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Pain management seminar slated for Sept. 6 by Heather Woolwine Public Relations Pain. We’ve all felt it, but to experience it is  different for each of us. While our experiences with pain may vary and must be  endured and overcome, most of us never invited pain.   September is Pain Awareness Month, and Karanne Campbell, certified pain management specialist and nurse practitioner, and Sheri Stewart, R.N., certified pain management specialist and master’s level pediatric pain management coordinator, want to remind the MUSC community about pain’s prevalence and what MUSC is doing to better manage it for patients and their care providers.   On Sept. 6 and 7, registered participants in a pain seminar will learn more about developing appropriate pain management techniques for a variety of patients. Lunch-and-learn sessions on various pain-related topics will be offered throughout the month.   With only a year or so under its belt, the collaborative pain management program at MUSC is making headway on a tough topic. Pain is vastly misunderstood in the medical community, not from an intentional lack of concern, but due to gaps in pain management training.   “There is not a lot of pain management training in the current  curriculum for people on the front line with pain everyday,” Stewart said. Meanwhile, this lack of training leaves the door wide open for physicians and other practitioners to form incorrect assumptions about people in pain, and therefore they do not optimally treat it.   Campbell’s job as the adult pain coordinator for the hospital is to educate nurses and other health care practitioners about how to recognize pain, score it and manage it. She also consults with physicians and other concerned practitioners for recommendations on pain and symptom management for patients throughout the hospital.   Having spent nearly a year at MUSC, Campbell said it has taken some time to build her practice, but she’s optimistic about the climate at MUSC. While some notable strides have been made in the last couple of years, both Stewart and Campbell look forward to the progress that remains.   “We’re really working to improve nurse documentation-related pain and improving patient education material to assist the nursing staff,” Stewart said. “We’ve had an  increase in the number of consults all across the spectrum to treat both adults and children, so it’s great to see that our system seems to be working. And I think that it has helped for people to understand that managing pain is not always about giving medication. We use guided imagery, breathing and relaxation techniques, also.”   Adult and pediatric pain management services include developing relationships with patients and units to better manage and understand pain, assisting with outpatient cases and helping with follow-up, and acute pain management services for inpatients. The pain management team provides nurses, physicians, technicians and many other disciplines skilled in pain management techniques including drug conversions, taking accurate pain histories, serving as patient advocates, and monitoring medication dosing pre- and post-hospitalization. The pain management team  includes Stewart, Campbell, Winnie Hennessy, R.N., Palliative Care Program, Rick Smith, M.D., director of MUSC’s pain clinic, and other supporters in clinics and units across campus.   “[Most] pain is not necessary with today’s advanced techniques and medications,” Stewart said. “We have put together a multidisciplinary team of physicians, child life specialists, pharmacists, psychologists, nurses and social workers here in the Children’s Hospital to address all aspects of pain in children with the goal of increasing communication and understanding of pediatric pain.”   Pain and Addiction Stewart chairs the MUSC Pain Committee, which is responsible for policies that reach across the institution. “There is so much more to pain than people, including health care professionals, realize,” she said. “It can be a disease. One of the hardest things for people who suffer from chronic pain is the social stereotype that they are complainers or drug addicts, because they need help in managing their pain. There are differences among dependence, tolerance and addiction that often are not recognized, even by health care workers.”   For instance, dependence means that a person’s physiology becomes so accustomed to a substance that he or she would experience withdrawal symptoms if the medication were stopped. Withdrawal (or abstinence syndrome) is not necessarily an indicator of addiction. Addiction occurs when a psychological dependence upon a substance facilitates the use of that substance for unintended purposes, and causes continued use despite the harm it causes. Tolerance describes another physiological phenomenon characterized by a decrease in the therapeutic effect of a substance given stable dosage levels, but doesn’t always indicate an addiction.   Characteristics of addiction are not just characteristics of abuse of opiates but also can be manifested through other agents of abuse like food, exercise, sex and alcohol.   “A person can become physically dependent on a substance taken for pain and still not become an addict,” Hennessey said. “They are two completely different things. If all health care professionals would remember this and believe in it, pain management everywhere would be a much better system.”   According to Campbell, only about 1 percent of the population who seeks pain medication is doing it for the purpose of scoring an illegitimate prescription.   “If a patient says he has pain, then he has it in some form or another,” Smith said. “Pain always has a right to be addressed, but not all pain can be eliminated. Even our many state-of-the-art techniques still don’t allow elimination of all pain. Of course, total elimination is a goal of ours and the field is definitely growing in terms of what we have to offer patients”   Stewart said that pain is whatever her patients say it is, provided they are given the proper tools to explain in the best way possible what they are feeling.   “The gold standard in pediatric pain management is not relying so heavily on the physical indicators, instead using self-report, parent report and behavioral cues to gauge pain. Adults are the same except they get numeric pain rating scales or, in case of cognitive deficits, facial expression scales,” Stewart said.   Even after clinicians agree that a patient is in pain, treatment of the pain is highly varied based on a person’s disease, symptoms and life stage.   “I think it’s a safe assumption to say that just about all pain can be managed,” Hennessy said. “But patients must understand that what’s offered only works if they are compliant, and also that some conditions are lifelong and that there will be good and bad days.”   Stewart and Campbell said they were pleased to notice the increasing amount of attention that pain management is receiving throughout campus, but they both want more for MUSC. “Our service has been growing steadily. The success has been the result of better pain management one patient at a time…Our interdisciplinary pain management team is changing the way that health care providers, patients and families think about and address pain. Our goal is to put MUSC on the map as a center for excellent pain  management and education. We are sponsoring a pain education conference featuring Chris Pasero in September, (and) we have more than 400 nurses, pharmacists, and even a  respiratory therapist attending from four different states.”   Campbell is planning to start a chapter of the American Society of Pain Management Nurses on campus and said that membership is open to anyone interested in learning more about pain management. For information, e-mail campbee@musc.edu. Pain Myths Some common myths associated with those who suffer from chronic or acute pain include: Adults who ask for more pain medication are addicts exhibiting drug-seeking behavior. The reality is that only 1 percent of these adults are addicts. Children and the elderly don’t feel pain. A child’s nervous system may operate a little differently than an adult’s, but that does not mean that the pain isn’t there, it’s just different. This belief can be perpetuated, because children often lack the verbal skills to convey the level of pain that is felt. People assume that someone is an addict if he continues to need higher doses of pain medication. The longer a person is on a particular pain medication, the more that person may require to get the same pain-relieving effect. Contrary to some beliefs, people with pain are not after a euphoric high,  rather, they get pain relief without any euphoria. Children lie about pain. The opposite seems to be true, that children are more prone to lie about not having pain, because of fear of going to the hospital or undergoing certain procedures. If a child takes pain medication, he will become addicted. This  is not true. There are differences between dependence, addiction and tolerance. Lunch and Learn sessions Learn about pain issues and receive a free lunch from noon to 1 p.m. Sept. 8, Room 204, CH --Cancer Pain: Elisabeth Mouw, PharmD --Pharmacology of Pain Medications: Jill Thompson, PharmD Sept. 8, 2W Amphitheater --Forum for questions on pain management and specifics for representatives from Purdue-oxycotin Sept. 12, Room 841, CH --Epidurals: Arthur R. Smith, M.D. --Pain Forum: Issues that affect you Sept. 12, 2W Amphitheater --Forum for questions on pain management and specifics for Palmetto Infusion Sept. 20, Room 841, CH --Intrathecal Pumps: Medtronic --Non-Pharmacological Interventions: Stephanie L. Mishoe and Betsy McMillan, child life specialists Sept. 20, Room 102, Education Center/Library --Forum for questions on pain management and specifics for Medtronic Intrathecal Pumps Sept. 28, Room 204, CH --Sickle Cell Pain: Sherron Jackson, M.D. --Post-operative Pain: Kathy H. Chessman, PharmD Sept. 28, 2W Amphitheater --Forum for questions on pain management and specifics for Prialt   For more information, e-mail Sheri Stewart at stewars@musc.edu.     Friday, Sept. 1, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.