October 2006  

In this issue…

Upstate Hospice Provider Receives LAF Grant

Husband-Wife Team Writes Pain Guide

South Carolina Pain Management Studies

Pain Research Notations

October Pain Facts: Breakthrough Pain

November Pain Events

Upstate Hospice Provider Receives LAF Grant

Hospice of the Upstate recently received a $10,000 grant from the Lance Armstrong Foundation (LAF) to support a Cancer Pain Initiative in Anderson County. Hospice of the Upstate was one of 27 community, non-profit organizations across the country to receive LAF grants to help people with the physical, emotional, and practical challenges of cancer.

 

The Cancer Pain Initiative will ask cancer survivors to rate their level of pain and explore their knowledge of options for pain management. “We are pleased to be partnering in this significant initiative with AnMed Health, Clemson University and The Carolinas Center for Hospice and End of Life Care,” says Pam Cox, Community Education Coordinator.

 

To learn more about Hospice of the Upstate, visit www.hospicehouse.net. To learn more about LAF, visit www.livestrong.org. (press release provided by Hospice of the Upstate)


Husband-Wife Team Writes Pain Guide

Allan Platt, PA-C, and Susan Platt, MD have written a pain guide for patients and family members that explains and outlines treatment options for afflictions including arthritis, back and neck pain, angina, and diabetes. The guide has been described as “easy to read and comprehensive.” Allan Platt is a faculty member in the Emory Physician Assistant Program. Susan Platt is a clinical instructor at the Emory University School of Medicine. “Overcoming Pain: What It Is, Why It Is, and Successful Ways to Treat It” includes a forward that was written by William Rowe, executive director of the American Pain Foundation. He endorses the book and refers to it as “an important reference resource. Allan Platt is also the author of “Hope and Destiny: A Patient’s and Parent’s Guide to Sickle Cell Disease and Sickle Cell Trait.” (Emory University On-line Publication)


South Carolina Pain Management Studies

According to a query of the United States National Institute of Health on-line clinical trials database, there are currently 8 pain management studies with South Carolina sites participating. Seven are in the recruitment phase and 1 is not yet open to recruitment. The studies include a pain management protocol for pediatric sickle cell disease, a migraine headache pain study, and a radiation therapy and bone pain study. A query of studies including the key words “pain” and “South Carolina” resulted in 28 additional studies with most in the recruitment phase. Click here to view objectives and eligibility information about these pain-related studies and others around the country.


Pain Research Notations (the following taken from The Carolinas Center Weekly Updates)

  • Researchers at Harvard Medical School recently carried out the first study comparing the effectiveness of two placebos, rather than one placebo against a drug. Both sugar pills and sham acupuncture (with a needle that slides back into the holder) were effective in treating pain from repetitive strain injury. Both also had side effects, with 15% of the sugar pill recipients reporting drowsiness and 20% of the acupuncture patients reporting pain from the “puncture site.” Another study from the University of Turin found that proglumide enhances the brain’s “expectation pathways,” relieving pain “if, and only if, it is associated with a placebo that creates an expectation of pain relief.” (Fortune, 9/18)

  • Researchers looking for biological pest controls have discovered a new enzyme inhibitor that may eventually lead to new pain medicines for patients with inflammatory diseases such as arthritis. Tests in rodents show the compounds to be as effective as low doses of Celebrex and Vioxx, but do not produce the blood chemistry changes associated with heart attacks. One inflammatory disease expert called it “the most significant discovery in inflammation in more than a decade.” (Pharma Business Week, 9/18)

  • A survey by Idaho’s Center for the Study of Aging, at Boise State University, has found that 63% of respondents “consider living with great pain to be worse than death.” The full report and an executive summary are available at the Center for the Study of Aging’s Web site. (Center for the Study of Aging Website; KTRV-TV Website, 10/4)


October Pain Facts

25 Facts on Breakthrough Pain (pain.com on-line publication, 10/23)

  1. Chronic pain can be of two types: persistent pain, which is continuous pain, and breakthrough pain, or incident pain.

  2. Breakthrough pain (also known as episodic pain) is called that because it “breaks through” a regular pain medicine schedule.

  3. Breakthrough pain may be different for each person and it is often unpredictable.

  4. Breakthrough pain typically has a rapid onset, can last up to an hour.

  5. The quality of breakthrough pain may feel very much like persistent pain, except that it is more severe.

  6. Medications used for treating breakthrough pain, as generally short-acting medications, and are called rescue medicines.

