October 2007
In
this issue…
Eleven
State Pain Initiatives Receive Grants for Pain Relief Efforts
South
Carolina Pain Survey Results Available
Important
Safety Update on Fentora®
Pain
Drugs Are Banned for the World’s Poor
Eleven
State Pain Initiatives Receive Grants for Pain Relief Efforts
AUSTIN,
Texas — September 26, 2007 — The Lance
Armstrong Foundation (LAF) and the Alliance
of State Pain Initiatives (ASPI) announced today the selection of
eleven State Pain Initiatives (SPIs) that will receive grants
to carry out projects directed at overcoming barriers to pain relief at
the state and local level and improve the quality of life for people
living with cancer. 
The
grant
funding made possible through a national partnership of the LAF and
ASPI will improve cancer pain management nationwide while providing
infrastructure, financial and programmatic support to the individual SPIs
that make up the ASPI network.
The
SPIs and activities selected to receive funding for 2007–2008 include:
-
Idaho Pain Initiative to facilitate a statewide stakeholders meeting to identify the barriers to pain management and create educational outreach to healthcare providers;
-
Massachusetts Pain Initiative to improve pain assessment and management practices in healthcare institutions and facilitate planning sessions to identify strategies for the future growth of the MPI;
-
Michigan Cancer Pain Initiative to develop a comprehensive interactive website to devoted to pain management;
-
Missouri Pain Initiative to hold a “Prescribers School” aimed at increasing the number of physicians knowledgeable about appropriate pain management practices and current legal parameters;
-
Montana Pain Initiative to develop a plan for implementation of statewide pain management goals and to improve pain assessment and management practices in healthcare institutions;
-
Nebraska Pain Initiative to conduct pain educational presentations on pain management throughout the state during Pain Awareness Month;
-
New Hampshire Pain Initiative to develop, present and video-tape skits providing pain management information for senior centers and long-term care facilities statewide;
-
New Mexico Pain Initiative to increase the understanding of pain management and state pain policies through a series of workshops bringing together clinicians, regulators and representatives of law enforcement;
-
South Carolina Pain Initiative to produce a video-based pain management educational package for patient use in hospitals throughout the state;
-
Washington and Alaska Pain Initiative to develop and implement strategies for clarifying the laws, regulations and practice guidelines governing the use of opioid analgesics in the state of Washington;
-
Wyoming Pain Initiative to facilitate a statewide stakeholders meeting to build on the work of the legislatively-mandated “pain management committee” and create strategies for sustaining the WPI.
“The
State Pain Initiatives use their pain management expertise and extensive
knowledge of their state and local communities to implement innovative
programs aimed at the undertreatment of pain. These grants take us far
forward toward our goal of transforming the culture of pain care,” said
Michelle Grant Ervin, MD, chairperson of the ASPI advisory council.
More
than half of all persons with cancer experience pain. Unrelieved pain
adversely affects physical function, productivity, psychological
well-being and social interactions.
“Ensuring people with cancer can access pain control that is safe and effective is fundamental to our goal of helping people with cancer live life on their own terms,” said Andy Miller, vice president of programs and policy at the Lance Armstrong Foundation. “We are pleased to support these efforts and the important work of the Alliance of State Pain Initiatives.”
South
Carolina Pain Survey Results Available
In April 2007, the SC Pain Initiative worked with the USC Institute of Public Affairs to commission a statewide survey to determine the prevalence and impact of pain on South Carolinians. The survey was funded by grants from the American Cancer Society and the SC Cancer Alliance. The survey found that over 1.2 million South Carolina adults experience mild to severe pain on at least a monthly basis. South Carolinians who experience pain generally report that this pain has an impact on various aspects of their life. More than two-thirds of these respondents—representing 880,000 adults—believe that pain had a negative impact on their overall physical condition. More than 60% of those who regularly experience pain felt that it interfered with their ability to work and their productivity, 57.8% thought it caused feelings of anxiety or depression, and half believed that it has had a negative financial impact. The most frequently mentioned barrier to treatment was expense, followed by lack of insurance coverage. The complete survey and an executive summary is available here. For more information about the survey or the SC Pain Initiative, please contact Shannon Johnson, SCPI Coordinator.
Important
Safety Update on Fentora®
The FDA recently
posted a safety alert to inform health care providers of important safety
updates from Cephalon regarding Fentora®, the fentanyl buccal tablet.
Fentora® is a prescription opioid medication that is indicated only for
the management of breakthrough pain in adults with cancer pain. Serious
adverse events, including death, have been reported when this medication
was not prescribed and used appropriately.
