nurses and pharmacists in study in 2008 in an effort to understand the contributing to inadequate pain care. The fourth concentrates on results underreporting of cancer-related pain and the of a general household poll. current level of uncontrolled pain among cancer patients contacting the NCIC. The pilot A fifth abstract, Knowledge, Attitudes and Practices of Texas Healthcare tracked the pain reporting trends among Professionals May Contribute to Inadequate Pain Care, comparing data from callers and identified those who could benefit all the health professional surveys, was accepted for a poster at the from education on how, when and to whom to International Association for the Study of Pain 12th World Congress on report their cancer-related pain. Phase II of the Pain held in Glasgow, Scotland in August 2008, where there were more Pain Project will begin in about November than 6,000 professionals in attendance. This abstract also was accepted at 2008 and will continue to collect data from the Alliance of State Pain Initiatives Annual Meeting being held in Austin, callers and to offer specific resources or Texas, October 30 – November 1, 2008. recommendations to assist callers with pain The posters were authored by Scott A. Strassels, PharmD, PhD, BCPS, The management needs. Texas-specific data will be University of Texas at Austin College of Pharmacy; Helen Ross Petty, available at the completion of this project. MMIP & Associates; Karen Torges, American Cancer Society High Plains TxPAIN is interested in examining the pain Division; and Larry C. Driver, MD, The University of Texas M.D. experience for those in other than oncology Anderson Cancer Center. settings and is developing a survey for use Poster production was underwritten by The University of Texas at Austin among chronic pain patients in settings other College of Pharmacy, an active participant in TxPAIN. than oncology. 9 2008 Annual Report
  11. 11. Public Awareness and Media Relations The patient education brochure, Your Pain Treatment Bill of Rights, was created as a simple three-fold pamphlet intended to clarify what patients should expect from their healthcare providers. It includes a sample pain log denoting date/time, activity, pain scale, description of what action the patient took to relieve the pain and results. It is available at no charge in print format from your American Cancer Society High Plains Division, or electronically at the webpage noted below. When Your Body Hurts… Fears, Myths & the Truth About Pain. This 35 slide-deck PowerPoint presentation includes a simple overview of pain, scope of the problem, causes and barriers, assessment and treatment concepts, consequences of unrelieved pain and sources of qualified pain When Your Body management resources. It is intended for qualified healthcare professional When Your Body Hurts… Hurts… presenters’ to use with lay audiences and includes speaker notes for presentation aid purposes. Fears, Myths & the Truth Fears, Myths & the Truth about Pain about Pain For September’s Pain Awareness Month, TxPAIN approached a group of 30 public health/academic librarians in Harris County about collaborating Texas Texas on a public awareness pilot. The Library Project presents a resource PPain ain A dvocacy && A dvocacy package that includes the below mentioned resources, along with a press Information Information Network Network release and speakers bureau request application. Although Hurricane Ike affected initial implementation; additional sites will be included in the next phase. A simple one page Q&A, Fast Facts about Pain, includes succinct information on pain prevalence, pain management, and an information about the Texas Pain Advocacy and Information Network and the Alliance of State Pain Initiatives. The Pain Resource Guide is an alphabetical listing of pain management resources including brief explanation and contact information intended for use by healthcare professionals, persons in pain, and their caregivers. These resources are available electronically http://www.cancer.org/texaspain. 10 2008 Annual Report
  12. 12. Protecting Consumer Interests: Advocacy, Public Policy, and Collaboration with Regulatory and Law Enforcement Agencies Eliminating Treatment pain control and management and to controlled substances in examine how the statutes affect Schedules II-V Barriers public health needs, the professional TxPAIN Chair and Texas Pain Recommend which data should be medical community, and persons Society member, Dr. Larry Driver provided to the DPS affected by acute, chronic, or end-of- collaborated with the Texas Medical life pain. Monitor and develop Association (TMA) Committee on recommendations regarding Cancer to propose a TMA resolution The committee was to have issued its implementation and enforcement to eliminate the use of special final report by September 1, 2008. As of the system serialized Government Issue of October 2008, full committee appointments have not been made Recommend procedures necessary prescription forms for Schedule II and no quorum could be established. for real-time access for controlled substances. Texas is the authorized practitioners only state in the nation to maintain such a requirement long thought to Recommend procedures for how the be a barrier to appropriate pain Electronic Monitoring department shares information management. The TMA reference related to drug diversion with a SB1879 establishes a mechanism for committee prepared a report to the licensing authority or a licensing monitoring all controlled substances, TMA House of Delegates which was authority shares information expanding the Department of Public accepted unchanged in May 2008. related to diversion of controlled Safety’s authority to monitor The TMA legislative department is substances with the department Schedules III-V. Moreover, SB1879 reviewing this for consideration as a gives the director authority to priority for the 81st Regular Texas determine the length of prescription Legislative Session which begins validity for Schedule II prescriptions Limitations on Pain January 2009. the intent being that the then 7-day Clinics rule may be too short a time frame The Texas Pain Advocacy and and may present unintended barriers Information network is your Pain Treatment Review to pain patients receiving needed proactive advocate for better patient Committee medications. TxPAIN members care. We are monitoring an advocated for extending the time During the 80th Texas Regular interagency taskforce currently frame, and ultimately the