2009 CCOE Award Recipients
Pain Management Center
M.D. Anderson Cancer Center, Houston, TX
The unique mission at the Pain Management Center in the M.D. Anderson Cancer Center is to manage cancer pain. The center provides a full spectrum of multidisciplinary care for both acute and chronic cancer pain. To carry out this mission, the program utilizes interdisciplinary chronic pain team members who provide comprehensive pain evaluation and treatment, medical management, psychological evaluation and therapies, and more. The Pain Medicine Center believes adequate pain relief for cancer patients is integral to cancer treatment. The team oversees the assessment and management of cancer pain from the time of diagnosis, through curative treatment, during survivorship, and at the end of life. In order to focus on this continuity of care, the group utilizes anesthesiologists, physical medicine and rehabilitation practitioners, neurologists, nurses, psychologists, social workers, and chaplains.
The center also focuses its efforts on advancing scientific knowledge related to pain and providing information to colleagues through clinical research, peer-reviewed articles, and presenting inservice programs and lectures. The center's clinical research focuses on chemotherapy-induced neuropathic pain, fatigue, breakthrough pain, and noninvasive and interventional procedures for pain control. Basic science research tackles cellular and molecular mechanisms of pain and the development of novel pain analgesics. And educational research is highly concentrated in team training.
In addition, the center hosts visiting medical and nursing colleagues from throughout the world. They train 6 fellows and 50 residents in clinical care annually. Twenty basic science fellows and graduate students receive training each year, too.
They are very active with state pain management initiatives, leading acute and chronic cancer pain care workshops for local health organizations in Texas. The center's team wrote a pain medicine guidebook which was distributed to more than 30,000 physicians in Texas. In addition, they contributed to the Texas Pain Society Opioid Agreement/Informed Consent. The team members at the center are the founders of the Gulf Coast Cluster for Translational Pain Research and will host the 2nd Annual Gulf Coast Translational Pain Research Symposium in 2009.
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center, New York, NY
The Beth Israel Medical Center's Department of Pain Medicine and Palliative Care (DPMPC) offers a comprehensive inpatient and outpatient pain program. Established 11 years ago as the first department in a University Hospital devoted to pain management and palliative care, the DPMPC has created a unique model, which links two clinical divisions (Pain and Palliative Care) and three academic divisions (Research, Institute for Education, and Pain and Emergency Medicine Institute) under one leadership reporting directly to hospital senior management.
Clinically, the DPMPC oversees interdisciplinary inpatient consultation teams for acute perioperative pain, chronic pain, and palliative care; an 18-bed inpatient unit for pain, palliative care and hospice patients; and outpatient practices in pain management and in symptom control and palliative care. Among the innovations are a nurse practitioner-led "fast track" program to expedite appointments, a program in transcranial direct current stimulation, on-site acupuncture, and a Pain and Fatigue Study Center. It collaborates with other organizations, providing pain care to the HIV/AIDS clinic and to a nearby ambulatory rehabilitation facility, and physician coverage to a home care program in palliative care.
Academically, the DPMPC is home to two accredited physician training programs (pain management, and hospice and palliative medicine); a nurse fellowship and social work fellowship; a caregiver program and web-based public and professional education (www.StopPain.org); and a large clinical research program. It maintains a unique Asian Family Caregiver Program, has a faculty that educates and volunteers in national and international committees, and publishes the Journal of Pain and Symptom Management. It also has a nationally-recognized quality improvement (QI) program, which guides pain-related activities in the department, the hospital and the related integrated health system.
University of Virginia Division of Pain Medicine
University of Virginia Health System, Charlottesville, VA
The Division of Pain Medicine and the Pain Management Center at the University of Virginia Department of Anesthesiology, the University of Virginia Health System, encompass a pain team that cares for patients of all ages and conditions with acute and chronic pain in multiple settings, focusing on the individual patients specific needs and goals for treatment. Since its early inception, the multidisciplinary pain program has focused on the patient in the broader context of their psychosocial lives, involving coordination of psychological, physical, and social aspects of the patient's pain. The program utilizes close collaboration with an addictionologist in order to facilitate safe management of all patients, no matter their level of complexity of treatment.
The Center is committed to education. Patient encounters focus on teaching the patients about their pain and the rationale for the care plan, as well as disseminating informative instruments. Care plans routinely incorporate the spectrum of treatments from yoga to interventions. The faculty and fellows educate referring physicians about pain management to optimize referrals of patients with persistent pain. Faculty and fellows lecture within the institution as well as at state, regional, national and international venues. Faculty members are involved in multiple national pain organizations, including the ASA, ABA, AAPM, ASRA, and ABPM. The team gains knowledge from weekly educational conferences, national meetings, and literature review, and incorporates that knowledge into treatment decisions. Electronic medical records allow efficient sharing of the information with all involved in the treatment plan. The Division is coordinating a regional consortium for pain fellows in 2009.
Overall, the program represents a full, multidisciplinary team that is invested in the goals and approaches of the program, including coordination of care with a wide range of consultative services.