Pain
Drugs Are Banned for the World’s Poor
“Drugs
Banned, World’s Poor Suffer in Pain,” an article in The New York Times,
says that millions of people in the world’s poorest countries die in
pain because morphine is banned. The article is part of a series on pain
throughout the world. Other titles in the series include “Japanese
Slowly Shedding Their Misgivings About the Use of Painkilling Drugs,”
“No Relief: In India, a Quest to Ease the Pain of Dying,” “Experts
Debate the Meaning of Addiction,” and “Doctors Without Borders,
Without Painkillers.”
According
to World Health Organization estimates, “4.8 million people a year with
moderate to severe cancer pain receive no appropriate treatment. Nor do
another 1.4 million with late-stage AIDS. For other causes of lingering
pain—burns, car accidents, gunshots, diabetic nerve damage, sickle-cell
disease and so on—it issues no estimates but believes that millions go
untreated.”
The
International Narcotics Control Board says that six countries—Australia,
Britain, Canada, France, Germany and the United States—use 79% of the
world’s morphine, while 80% of the world’s population, in poor and
middle-income countries, use only 6%. Morphine is neither expensive nor
hard to come by, but, according to David E. Joransen, head of the
University of Wisconsin’s Pain Policy Study Group, doctors in developing
countries have an “intense fear of addiction.”
In
some countries, such as Sierra Leone, only doctors can handle morphine.
But Sierra Leone has one doctor for every 54,000 people, compared to 1 for
every 350 persons in the United States. Gabriel Madiye, founder of
Shepherd’s Hospice, says, “It’s opioid phobia. We are coming out of
a war where a lot of human rights violations were caused by drug abuse.”
In other countries, such as Uganda, pharmacists will not stock morphine
because of the fear of robberies.
In
Sierra Leone, some nurses have not been paid in three years, so they
support themselves by filling the prescriptions written by the doctors. At
least one doctor says he won’t order morphine for that reason—”I
wouldn’t want to leave my staff in charge of morphine. The potential for
abuse is so high.” The chief of enforcement of the National Pharmacy
Board says that painkillers are not imported because what little money
there is must go to the top five killers in the country—”diarrhea,
pneumonia, tuberculosis, malaria and sexually transmitted diseases.”
Gabriel
Madiye is frustrated by the answers given by the officials. He “cannot
get the one drug that would let him give people…the dignified deaths
that in the West would be their birthright.” “How can they say there
is no demand when they don’t allow it?” he questions. “How can they
be so sure that it will get out of control when they haven’t even tried
it?”
The
series can be accessed by searching for “morphine,” without quotes at
The New York Times
Web site.
The New York Times requires a one-time, free registration. (The
New York Times, 9/10, The Carolinas Center Weekly Updates, September
21, 2007)
Proposals
Requested
The
American Academy of Pain Management is currently accepting Speaker
Abstract Proposals for the American Academy of Pain Management’s
19th Annual Clinical
Meeting to be held in Nashville, Tennessee August
21–24, 2008. If you would like to present, please complete the attached
form and return by November 1, 2007. The Education Advisory Committee will
review all submissions. They welcome interesting, educational, and
innovative presentations across all disciplines of pain management. Please
keep in mind that all presentations, must be in compliance with ACCME
standards, and free of commercialization and proprietary references. They
are asking that presentations contain appropriate and valid references to
assure scientific integrity.
Speaker
Abstract Proposal Form
Accepting Poster Abstract Proposals for 2008. Please
complete the form below and return it no later than March 30, 2008.
Currently accepting 2008 Award Nominations. To
nominate a candidate for 2008, please complete the form below and return
it no later than September 15, 2007.
Pain
and Palliative Care Notes
A
German research study has found that “fake acupuncture works nearly as
well as the real thing for low back pain, and either kind performs much
better than usual care.” Since fake acupuncture outperforms usual care,
researchers “wonder whether pain relief came from the body’s reactions
to any thin needle pricks or, possibly, the placebo effect.” The study
co-author says that the findings “are in line with a theory that pain
messages to the brain can be blocked by competing stimuli.”
Nebraska
has established a pilot program, Ticket to Work Palliative Care Program,
that “will select thirty people in the Lincoln area to work with a
palliative care team to address pain and symptom issues.” The program
hopes to address these issues in ways that improve the participants’
ability to work. More information may be found on the Nebraska Ticket to
Work Web
site.
The
Michigan Department of Community Health Web site has a new Pain &
Symptom Management section. The site includes links to information for
patients, families, advocates and the general public, information for
health care professionals, and information on the Michigan Advisory
Committee on Pain & Symptom Management. (Michigan
Department of Community Health Website)
The
American Academy of Pain Management recently held its annual meeting, with
a focus on the undertreatment of pain, and new pain treatments. Symposia
included ethical issues in the treatment of nonmalignant pain and emerging
solutions in pain.
