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APS
E-News Important Dates 2007
Conference: NAPF
Forums: In This Issue Pharmacologic Management of Neuropathic Pain: Evidence-Based Clinical Recommendations New Evaluation and Progress Report Card News
Highlights from The Journal of Pain Pain Control in the Primary Care Setting Call for Paper and Poster Abstracts
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| Acknowledgment:
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| American
Pain Society |
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September is Pain Awareness Month. This is your extra issue of APS E-News.
Pharmacologic Management of Neuropathic Pain: Evidence-Based Clinical Recommendations APS recently endorsed a new International Association for the Study of Pain (IASP) guideline, Pharmacologic Management of Neuropathic Pain: Evidence-Based Clinical Recommendations. Guideline developers include the following international experts: Robert H. Dworkin, Alec B. O'Connor, Miroslav Backonja, John T. Farrar, Troels S. Jensen, Eija A. Kalso, John D. Loeser, Christine Miaskowski, Turo J. Nurmikko, Russell K. Portenoy, Andrew S. C. Rice, Brett R. Stacey, Rolf-Detlef Treede, Dennis C. Turk, and Mark S. Wallace. Patients with neuropathic pain (NP) are challenging to manage. NP is estimated to afflict millions of people worldwide; many common diseases, injuries, and interventions cause NP by producing lesions in somatosensory neurons in the peripheral or central nervous system. The management of patients with chronic NP is complex, and response to existing treatments is often inadequate. Because of gaps and controversies in the literature, considerable interpretation of available evidence, judgment, and clinical experience are required to develop treatment approaches that can be used in clinical practice. This guideline panel convened with the following objectives: (a) review the results of randomized controlled trials examining medications for the treatment of NP; (b) develop up-to-date, evidence-based guidelines for the pharmacologic management of NP that take into account clinical efficacy, adverse effects, impact on health-related quality of life, convenience, and costs; and (c) provide specific recommendations for the use of these medications in clinical practice. The completed guidelines have been submitted for publication in The Lancet.
New Evaluation and Progress Report Card The University of Wisconsin Pain and Policy Studies Group (PPSG) will release its new 2006 Evaluation Guide and 2006 Progress Report Card this month. This new edition of the Evaluation Guide is the third in a series of evaluations of federal and state pain policies. The 2006 editions include a more complete picture of the policy environment in each state, including professional education, healthcare facility care standards, and osteopathic practice. The Progress Report Card quantifies state pain policies and benchmarks progress to promote pain management and reduce policy barriers by comparing 2006 state policy grades with those from 2000 and 2003.
News Highlights from The Journal of Pain
Factors
Associated with Delay to Analgesia in Emergency Departments Waiting time for administration of opiate analgesia is used to measure the quality of care in hospital emergency departments. According to the authors, it remains unclear if specific demographic and clinical variables are associated with analgesia delays. Therefore, this study set out to determine the percentage of emergency department patients who require intravenous opiate analgesia and what, if any, factors can predict when it might take more than an hour before administration of the initial dose. This is the first study to establish a predictive model for delay to analgesia. For 3 months, the authors examined medical records of 857 patients who received parenteral opiate analgesia in the emergency department. They found that 52.6% were treated in less than 60 minutes. For those who waited longer than 60 minutes, the study concluded
The authors recommended that triage nurse-initiated pain management may offset inefficiencies in the timely delivery of analgesia. They pointed out that expanding or introducing triage nurse-initiated pain management can significantly reduce time to analgesia. Further, studies show that nurse-initiated narcotic administration is safe and efficient and can assist in the diagnostic process.
To test their hypothesis that patients with neuropathic and non-neuropathic pain have different symptom profiles, the authors examined 618 patients with peripheral neuropathic pain conditions, osteoarthritis, and low-back pain before their treatments had begun. They found that specific pain symptoms differ between patients with peripheral neuropathic pain and those with inflammatory and musculoskeletal pain. In particular, patients with neuropathic pain reported significantly more hot, cold, sensitive, itchy, and surface pain. Non-neuropathic pain subjects rated dull and deep pain as their most intense discomfort. However, sharp pain, which usually is associated with neuropathic conditions, was the only symptom with no discrimination between the groups. The authors concluded that clinical methods should be developed for characterizing pain symptoms, assisting in diagnosis, and providing guides to underlying mechanisms and treatment targets.
