TxPAIN 09 Annual Report

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Texas Pain Advocacy & Information Network

2| 2009 TxPAIN Annual Report

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2009 TxPAIN Annual Report| 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

and quoted in local, regional and national publications and media

outlets. We have written and published essays and articles in

newspapers and magazines, as well as scholarly journals. We have

given testimony to the President’s Council on Bioethics, the Food and

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!

Larry C. Driver, MD, TxPAIN Chair

Professor, Department of Anesthesiology and Pain Medicine, The University of Texas M.D. Anderson Cancer Center Houston


2009 Steering Committee

Krisha Cook. RN, BS, OCN American Cancer Society National Cancer Information Center Austin, TX

Krista Crockett Texas Pain Society Austin, TX

Larry Driver, MD, Chair UT MD Anderson Cancer Center Houston, TX

Kristi Dover, PharmD Purdue Pharma L.P. Colleyville, TX

Gloria J. Duke, PhD, RN The University of Texas at Tyler College of Nursing & Health Sciences Tyler, TX

Stephanie Gonzalez, MHA Physician Oncology Education Program Texas Medical Association Austin, TX

Brian Howell, PharmD

Endo Pharmaceuticals Inc. Raleigh, NC

Mary Beth Kean, DNP, RN-C, CNS

Central Texas Veterans Healthcare System Temple, TX

Brenda McCoy, PhD University of North Texas College of Public Affairs & Community Service Denton, TX

Andy Miller, MHSE, CHES Lance Armstrong Foundation Austin, TX

Anne K. Moore, LMSW Texans for Compassionate Care Midland, TX

Dennis Pabis, PharmD, BCPP King Pharmaceuticals San Antonio, TX

Helen Ross Petty Texas Network of Youth Services Austin, TX

Kris Robinson, PhD, FNP-bc, RN University of Texas at El Paso School of Nursing El Paso, TX

Linda Schickedanz, RN, MSN, CNS Weatherford, TX

Beverly Shaw American Cancer Society National Cancer Information Center Austin, TX

Daniel Still, PharmD, BCPP Cephalon, Inc. San Antonio, TX

Scott Strassels, PharmD, PhD, BCPS University of Texas at Austin College of Pharmacy Austin, TX

Karen Torges American Cancer Society High Plains Division Austin, TX

Joni Watson, RN, MSN, OCN Nurse Oncology Education Program Texas Nurses Association/Foundation Austin, TX

Advisors

Alliance of State Pain Initiatives June Dahl, PhD University of Wisconsin School of Medicine and Public Health Madison, WI

American Pain Foundation Mary Bennett, MFA Baltimore, MD

American Cancer Society Rebecca Kirch, JD National Government Relations Department Washington, DC le

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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)


The Texas Pain Advocacy & Information

Network

mission

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

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 [email protected], or visit online at www://

aspi.wisc.edu

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

quality pain management for people of all communities & cultures in Texas

through public policy initiatives, public awareness campaigns, & patient &

provider education.

For more information about TxPAIN: Visit online at www.cancer.org/texaspain


http://www.cancer.org

mailto:[email protected]

http://aspi.wisc.edu



http://www.cancer.org/texaspain


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,

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 [email protected]. 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

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http://www.facebook.com/pages/TxPAIN/116372608091


81st Regular

Texas Legislative Session

Summary

Senate Bill 904—Williams Authorizes a prescribing practitioner to issue multiple

prescriptions authorizing a patient to receive a total of up to

a 90-day supply of a Schedule II controlled substance under

certain conditions.

Status: Signed into law.

Senate Bill 911—Williams Establishes a pain management clinic certification and

specifies exemptions. Sets out procedures relating to

inspections, investigations, and certificate application,

issuance, expiration, and renewal. Includes provisions

relating to regulation of persons affiliated with a pain

management clinic and to disciplinary action.


Senate Bill 912—Williams Related to the diversion of a controlled substance by those

who have access to the substance by virtue of profession or

employment; providing penalties.

Status: Did not pass this session.

Senate Bill 1281—Williams Related to fraudulently obtaining a controlled substance from

a practitioner and providing a penalty.


House Bill 1107—Christian Related to licensing advanced practice registered nurses and

the authority of those nurses to prescribe certain controlled

substances.


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.


Advocacy Initiatives

TxPAIN actively advocates for people with pain to have

optimal pain management. As a part of its mission,

TxPAIN works to remove or minimize barriers that

prevent people from receiving optimal care. Our

studies corroborate national research conducted over

the past four decades indicating that a primary barrier

to optimal pain management in Texas is fear of

regulatory and law enforcement scrutiny by healthcare

professionals who use controlled substances, in

particular opioid medications, for the relief of pain.

Such fear results in what is known as a ―chilling effect‖

or reluctance to provide state-of-the-science care.

Consequently, TxPAIN supports a public policy agenda

that promotes good pain management and opposes

policies that present barriers or that could have a

―chilling effect‖ on the practitioner’s ability or

willingness to use the full array of modalities available

for treating pain.

The 81st Regular Texas Legislative Session saw more

new pain-related legislation than ever before. The

sidebar at left summarizes key information. We

partner and collaborate with healthcare organizations

and professional associations to pursue public policies

on both the federal and state levels that are conducive

to the relief of pain. These include the American

Cancer Society, American Society for Pain

Management Nursing, American Pain Foundation,

Lance Armstrong Foundation, Texas Medical

Association and Texas Pain Society.

protect


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.