Mike
Roman, a car racer who suffered a decade of “debilitating pain” and
drug addiction after losing a leg, founded the Web site Race Against Pain after a
St. Louis pain
specialist implanted a spinal cord stimulator and gave him
his life back. Roman’s Web
site,
provides “chronic pain information, resources and an online community”
for pain sufferers.
Richard
Paey, the disabled Florida man who was sentenced to 25 years for drug
possession and trafficking in a controlled substance by fraud, has been
released from prison. At the time of his sentencing, Paey got around in
leg braces and on crutches and “was a man in extreme, excruciating,
unrelenting pain, the result of severe back injuries sustained in a car
accident, a botched surgery and the onset of multiple sclerosis.” Paey,
who forged prescriptions to get enough medication to treat his own pain,
was sent to jail and “fitted with a morphine pump, which administered,
at state expense, more drugs than the inmate had been convicted of
illegally possessing.” Governor Charlie Crist (R) granted Paey a full
pardon, saying, “They call it justice. That’s what we’re doing here
today. We aim to right a wrong and exercise compassion, and to do it with
grace.”
In
a telephone interview, Dr. Timothy
Quill, director of the Palliative Care
Program at Rochester’s Strong
Health, envisions an “ideal scenario”
of physician-patient relationship when a patient is dying. The
relationship would be one in which “a physician and patient who have a
solid relationship openly discuss treatment options, find ways to treat
pain and other symptoms, mobilize emotional support, use the services of a
psychiatrist, and consult with another physician.” Quill is the author
of A
Midwife Through the Dying Process: Stories of Healing and Hard Choices at
the End of Life.”
South
Carolina primary care doctors are often not prescribing any Schedule II
drugs, says an article in The Post and Courier, leaving pain
management specialists to deal with additional patients who have chronic
pain. Most are afraid of DEA charges, and those who do prescribe narcotics
are careful to protect themselves by making “stringent agreements”
between themselves and their patients about the use of the drugs. Others
refuse to rewrite prescriptions for lost medication, such as Dr. Marc
Dubick of Roper St. Francis’ Pain Management
Center. “People who
really need it to function don’t lose it,” he said.
Growth
House,
a Web site dedicated to improving care for the dying, has made available
full-text extracts in their online edition of Dr. Joanne Lynn’s new
book, The Common Sense Guide to Palliative Care.
Pain
scales accuracy
An
article from Medscape focuses on the accuracy of Pain scales. To read the
article in its entirety visit the Medscape Web
site.
Building
Palliative Care Programs in Hospitals: Tools and Strategies for Success
November
1–3
InterContinental
Mark Hopkins Hotel, San Francisco, California.
This
CAPC Level I Seminar is renowned as the field’s basic primer for
planning, exploring and starting a palliative care program. You will come
away with a comprehensive, practical overview of all financial and
operational tools needed to build a successful palliative care program.
Seminar
highlights include:
-
Develop and implement a strategic plan for establishing a program
-
Create compelling business and financial plans
-
Collect, interpret and present data needed to justify a program and to evaluate outcomes
-
Select among various organizational and delivery models
-
Identify target audiences and implement marketing strategies
-
Outline strategies for funding programs
-
Develop successful hospital-hospice partnerships
-
And more!
This
conference is intended for hospital and hospice physicians, nurses, social
workers, finance managers, administrators and others responsible for
planning or implementing a palliative care program in hospitals and health
systems.
To learn more and register, call the CAPC Events Line at (212) 201-2680 or visit the CAPC Web site.
The
Building Blocks for Pediatric Palliative Care Symposium
November 9–10
Double
Tree Guest Suites in Charlotte, NC
This
is an interdisciplinary two day conference addressing the needs and care
of infants, children, and their families who are living with
life-threatening diagnoses. Topics include: communication, ethics,
spirituality, pain and symptom management, Child Life, children’s grief
camp, compassion fatigue, family advocacy, suggestions for peaceful death
in the ICU, and perinatal/neonatal palliative care. The target audience is
MDs, RNs, Social Workers, Case Managers, Counselors, Child Life
Specialists, Pastoral Care providers, and family members of children who
have experienced life-threatening illnesses. For more information, please
contact Jason Clapp at (704) 512-6573 or visit the Charlotte Area Health
Education Center Web
site.
Spartanburg
Regional Hospital System
November
16, 2007
Spartanburg,
SC
The
Carolinas Center Palliative Care Day 2007
December
5
SCHA
Conference Center
Columbia,
SC
Save
the Date!
South
Carolina Cancer Alliance Quarterly Meeting
January
18, 2008
Charleston
Marriot
Charleston,
SC
SCCA
Friday Night FUNdraiser- A Low Country Celebration
January
18, 2008
Charleston
Marriott
Charleston,
SC
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