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(258) Implementing evidence based pain competencies into prelicensure physical and occupational therapy curriculum
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Abstracts
The Journal of Pain
C. Ethical, Legal, Financial & Education
(259) Placebo use among medical providers: patient perceptions and the effects of a mechanism-based educational intervention
C01 Education: Professional and Lay
N Kisaalita and M Robinson; University of Florida, Gainesville, FL
(257) The Pain Undergraduate Research Experience (PURE): an innovative pipeline for future pain scientists and clinicians B Kolber and K Tidgewell; Duquesne University, Pittsburgh, PA Most medical schools fail to provide adequate training of clinicians in the treatment of pain. Similarly, despite the fact that over 1/3 of Americans suffer from chronic pain, NIH funding for pain represents only 1% of the NIH budget.1 To address these gaps in training and funding, we argue that exposing students to pain science early in their careers, at the undergraduate level, may be an effective method to develop a pipeline for future pain scientists and clinicians. In 2015, we implemented a full-scale launch of a cross-disciplinary and community-engaged biomedical summer research program in pain. The Pain Undergraduate Research Experience (PURE) summer program involved both offsite and on-site experiences with a focus on pain research to expose undergraduate students to the range of careers in the pain field. The objective of the 10-week long PURE program was to expose undergraduate students to pain basic science, clinical practice, and the patient experience. We wanted to entice top undergraduates to consider pain as a future area of study, practice, and/or research. Outcomes to be presented include student attitudes to patient needs, interest in pain research, confidence in describing pain to both experts and laity, and understanding of basic pain terminology. (1. Bradshaw et al, Journal of Pain, 2008.)
(258) Implementing evidence based pain competencies into prelicensure physical and occupational therapy curriculum S McNulty, A Burke-Doe, T Roberts, C Ingstad, C Ivey, K Johnson, S Laslovich, J Matthews, K Smith, J Warren, E Lowe, and A Edwards; University of St. Augustine for Health Sciences, San Marcos, CA
The International Association for the Study of Pain (IASP) and pain experts have provided coordinated guidelines and a framework for interprofessional pain education but exactly how these competencies would be implemented was not delineated. A team of physical and occupational therapy faculty completed a 2 step process to evaluate current pain content and test pain knowledge and attitudes to determine if curricula covers critical pain content. First, the faculty evaluated the curriculum by mapping it to the IASP core competencies to identify gaps. Second, students were evaluated on pain knowledge and attitudes using the City of Boston’s Rehabilitation Professional’s Knowledge and Attitudes Survey Regarding Pain (COBS) and statistical procedures were used to assess results. The purpose of this research study is to implement interprofessional core competencies in pain assessment and management for prelicensure occupational and physical therapy students as developed by the IASP. Mapping of the curriculum elucidated key gaps in competencies taught such as knowledge of central versus peripheral pain, the multidimensional nature of pain and medications appropriate for various types of pain. Two hundred forty physical and occupational therapy students completed the COBS survey (85.1% response rate). Over 87% of student’s overestimated the amount their patients would over-report pain and less than half of the students recognized that non-drug interventions were effective for both moderate and more severe pain. Findings from the surveys revealed that 85.2% of students overestimated the likelihood that patient use of opioids would result in addiction. Our findings indicate that existing curricula should be augmented with learning activities that incorporate pain competencies as next steps. To maximize the impact of prelicensure pain management efforts, competencies in pain education should be woven throughout the curriculum in didactic and case based learning opportunities.
Recent literature suggests that medical providers frequently use placebo treatments, often unbeknownst to patients. The ethics of interventional placebo use remains a debated topic, particularly within the realm of pain management, as placebo analgesic effects have demonstrated effect sizes comparable to active pain treatments. Moreover, recent research suggests that patients with chronic pain are open to placebo treatments under certain contexts, and find these interventions more acceptable when provided education about their psycho-neurobiological underpinnings. The current study sought to examine patients’ perceptions of healthcare provider placebo use frequency, and to determine whether these perceptions could be altered using a mechanism-based educational intervention. Patients with chronic musculoskeletal pain completed a comprehensive, web-based survey regarding placebo acceptability and perceived knowledge. In a survey subsection, patients rated how frequently they believed placebo treatments were used to manage chronic pain for six medical disciplines: physicians, dentists, physician assistants, nurses, physical therapists and chiropractors. Using a pre-post educational intervention design, patients completed the survey on two occasions; between first and second completions, patients were randomized to receive either a control educational prompt (n = 28) or the placebo educational intervention (n = 29). Results demonstrated that patients perceived significant differences in the frequency of placebo use across the provider disciplines, with the highest use among chiropractors and the lowest use among dentists. In addition, patients receiving the educational intervention rated placebo use significantly higher across all medical providers. Study findings support the extant literature on perceptions of placebo acceptability and knowledge among patients with chronic pain, and highlight the utility of a brief educational intervention. Additional research is needed to explore differences in placebo use across medical disciplines. Research Supported by Grant 5R01AT00142406 from the National Center for Complementary and Alternative Medicine (NCCAM) of the NIH.