director Legislative Session, TxPAIN working to establish guidelines and extended prescription validity to 21 collaborated with Texas regulations on limited pain days. Furthermore, the bill Representative Ruth Jones management clinics. While the intent established an advisory committee to McClendon to propose a bill is to control diversion of pain the Texas Department of Public establishing a Pain Treatment Review medicines to the illicit market, we Safety to: Committee. Attached to SB1879, the remain concerned that the measure passed. The committee’s Develop recommendations regarding unintended effect will present purpose is to study relevant improvement of the official barriers to legitimate pain patients in provisions in Texas law that relate to prescription program need of treatment. the administration of prescription Develop recommendations regarding medication, controlled substances, implementation of an electronic and the needs of patients for effective monitoring system that would be used for prescriptions of 11 2008 Annual Report
  13. 13. Special Populations (Access & Disparities) Quality Improvement in Long-Term Care Primary Care Practice Patterns TxPAIN is developing a strategy to interview primary care physicians (and possibly advance nurse practitioners) to gain baseline knowledge of pain specialist referral using three case studies – patients with no history of pain medication abuse, those with a history of abuse, and those with active abuse issues. This would help identify practice pattern needs of primary care physicians and resources available to Texas Partnership for End-of-Life Care patients who have complex pain care needs regardless of insurance coverage. As of October 2008, IRB approval is still being sought for the primary care study TxPAIN, the Texas Partnership for End-of-Life Care (Texans for pilot. Compassionate Care) and the Alliance of State Pain Initiatives are collaborating to implement the ASPI’s Pain Improvement Partnership project in Dallas and the greater Austin area in the next eighteen months. The Pain Improvement Partnership (PIP) is an evidence based quality improvement project aimed at assisting long term care facilities, home care agencies, and small community hospitals in improving pain management practices. This seven-month project is a demonstrated effective quality improvement process that will equip facilities for long-term success. Support for the program has been received from the following organizations. Alliance of State Pain Initiatives Baylor Healthcare System, Dallas Endo Pharmaceuticals Purdue Pharma, L.P. Texas Partnership for End-of Life Care (Texans for Compassionate Care) Texas Pain Advocacy & Information Network American Cancer Society Nurse Oncology Education Program Texas Nurses Association/Foundation Cancer Prevention & Research Institute of Texas 12 2008 Annual Report
  14. 14. Texas Proud... TxPAIN is “Texas Proud” of its members whose dedication to improving pain management for all merits national recognition. 2008 State Pain Initiative 2008-2009 Mayday Pain Championship Award and Society Fellowship Larry Driver, MD, Professor of Anesthesiology and Pain Scott Strassels, PharmD, PhD, BCPS, Assistant Professor of Medicine at the University of Texas M.D. Anderson Cancer Pharmacy Practice at the University of Texas at Austin Center, Houston is a 2008 recipient of the Alliance of State College of Pharmacy and Adjunct Assistant Professor of pain Initiatives’ State Pain Initiative Championship Award. Public Health at the University of Texas School of Public The award recognizes individuals who have made Health, Austin Regional Campus in Austin, is a recipient of a outstanding contributions to the growth, development, and 2008-2009 Mayday Pain Fellowship. accomplishments of a State Pain Initiative. Since 2004, the Mayday Pain & Society Fellowship: A Media and Dr. Driver also was a recipient of a 2006-2007 Mayday Pain Policy Initiative trains healthcare professionals, scientists, and Fellowship. legal scholars to “become players in the pain field, and ultimately have real impact on the lives of people in pain.” 13 2008 Annual Report
  15. 15. By the Numbers: Report of Activities for 2008 Conferences/Symposia/Online Continuing Education Participants Politics of Pain Report Distribution Hard Copy Texas Medical Association Council on Scientific Nurse Oncology Education Program (NOEP) Affairs 12 Nursing Principles of Pain Management Independent Study Online 394 University of Texas at Tyler 10 Oncology Certified Nurse (OCN) Review American Cancer Society High Plains Division Course, Tyler, Texas 48 Leadership Staff 15 Pain Management Plus Cancer Screening Conference, Laredo, Texas 31 2007 Texas Pain Summit Stakeholders Meeting 95 Faculty Training Program, UT M.D. Physician Oncology Education Program Anderson Cancer Center, Houston, Texas 10 Steering Committee 20 24th Annual Update Conference, Laredo, Nurse Oncology Education Program Steering Texas 275 Committee 30 Texas Partnership for End-of-Life Care A National American Cancer Society Leadership Common Thread 2007, Austin, Texas 175 Staff 5 American Pain Foundation Power Over Pain Action Network Annual Leadership Training, Baltimore, Maryland 30 2006 Texas Summit Participants 75 Poster Sessions Attendees Texas Pain Society Board 15 American Pain Society 27th Annual Scientific Texas Pain Summit Committee Meeting Poster Session, Tampa, Florida 1,300 Members 60 International Association for the Study of Pain World Congress Poster Session, Glasgow, Scotland 6,000 Lance Armstrong Foundation 25 Newsletters, Newspaper Articles, University of Texas M.D. Anderson Cancer Promotions Readership Center 50 Texas Nurses Association/Foundation Texas Nurses Voice Newsletter 268,000 American Pain Foundation 40 Intercultural Cancer Council Board Members Newsletter 30 Webpage Hits, Report Downloads Physician Oncology Education Program, Texas C-Change Newsletter 150 Medical Association Webpage hits/downloads 33,593 NOEP E-Newsletter 7,000 Other Exposure Comprehensive Cancer Control State, Tribe & Territory Coalition Chairs Newsletter 52 Purdue Pharma L.P. E-Newsletter NOEP Pain Independent Study in Texas Comprehensive Cancer Control Coalition Texas Academy of Palliative Medicine & Texas Newsletter The Coalition Voice 300 Medical Directors Association Office Visit with Hospice Medical Directors, El Paso Times Article El Paso, Texas 100,000 Tyler, Texas Politics of Pain Posted on ASPI Website 14 2008 Annual Report

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