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.

educate

http://www.noeptexas.org

http://www.noeptexas.org/


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.

http://www.poep.org

http://www.poep.org


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

http://www.aspmn.org/index.htm


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

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

Texas Pain Society

http://www.texaspain.org/


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


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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.

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.


By the Numbers

Activity Audience Location

Attendance/

Readership/

Viewership, etc.

Austin American Statesman Commentary by TxPAIN

Member Scott Strassels on Sickle Cell Pain General Public Austin 350,000

KTEP Radio Show with TxPAIN Member Kris Robinson General Public El Paso 50,000

YouTube Caring for the Person with Chronic Pain by

TxPAIN Member Kris Robinson General Public El Paso 270

The Asian-American Health Coalition Presentation by

TxPAIN Member Gloria Duke General Public Houston 20

The Boat People SOS Presentation by TxPAIN Member

Gloria Duke General Public Houston 20

APF Caring for the Caregiver Live Online Chat w/

TxPAIN Member Kris Robinson Patient/Caregiver Nationwide 30,000

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 Fredericksburg,

Harlingen, Corpus 247

NOEP In the Know with NOEP E-News Article—Barriers

to Effective Pain Management at the End of Life Nurses Statewide 7,756

UTEP Alternative Methods for Managing Pain Class by

TxPAIN Member Kris Robinson Nursing Students El Paso 26

ASPMN-Alamo Chapter Program—Addiction & Pain Nurses San Antonio 16

ASPMN-Alamo Chapter Program—Current Trends in

Drug Diversion Nurses San Antonio 18

ASPMN-Alamo Chapter Program—Hypnosis & Pain Nurses San Antonio 14

ASPMN-Alamo Chapter Program—Regional Nerve

Blocks Nurses San Antonio 9


Activity Audience Location

Attendance/

Readership/

Viewership, etc.

UT Austin College of Pharmacy Interdisciplinary Pain

and Palliative Care Class Pharmacy Students Austin 20

El Paso Pain Society Presentations by TxPAIN Member

Kris Robinson 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

Member Larry Driver and Others

Physicians Statewide 220

TPS/TMA Annual Half Day Pain Symposium Physicians Austin 100

TPS/Texas Tech University Health Science Center

Annual Pain Symposium Physicians Lubbock 100

TPS/St. David's Hospital Grand Rounds Physicians Austin 35

TPS/Texas Society of Anesthesiologists Annual Meeting

Lecture Physicians San Antonio 50

POEP/UTHSC San Antonio--Cancer Pain Control and

Management Presentation Physicians Laredo 90

POEP 11th Annual Symposia: ―What Primary Care

Physicians Need to Know‖ Pain Management Panel

Presentation

Physicians Austin 126

NCI Office of International Affairs Distribution of Texas

Pain Report Multidisciplinary International 10

Interlink Healthcare Communications Shared TxPAIN

Posters Multidisciplinary Nationwide Unk.

POEP/Texas Health Presbyterian Hospital--Barriers to

Effective Pain Management Presentation Multidisciplinary Plano 21


research

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

and knowledge/practice.

Gloria Duke, PhD, RN

Associate Dean, Office of Nursing Research

& Scholarship, The University of Texas at

Tyler College of Nursing & Health Sciences


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

by pain management APRNs in states with practice restrictions to

those in states without restrictions. Study participants were

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-

third had active litigation. No one was diagnosed with

malingering or pain disorder with primarily psychological

origins. Depression coexisted with chronic pain and patients

reported serious impairment in physical, occupational, and

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.

Mary Beth Kean, DNP, RN-BC, CRRN, CNS

Clinical Nurse Specialist in Pain Management

Central Texas Veterans Healthcare System

Temple

Kris Robinson, PhD, FNP-bc, RN

Associate Professor, Assistant Dean for

Graduate Nursing, Director of Advanced

Practice Programs, The University of Texas at

El Paso School of Nursing


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

time of their call, with nearly two-thirds rating

their pain intensity on the 0-10 scale as moderate

(27% rated pain 4-6) or severe (36% rated pain 7

-10).

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.

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

Krisha Cook, RN, BS, OCN

Oncology Nurse Information Specialist American Cancer Society

National Cancer Information Center Austin

Beverly Shaw

Director of Mission Delivery American Cancer Society

National Cancer Information Center Austin

http://caonline.amcancersoc.org:80/cgi/content/full/59/5/285

http://caonline.amcancersoc.org:80/cgi/content/full/59/5/285


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

ASPI as a whole, reinforcing supports for state initiatives, developing or enhancing the

right partnerships and providing communications conduits between and among the ASPI

and its affiliates.

National Pharmacy Pain Summit 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

The service you do

for others is the rent

you pay for the time

you spend on earth.

Mohammed Ali

(1942- )

http://www.siue.edu/pharmacy/pain


2005-06 Fellow

Larry C. Driver, MD

Professor in the Department of Anesthesiology and Pain Medicine at The University of Texas M.D. Anderson Cancer Center, Houston, Texas

2008-09 Fellow

Lisa Robin

Senior Vice President, Federation of State Medical Boards, Dallas, Texas

2008-09 Fellow

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

Mayday Pain & Society

Fellowships

Established in 2004 by the Mayday Fund, The Mayday

Pain & Society Fellowship is a five-year initiative intended

to increase the pool of experts healthcare professionals,

scientists, and legal scholars in the pain management

community who communicate about pain—the research,

the problems and the solutions.

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.

honor


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Contact Karen Torges

P.O. Box 149054

Austin, Texas 78714-9054

(512) 919-1884

[email protected]

www.cancer.org/texaspain

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Documents

TxPAIN 09 Annual Report