(260) The interpretation of values education in a pain management class: a phenomenological study E Bernhofer; The Cleveland Clinic, Cleveland, OH Although hospitals may offer pain management education for nurses/clinicians, often there is only a slight improvement in pain care following class. It is known that personal values drive behavior and decision-making, but little has been taught or studied regarding the influence of clinicians’ personal values on how they treat pain. Therefore, a segment on personal values and pain management decision-making was added to the curriculum of a full-day pain management class at a large tertiary care medical center. The term ‘values’ was defined as the level of importance placed on an idea or belief. Following the class, a study using a qualitative phenomenological methodology was conducted to examine the pain-care decision-making experiences of twenty nurse-clinicians who participated in the class. Participants wrote out their answers to two open-ended interview questions. One of the themes that emerged from the data was Interpretation of Values indicating that respondents looked at ‘personal values’ in various ways that were or were not helpful: ‘‘Class helped me to understand my values and the possibility that my own prejudices could interfere with the patient’s pain treatment’’ and conversely, ‘‘I need something to offer more than just understanding my own values.’’ A majority (13/20) wrote that the lesson on values was helpful in their practice, but seven of those did not explain how. Only 4/20 defined the values that contributed to the care they provided such as the value of ‘‘respect their [patient’s] decisions’’. Implications for future instruction include clarifying the definition of values, discussing desirable values that may lead to optimal pain management decisions, and providing inspirational examples. More rigorous research is needed to
Abstracts
The Journal of Pain
C. Ethical, Legal, Financial & Education
(259) Placebo use among medical providers: patient perceptions and the effects of a mechanism-based educational intervention
C01 Education: Professional and Lay
N Kisaalita and M Robinson; University of Florida, Gainesville, FL
(257) The Pain Undergraduate Research Experience (PURE): an innovative pipeline for future pain scientists and clinicians B Kolber and K Tidgewell; Duquesne University, Pittsburgh, PA Most medical schools fail to provide adequate training of clinicians in the treatment of pain. Similarly, despite the fact that over 1/3 of Americans suffer from chronic pain, NIH funding for pain represents only 1% of the NIH budget.1 To address these gaps in training and funding, we argue that exposing students to pain science early in their careers, at the undergraduate level, may be an effective method to develop a pipeline for future pain scientists and clinicians. In 2015, we implemented a full-scale launch of a cross-disciplinary and community-engaged biomedical summer research program in pain. The Pain Undergraduate Research Experience (PURE) summer program involved both offsite and on-site experiences with a focus on pain research to expose undergraduate students to the range of careers in the pain field. The objective of the 10-week long PURE program was to expose undergraduate students to pain basic science, clinical practice, and the patient experience. We wanted to entice top undergraduates to consider pain as a future area of study, practice, and/or research. Outcomes to be presented include student attitudes to patient needs, interest in pain research, confidence in describing pain to both experts and laity, and understanding of basic pain terminology. (1. Bradshaw et al, Journal of Pain, 2008.)
