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11 Articles in Volume 15, Issue #4
Biofeedback: Information for Pain Management
False-Positive Screen for Marijuana
Hypnosis: Tool for Pain Management
Managing Headaches in Children and Adolescents
National Pain Strategy—A Positive Step Forward
Neuropathy in HIV Patients: Pain Management Concerns
Novel Treatment Device for Phantom-Limb Pain
Pain in Children
Pain Studies Program Emphasizes Pain Education as a Public Health Imperative
Targeting a Saboteur of Surgical Outcomes: Pain Catastrophizing
The History of Prolotherapy

Pain Studies Program Emphasizes Pain Education as a Public Health Imperative

An interview with Daniel B. Carr, MD

The Pain Research, Education, and Policy (PREP) program at Tufts University School of Medicine, Boston, Massachuesetts takes a unique approach to pain education. Practical Pain Management spoke with founding director of the PREP program Daniel B. Carr, MD, about the goals and vision of the program. Dr. Carr is Professor of Public Health and Community Medicine at Tufts University, where he also is a Professor of Anesthesiology and Medicine.

Q: What is the Pain Research, Education, and Policy (PREP) program and what makes it unique among pain fellowship programs?

Dr. Carr: The PREP program is the first and only interprofessional postgraduate pain curriculum of its kind in the United States. Started in 1999, the program is designed to prepare clinicians, researchers, and advocates with knowledge to advance their careers and implement new models of more effective pain control.

The PREP program is the only pain education program that has its primary home within a department of public health. Housed in Tufts Medical School’s Department of Public Health and Community Medicine, the program emphasizes pain as a public health issue and pain education as a public health imperative. These ideas were ahead of their time at the start of our program but subsequently have been advanced in white papers from the Institute of Medicine, the Mayday Fund, the American Academy of Pain Medicine, and the World Health Organization.1-4

These white papers document the wide prevalence of pain as well as the major economic and human burden resulting from the undertreatment of pain. These ideas also are emphasized in the recently released draft of the National Pain Strategy prepared by the National Institutes of Health for the Department of Health and Human Services.5 (See Editor's Memo).

Other concepts linking pain and public health include the importance of prevention or early intervention to keep acute pain from becoming chronic, the importance of optimal pain control for patient-centered care, disparities in pain assessment and treatment experienced by minorities and other under-represented groups such as women or those at the extremes of age, and the need “to adopt a population-level prevention and management strategy.”1

Related to all of these concepts is the growing perspective that access to pain control is a fundamental human right that fits within a larger social justice framework. The PREP program uses the paradigms of research, education, and policy to examine how different types of pain can be more effectively prevented, treated, and managed at the population, healthcare system, and individual levels, to benefit the public’s health.

The PREP program also is unique in terms of its curriculum and the array of interdisciplinary educational opportunities it offers (Table 1). Our program benefited enormously by the recruitment of an Academic Director several years ago. Libby Bradshaw, DO, MS, is a long-term public health faculty member. In addition to educational expertise, Libby brings a background in osteopathic medicine and extensive clinical experience in emergency medicine and family practice. Her guidance, along with that of a core PREP faculty group spanning disciplines of nursing, medicine, dentistry, pharmacy, palliative care, and integrative medicine (including acupuncture), has been invaluable in refining our curriculum as well as managing a myriad of student-based and administrative issues. The PREP curriculum is based on helping clinicians and nonclinicians understand biological, social, and psychosocial factors shaping the pain experience. Pain is placed in the broader context of culture, social determinants of health, population health, health care delivery, and interprofessional team involvement in pain management.

Q: What are the vision and mission of the PREP program?

Dr. Carr: The vision of the PREP program is to improve the health of the public by promoting the fundamental human right to be free from needless pain. The mission of the program is to champion an interprofessional educational program that addresses the multi-dimensional public health burden of pain by preparing diverse learners to contribute with expertise and compassion to pain research, education, and policy.