Center for Pain Management
Rehabilitation Institute of Chicago
Comprehensive care is based on a biopsychosocial assessment and treatment approach. The Center for Pain Management's (CPM) evidence-based model is facilitated by close collaboration with the Rehabilitation Institute of Chicago's (RIC) pain research center, the Center for Pain Studies (CPS). The CPM offers the majority of services employing a number of pain experts in a variety of disciplines, including physical medicine and rehabilitation, neurology, anesthesia, pain psychology, and allied health. The interdisciplinary approach begins with an evaluation from a physiatrist, a pain psychologist, and a vocational counselor. Formal programs include full and half-day individual and group-based treatment programs.
In addition, the team works closely within the RIC's continuum of care, including the RIC inpatient rehabilitation hospital, Sport and Spine Rehabilitation, Women's Health, Arthritis Centers, and amputee program. The CPM also educates others on the art of multi- and interdisciplinary care as a training center for 5 fellows in the combined ACGME accredited multidisciplinary pain fellowship in collaboration with Northwestern University's departments of anesthesia and physical medicine and rehabilitation.
In 2008, the CPM moved to a state-of-the-art, 12,000 square foot facility to accommodate increasing patient volumes and space needs, which allows the center to expand the number of programs it offers, such as an adolescent pain program, expand educational duties, including pain psychology training, and expand clinical outcomes and drug trial studies.
The CPM educates patients and clinicians in an annual educational series "Controversies in Pain Management," devoted to many different topics, including opioid management. The CPM has been featured in a number of national and international print articles and on national television news programs. Its strong involvement in education, research, and dissemination efforts shows the center's commitment to advancing and applying scientific knowledge related to pain.
"Rehabilitation is a process of helping patients to take an active role in returning to greater physical and psychosocial function." — Steven Stanos DO, Medical Director, Center for Pain Management.
University of California-Los Angeles Pediatric Pain Program
Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA
The University of California-Los Angeles (UCLA) Pediatric Pain Program (PPP) at the UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA is comprised of an interdisciplinary group of clinicians and investigators who are focused on research and education for children with pain. The PPP integrates research and clinical care through application of studies to its daily patient care. For example, an NIMH-funded study investigating the biopsychosocial model of pediatric pain care, included qualitative, transactional, and quantitative analyses, and included an historian, anthropologist, sociologist, pediatrician, and psychologists. Our PPP includes Iyengar yoga, craniosacral therapy, hypnotherapy, biofeedback, acupuncture, art and music therapy, mindful awareness, as well as medical, psychological, psychopharmacological, and physical therapies. The program strives to create a paradigm shift in children's and parents' ideas about pain, recovery, and function, examines their clinical processes, tests new interventions, and changes practice through new findings.
Treatment begins with a two-hour consultation, which allows time for patients and parents to tell their stories about pain, as well as an opportunity to understand the child's pain, disability, and factors needing modification to reduce suffering and enhance function. Findings and hypotheses are integrated into a treatment plan with modification through case discussions at weekly interdisciplinary team meetings. By working within the same pain model with good team communication, each practitioner has a consistent, unified message, which provides patients and their families support from the pain team while also fostering child and parent independence. The program works closely with referring physicians and patients' community clinicians to keep the therapy plan focused and collaborative.
The PPP also carries out research on effectiveness and mechanism of a variety of complementary and alternative therapies, such as Iyengar yoga, acupuncture, hypnotherapy, and meditation in children. This research is carried out both at UCLA as well as in collaboration with several non-profit organizations, including UCLArts, InnerKids, and the Children's Music Fund. Examples of such programs include drumming circles, programs to enhance mindful awareness in school children and to reduce children's suffering through music. The PPP also educates the public through local and national media, the PPP Web site, and conversations with legislators to enhance pain care policies.
Walter Reed Army Medical Center, Washington, DC
National Naval Medical Center, Bethesda, MD
The joint Walter Reed Army Medical Center (WRAMC) and National Naval Medical Center (NNMC) pain team is meeting, treating and researching the pain associated with combat trauma. The use of forward deployed surgical units has resulted in unprecedented survival rates among severely injured military personnel, many of whom experience significant pain. Pain care is provided across the continuum, beginning at point of injury on the battlefield and continuing throughout the recovery, rehabilitation and reintegration process.
The joint WRAMC/NNMC Pain Service provides care to more than 11,000 patients annually. Comprehensive services offered include pain consultations, ultrasound-guided placement of continuous peripheral nerve blocks, diagnostic and interventional procedures for chronic pain conditions, and the use complementary and alternative treatment techniques. In addition, the pain team has implemented the use of epidurals, continuous peripheral nerve blocks, and IV ketamine infusions in field hospitals and on evacuation aircraft, resulting in advanced pain care being deployed far forward of the combat casualty receiving hospitals in the United States.
The Wounded Warrior Primary Care Clinics at WRAMC and NNMC provide care to outpatient troops who have been injured. These troops are assigned a case manager, who facilitates communication and coordinates the entire health care team, including pain management. This coordinated approach optimizes the recovery of injured troops.
The Army/Navy pain team's dedication to the advancement of knowledge regarding pain care across the continuum is exemplified in the Regional Anesthesia and Analgesia Tracking System, which houses the largest database of combat casualty pain in the United States. The joint WRAMC & NNMC pain team is setting precedent for the value of early and aggressive treatment of acute pain; maintaining pain control throughout evacuation; and comprehensive, multi-disciplinary pain management upon return to the United States.