(258) Implementing evidence based pain competencies into prelicensure physical and occupational therapy curriculum S McNulty, A Burke-Doe, T Roberts, C Ingstad, C Ivey, K Johnson, S Laslovich, J Matthews, K Smith, J Warren, E Lowe, and A Edwards; University of St. Augustine for Health Sciences, San Marcos, CA
The International Association for the Study of Pain (IASP) and pain experts have provided coordinated guidelines and a framework for interprofessional pain education but exactly how these competencies would be implemented was not delineated. A team of physical and occupational therapy faculty completed a 2 step process to evaluate current pain content and test pain knowledge and attitudes to determine if curricula covers critical pain content. First, the faculty evaluated the curriculum by mapping it to the IASP core competencies to identify gaps. Second, students were evaluated on pain knowledge and attitudes using the City of Boston’s Rehabilitation Professional’s Knowledge and Attitudes Survey Regarding Pain (COBS) and statistical procedures were used to assess results. The purpose of this research study is to implement interprofessional core competencies in pain assessment and management for prelicensure occupational and physical therapy students as developed by the IASP. Mapping of the curriculum elucidated key gaps in competencies taught such as knowledge of central versus peripheral pain, the multidimensional nature of pain and medications appropriate for various types of pain. Two hundred forty physical and occupational therapy students completed the COBS survey (85.1% response rate). Over 87% of student’s overestimated the amount their patients would over-report pain and less than half of the students recognized that non-drug interventions were effective for both moderate and more severe pain. Findings from the surveys revealed that 85.2% of students overestimated the likelihood that patient use of opioids would result in addiction. Our findings indicate that existing curricula should be augmented with learning activities that incorporate pain competencies as next steps. To maximize the impact of prelicensure pain management efforts, competencies in pain education should be woven throughout the curriculum in didactic and case based learning opportunities.
Recent literature suggests that medical providers frequently use placebo treatments, often unbeknownst to patients. The ethics of interventional placebo use remains a debated topic, particularly within the realm of pain management, as placebo analgesic effects have demonstrated effect sizes comparable to active pain treatments. Moreover, recent research suggests that patients with chronic pain are open to placebo treatments under certain contexts, and find these interventions more acceptable when provided education about their psycho-neurobiological underpinnings. The current study sought to examine patients’ perceptions of healthcare provider placebo use frequency, and to determine whether these perceptions could be altered using a mechanism-based educational intervention. Patients with chronic musculoskeletal pain completed a comprehensive, web-based survey regarding placebo acceptability and perceived knowledge. In a survey subsection, patients rated how frequently they believed placebo treatments were used to manage chronic pain for six medical disciplines: physicians, dentists, physician assistants, nurses, physical therapists and chiropractors. Using a pre-post educational intervention design, patients completed the survey on two occasions; between first and second completions, patients were randomized to receive either a control educational prompt (n = 28) or the placebo educational intervention (n = 29). Results demonstrated that patients perceived significant differences in the frequency of placebo use across the provider disciplines, with the highest use among chiropractors and the lowest use among dentists. In addition, patients receiving the educational intervention rated placebo use significantly higher across all medical providers. Study findings support the extant literature on perceptions of placebo acceptability and knowledge among patients with chronic pain, and highlight the utility of a brief educational intervention. Additional research is needed to explore differences in placebo use across medical disciplines. Research Supported by Grant 5R01AT00142406 from the National Center for Complementary and Alternative Medicine (NCCAM) of the NIH.
(260) The interpretation of values education in a pain management class: a phenomenological study E Bernhofer; The Cleveland Clinic, Cleveland, OH Although hospitals may offer pain management education for nurses/clinicians, often there is only a slight improvement in pain care following class. It is known that personal values drive behavior and decision-making, but little has been taught or studied regarding the influence of clinicians’ personal values on how they treat pain. Therefore, a segment on personal values and pain management decision-making was added to the curriculum of a full-day pain management class at a large tertiary care medical center. The term ‘values’ was defined as the level of importance placed on an idea or belief. Following the class, a study using a qualitative phenomenological methodology was conducted to examine the pain-care decision-making experiences of twenty nurse-clinicians who participated in the class. Participants wrote out their answers to two open-ended interview questions. One of the themes that emerged from the data was Interpretation of Values indicating that respondents looked at ‘personal values’ in various ways that were or were not helpful: ‘‘Class helped me to understand my values and the possibility that my own prejudices could interfere with the patient’s pain treatment’’ and conversely, ‘‘I need something to offer more than just understanding my own values.’’ A majority (13/20) wrote that the lesson on values was helpful in their practice, but seven of those did not explain how. Only 4/20 defined the values that contributed to the care they provided such as the value of ‘‘respect their [patient’s] decisions’’. Implications for future instruction include clarifying the definition of values, discussing desirable values that may lead to optimal pain management decisions, and providing inspirational examples. More rigorous research is needed to