  7. Rescue medications are used to manage and resolve breakthrough pain episodes more rapidly.

  8. Breakthrough pain is relieved with rescue medications that are taken ONLY at the time of a breakthrough pain episode.

  9. Rescue medication should be taken at the first sign of breakthrough pain.

  10.  Pain can occur even through a patient is adhering to their medication schedule and are taking the correct dose of pain medication.

  11. Pain that is allowed to build up is much harder to control.

  12. Episodes of breakthrough pain may either be spontaneous, occurring without a precipitated event, or precipitated; initiated by a volitional or nonvolitional event.

  13. As patients learn that certain actions cause breakthrough pain, these episodes can be anticipated and may allow patients and physicians to either prepare a treatment response or to treat prophylactically.

  14. The etiology of breakthrough pain can be related to a disease or condition, or to its treatment. Although specific etiology may not explain manifestation as breakthrough pain, determination is essential for effective management.

  15. Specific characteristics that define breakthrough include its relationship to the fixed opioid dose for persistent pain, temporal features, precipitating events, and predictability.

  16. It is possible to experience breakthrough pain just before or just after taking your persistent pain medication.

  17. Breakthrough pain is associated with greater pain-related functional impairment, worse mood, and more anxiety.

  18. Breakthrough pain could be related to: a direct relationship between a tumor progression, such as bone metastasis, or nerve compression, in the cancer patient, or as a result of a treatment modality, such as a prostatectomy or mastectomy, or a variety of disorders, such a arthritis.

  19. Treating breakthrough pain with oral medication is the most convenient and cost-effective for patients.

  20. When treating breakthrough pain, oral medications can take up to 30 or 45 minutes to reach effectiveness.

  21. When treating breakthrough pain, rectal medications, such as liquid morphine can produce effective analgesia in approximately 10 minutes.

  22.  Non-pharmacological techniques for breakthrough pain consist of relaxation training, imagery, hypnosis, distraction, touch, and music and pet therapy.

  23. Researchers estimate that up to 86% of chronic pain suffers, on long-acting medication, experience breakthrough pain.

  24. Breakthrough pain is more common in the cancer patient population.

  25. Currently, there is not an independently validated assessment tool available to evaluate breakthrough pain.


November Pain Events

2006 Geriatric Oncology Symposium

Deborah A. Boyle, RN, MSN- Keynote Address

Wednesday, November 8

8:30 a.m.–4:45 p.m.

Auditorium, University Center of Greenville

 

Focus on the Frail Elderly

Tuesday, November 14

9 a.m.–12 n.

Jo Bradley, MS, APRN, BC

PART 1: PAIN ASSESSMENT AND TREATMENT

PART 2: PRESSURE ULCER: EVIDENCE BASED PRACTICE OBJECTIVES

Community room–The Haven in the Village at Chanticleer, Greenville

 

SC Lowcountry Chapter ONS conference

Diagnosis Cancer: From Screening to Survival

Saturday, November 18

8 a.m.–4 p.m.

Holiday Inn, Mt Pleasant, SC

meaburn@msn.com

 

Acute Coronary Syndrome and Interventional Procedures

Wednesday, November 29

9 a.m.–4:30 p.m.

Jody Grahn, MSN, APRN, BC

11/29-3 A/B Employee Services Center, Greenville Hospital System, Greenville, SC

 

The Carolinas Center for Hospice and End of Life Care presents Breakfast for Brainiacs (phone conference) Palliative Care for Dementia

November 30

8:30–9:30 a.m.

Joshua Barclay, MD, Fellow, Palliative Medicine

cgoulet@carolinasendoflifecare.org

 

On-line Pain Management Course

Managing Chronic Pain: The Interdisciplinary Approach

Nathan J. Rudin, MD

University of Wisconsin, Madison School of Nursing

Estimated Completion Time: 1.5 hours

Contact Hours: 1.50

Fee: $20

Expiration Date: 12/01/2008

 

Objectives:

1.  Explain the ‘gold standard’ for managing chronic pain.

2.  Discuss the criteria for selecting optimal patient candidates for multidisciplinary approaches.

3.  Describe the common approaches utilized, their primary benefits and drawbacks.

4.  Identify approaches that may be used in the future.


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