An estimated 2% of the U.S. population has fibromyalgia, a condition characterized by pain and tenderness to light palpation, chronic fatigue, and sleep disturbances. Unlike patients with rheumatoid arthritis, fibromyalgia patients have multisystem symptoms, suggesting that pain from the disorder could be caused by impaired regulation of the neurotransmitter dopamine. This finding casts doubt on previous understanding that NDMA receptors contribute to fibromyalgia syndrome, and that the disease can be managed with low-dose ketamine therapy. Myers concluded that the growing body of evidence pointing to dopamine dysregulation as a possible cause of fibromyalgia pain may explain the heterogeneous symptom complex that characterizes fibromyalgia syndrome.
Call for SIG Members Interested in Pain in the Elderly A group of interested APS members is organizing a special interest group (SIG) to focus on the unique aspects of the basic science, diagnosis, and clinical aspects of pain in an older population. William Schwab, MD PhD, Chief of Geriatrics for Ohio Permanente Medical Group, will chair the SIG. If you would like to participate in this SIG, please e-mail your interest to William.S.Schwab@kp.org or call him at 216/470-2733. Please contact Dr. Schwab again even if you have previously expressed interest in this SIG. Response to date has been limited (less than 10 people), and Dr. Schwab is pulling together a comprehensive list of interested persons.
APS Volunteer Spotlight: Betty Ferrell, PhD RN
Dr. Ferrell's primary research focus is palliative care and patient education. She received a grant from the National Cancer Institute to develop an education program for pain and fatigue management. An APS member since 1987, Dr. Ferrell joined APS to take advantage of opportunities to network with colleagues in pain research. "Before the palliative care movement began, APS was the only resource for researchers interested in pain care at the end of life," she said. "Through the years, I have found APS to be a valuable source of information and professional support through its publications, SIGs, and the annual meeting. APS members can network with leaders in their field and also benefit from the organization's advocacy efforts on behalf of pain clinicians and researchers." Dr. Ferrell has a long record of service accomplishments as an APS volunteer. She has contributed to publications and position statements on pain in older adults, ethical issues in pain research, and pain management nursing. She also is an active member of the APS Nursing SIG. "I strongly encourage fellows and students interested in pain research to join APS," said Ferrell. The pain field still needs more young researchers, and APS is an excellent source for mentors."
National
Headache Foundation Invites Research Grant Submissions Pain Control in the Primary Care Setting
The book also includes the following special topics:
To purchase a copy of Pain Control in the Primary Care Setting, or for more information, visit our online store.
Call for Election Nominations: Coming Soon! Are you ready to pursue a national leadership position in APS? Do you demonstrate such leadership qualities as vision, strategic thinking, motivation, and a sense of dedication to the society and its mission? If you answered yes to any or all of these questions, or if this sounds like someone you know, the APS Nominating Committee requests your election nomination. Open positions include President-Elect, Treasurer, three Directors-at-Large, and seven positions on the Nominating Committee. Nominees must be active APS Regular Members and, most importantly, want to achieve positive outcomes for the society, its members, and those who are served by its efforts. Candidates will be elected this winter to take office at the 2007 annual meeting. Members will receive an invitation to nominate potential election candidates in October. Those with active e-mail addresses will be notified by e-mail. Those without e-mail will receive instructions by mail. In addition, position descriptions, a list of current board and nomination committee members and vacancies, and the disciplinary composition and geographic representation of the board is available on the APS Web site. APS has worked hard to make the nomination and voting process easy for you; your participation will make it meaningful. Please take advantage of this opportunity. Your participation is important.
APS Call for 2007 Paper and Poster Abstracts
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The
following highlights summarize selected articles from the September
2006 issue (volume 7, number 9).
As
she advanced in her career as an oncology nurse, Betty Ferrell,
PhD RN, knew she wanted to be involved in pain research full time.
She fulfilled that dream 17 years ago when she joined City of Hope
National Medical Center as a research scientist.
Pain
Control in the Primary Care Setting is the first resource that
is appropriate for any healthcare provider—primary care physician,
medical and surgical specialist, nurse, physician assistant, psychologist,
physical therapist, and pharmacist—who is interested in improving
the management of chronic noncancer pain in the primary care setting.
Chronic noncancer pain management is often complex and includes
a challenging array of medical and psychosocial problems. The Greater
Philadelphia Pain Society, in collaboration with APS, developed
this handbook, which includes