- Email: [email protected]
(260) The interpretation of values education in a pain management class: a phenomenological study
S40
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
determine which personal values and ethical interpretations support optimal pain management and how to measure the effect on patient pain care when clinicians are boldly and clearly taught those values.
(261) The development of 3D printed spine training models for educational purposes
The Journal of Pain
S41
Progress Reports. CX2 grantees met 10/26-27/2015 for a similar session. A total of 14 grantees will be sharing insights about barriers and facilitators of care, with models for improvement that others can employ. I-2 grantees present final results/reports September 2016; CX2 grantees follow April 2017. Results from these collaborations and the 14 grantees will be shared with the CME/CPD enterprise.
X Tian, J Caldwell, D DeKorte, and J Mooney; Penn State Hershey Medical Center, Hershey, PA
Interventional spine training programs encounter spine conditions with varying levels of complexity in an unpredictable fashion. There are few, if any, options for economical, commercially available, complex spine models to teach and evaluate trainees. This makes standardized skill assessment difficult. The goal of this project was to develop a standardized method of skills assessment, available nationally and internationally, at reasonable expense. After IRB approval, patient cases were identified with varying levels of spinal anatomic complexity as templates for model building. Imaging data of selected cases were obtained, and spine anatomy was isolated for reproduction using 3D printing and other rapid prototyping techniques. A torso model was concurrently developed to match the models. Trainees will perform clinically relevant tasks under fluoroscopy for skill evaluations in these reproducible models. This will allow standardized assessment of training across clinical locations and with lower cost of providing clinical education. This may help ensure proper progress during training, and adequate clinical skills in trainees. These may ultimately translate into improved patient care. Evaluations by experienced clinical providers are underway to assess each model for fidelity, utility and the level of difficulty to perform tasks. The three best models will be selected to create a Clinical Performance Evaluation Tool. This Clinical Performance Evaluation Tool will be validated by attendings as well as trainees at multiple institutions. The data for 3D printing of these spine models will be made available under a creative commons license, without fees. Given the expected reproducibility of these models many sites, both nationally and globally, may be able to incorporate these models into their training programs at little cost.
(262) Building collaborations for improving pain management employing learning and change strategies R Kristofco and S Rodrigues; Independent Grants for Learning and Change Pfizer Inc, New York, NY
Collaboration is an approach to problem-solving and practice improvement for care of pain patients. Needs assessment and identification of practice gaps support learning and change strategies to advance care. New models for partnership and industry independent grant making have emerged to enable new collaborative networks to explore this approach. Two collaborations, one addressing the advancement of inter-professional learning and practice (I-2) and another focusing on physician groups and systems of care (CX2), are highlighted here. These collaborations are partnerships between the California Academy of Family Physicians, Healthcare Performance Consulting, Interstate Post Graduate Medical Association and Nurse Practitioners Heathcare Foundation (I-2) and CAFP and CAPG (an organization of accountable physician groups) (CX2) and Pfizer Independent Grants for Learning and Change (IGLC).Content experts developed criteria, objectives and expected outcomes published in broadly disseminated Request for Proposals (RFP). Post-RFP calls answered respondents’ questions. Grant review panels, established by the partners included education, research, clinical, IPE/ IDE, systems, QI and measurement experts, reviewed of Letters of Intent and full proposals. Feedback was provided to applicants at both stages and the panel made award selections. CAFP+Partners built infrastructure for grantee/partner check-in calls, webinars, F2F meetings, wiggio and IGLC communications. Outcomes strategies to measure success on goals were designed. I-2 grantees met 2/9-10/2015 for sessions on metrics/measures, recruitment and data collection. They presented their projects with time for consultation, planning and group feedback. I-2 has completed two webinars: The Role of IPD-IDE and Grantee
C03 Economic Issues in Pain Management (263) A model to quantify potential medical events avoided and cost savings from abuse deterrent opioids A White, M Yenikomshian, M Carson, E Masters, and C Roland; Analysis Group, Inc., Boston, MA
A previously published model for estimating potential medical events avoided and cost savings to the United States (US) with the introduction of extended-release (ER) abuse-deterrent opioids (ADOs) was updated by incorporating new methods of estimating abuse deterrence from human abuse liability studies (HALs). An Excel model was developed to estimate reductions in abuse-related events and annual savings for the US. Model inputs included: opioid abuse prevalence, ADO cost and effectiveness and costs associated with opioid abuse-related events. Costs and prevalence were based on published administrative claims database analyses, substance abuse treatment center data, and national surveys. Differences in ADO and non-ADO positive subjective measures scores from HALs were used to estimate reductions in non-medical use (NMU) associated with ADOs. Direct (medical and drug) and indirect (work loss) cost savings (2014 USD) and abuse-related events were estimated assuming the entire ER opioid prescription (brand and generic) market is replaced by ADOs. Most (96%) ER opioid prescriptions (2Q 2013– 1Q 2014) are comprised of oxycodone, morphine, transdermal fentanyl, and methadone. Generics comprise 71.4% of all ER opioid prescriptions. Oxycodone consists almost entirely of a branded ADO, whereas others consist almost entirely of generic non-ADOs. Replacing the ER opioid market with ADOs is estimated to avoid annual abuse-related medical events by approximately 13-31% (e.g., 78,000–186,000 emergency department visits) and annual medical cost savings are approximately $550M-$1,300M, depending on ADO technology (physical barrier or agonist/antagonist). Total net savings vary depending upon ADO price relative to the non-ADO generics. Modeling the medical and economic impact of replacing the non-ADO ER opioid market with ADOs resulted in 13%-31% of abuse-related medical events avoided and annual medical cost savings of up to $1.3B. More events are avoided with the agonist/antagonist ADO technology. Total net savings are dependent upon the ADO price relative to non-ADO generics.