Q: Who enrolls in the PREP program?

Dr. Carr: The PREP program was designed for mid-career health care providers, who come into the program with their own concerns and insights on pain. Our program is not intended to gain initial licensure or clinical board certification, as most of our students are experienced practitioners and already licensed.

Our students have included nurses, physicians, dentists, physical therapists, nurse practitioners, physician assistants, pharmacists, researchers, acupuncturists, occupational therapists, massage therapists, social workers, palliative care providers, health advocates, and other professionals.

Our first 2 graduates were a woman internist from Saudi Arabia who returned there to set up a successful clinic focusing upon women’s pain, and a Scottish pharmacist who had just emigrated to the United States. The latter person became one of the editors of the Cochrane Collaboration’s Pain, Palliative and Supportive Care Review Group, while continuing to work full time as a hospital pharmacist at Tufts Medical Center. Increasingly, new and recent college graduates have used our program as a transition into graduate or medical school. Several enrollees were international medical graduates who went on to enter U.S. residency programs.

The program offers a blended learning model in which most courses start with a 1- to 2-day onsite weekend session followed by online learning or videoconferencing sessions, to allow working health care professionals to fit the courses into their workweek.

Q: What does the curriculum entail?

Dr. Carr: We address a range of pain-related topics such as the neurobiology of pain, the ethical and sociocultural aspects of pain, palliative care and end-of-life issues, public policy and legislation, and advocacy and communication. This curriculum allows our graduates to become resources on pain issues at their institution, including serving as educators for both their colleagues and the public. Our graduates include nurse educators for pain-related issues within their institutions.

We also address research methods, clinical issues, and the pharmacology of pain. In addition, students also study methods for evaluating how cultural, social, and economic factors affect pain, its sequelae, and its treatment. Students work closely with faculty on ongoing research activities and may develop their own independent research projects.

Although not curriculum per se, we have been very fortunate to have hosted a variety of visiting lecturers who are eminent individuals in the field of pain internationally. Visiting lecturers from the past few years include Edward Bilsky, PhD, Scott Fishman, MD, Rollin (Mac) Gallagher, MD, MPH, Judy Foreman, Henrik Kehlet, MD, PhD, Beth Murinson, MD, PhD, Rosemary Polomano, PhD, RN, FAAN, William Schmidt, PhD, Yoram Shir, MD. Videos of some of these talks may be viewed on our Web site (http://goo.gl/bFVNQn).

Q: What achievements have alumni of your program gone on to make?

Dr. Carr: Our graduates have gone on to a wide variety of worthwhile endeavors. Some of our graduates have advanced within the structure of the organization in which they work, such as by becoming educational or resource nurses or pharmacists who are the local pain experts and pain control champions. Consistent with our role of “training the trainers”, some work in health policy and hold leadership roles in health care systems including the Veterans Administration.

Other graduates are implementing what they learned in our program in clinical practice, including acupuncture and integrative medicine, thanks to our long-standing collaboration with the New England School of Acupuncture. Still others have become active in health communications through blogs or Web sites. Several work in the pharmaceutical or medical device industry, or have gone on to graduate programs including medical school.

Because our program enrolls a diverse interprofessional group of students, there is no single cookie cutter category into which our graduates fall. In general, our program allows graduates to advance further along whatever trajectory they choose. We encourage students with diverse backgrounds and interests to enroll and expect that they will have a range of contributions to pain control after graduation.

Q: What other aspects of the PREP program would you like to emphasize to readers of Practical Pain Management?

Dr. Carr: We are happy to enroll students with varying professional backgrounds and goals in the field of pain control. We have found that it is better not to apply one single goal of the program to all enrollees, but instead to accommodate the varying plans and interests of an entrepreneurial, outside-the-box group of students.

In addition, given the strong public health orientation of our program, graduates earn the authority and credentials necessary to influence and craft policy at the organizational, state, and federal levels.

Last updated on: February 19, 2016
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