C05 Impediments to Opioid Use (264) Managing pain: the experiences of community dwelling Black elders S Robinson; University of Michigan Medical School, Ann Arbor, MI Black elders represent a disparate population that has been shown to consistently have unmet pain needs. These adults are less likely to report pain concerns to providers and generally receive poorer quality of care with less access to services as compared to White elders. To better understand the pain management experiences and concerns of Black elders, an ethnographic study was completed within an urban, low-income, elder housing facility. 106 participants completed a questionnaire comprised of a demographic tool, the PROMIS Global Health Scale (PROMIS), the Brief Pain Inventory (BPI), and the Psychological Stress Measure (PSM-9). Additionally, participant observation, informal interviews, and 20 formal recorded interviews with individuals identified as having pain were completed. Results indicate that 86 percent of the sample had an average pain rating of 7 on a 0 to 10 scale with 5 pain sites. Pain interference, was about 4, on a 0 to 10 scale. Specific areas of interference included general activity (5.59), walking
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
determine which personal values and ethical interpretations support optimal pain management and how to measure the effect on patient pain care when clinicians are boldly and clearly taught those values.
(261) The development of 3D printed spine training models for educational purposes
The Journal of Pain
S41
Progress Reports. CX2 grantees met 10/26-27/2015 for a similar session. A total of 14 grantees will be sharing insights about barriers and facilitators of care, with models for improvement that others can employ. I-2 grantees present final results/reports September 2016; CX2 grantees follow April 2017. Results from these collaborations and the 14 grantees will be shared with the CME/CPD enterprise.
X Tian, J Caldwell, D DeKorte, and J Mooney; Penn State Hershey Medical Center, Hershey, PA
Interventional spine training programs encounter spine conditions with varying levels of complexity in an unpredictable fashion. There are few, if any, options for economical, commercially available, complex spine models to teach and evaluate trainees. This makes standardized skill assessment difficult. The goal of this project was to develop a standardized method of skills assessment, available nationally and internationally, at reasonable expense. After IRB approval, patient cases were identified with varying levels of spinal anatomic complexity as templates for model building. Imaging data of selected cases were obtained, and spine anatomy was isolated for reproduction using 3D printing and other rapid prototyping techniques. A torso model was concurrently developed to match the models. Trainees will perform clinically relevant tasks under fluoroscopy for skill evaluations in these reproducible models. This will allow standardized assessment of training across clinical locations and with lower cost of providing clinical education. This may help ensure proper progress during training, and adequate clinical skills in trainees. These may ultimately translate into improved patient care. Evaluations by experienced clinical providers are underway to assess each model for fidelity, utility and the level of difficulty to perform tasks. The three best models will be selected to create a Clinical Performance Evaluation Tool. This Clinical Performance Evaluation Tool will be validated by attendings as well as trainees at multiple institutions. The data for 3D printing of these spine models will be made available under a creative commons license, without fees. Given the expected reproducibility of these models many sites, both nationally and globally, may be able to incorporate these models into their training programs at little cost.
(262) Building collaborations for improving pain management employing learning and change strategies R Kristofco and S Rodrigues; Independent Grants for Learning and Change Pfizer Inc, New York, NY
Collaboration is an approach to problem-solving and practice improvement for care of pain patients. Needs assessment and identification of practice gaps support learning and change strategies to advance care. New models for partnership and industry independent grant making have emerged to enable new collaborative networks to explore this approach. Two collaborations, one addressing the advancement of inter-professional learning and practice (I-2) and another focusing on physician groups and systems of care (CX2), are highlighted here. These collaborations are partnerships between the California Academy of Family Physicians, Healthcare Performance Consulting, Interstate Post Graduate Medical Association and Nurse Practitioners Heathcare Foundation (I-2) and CAFP and CAPG (an organization of accountable physician groups) (CX2) and Pfizer Independent Grants for Learning and Change (IGLC).Content experts developed criteria, objectives and expected outcomes published in broadly disseminated Request for Proposals (RFP). Post-RFP calls answered respondents’ questions. Grant review panels, established by the partners included education, research, clinical, IPE/ IDE, systems, QI and measurement experts, reviewed of Letters of Intent and full proposals. Feedback was provided to applicants at both stages and the panel made award selections. CAFP+Partners built infrastructure for grantee/partner check-in calls, webinars, F2F meetings, wiggio and IGLC communications. Outcomes strategies to measure success on goals were designed. I-2 grantees met 2/9-10/2015 for sessions on metrics/measures, recruitment and data collection. They presented their projects with time for consultation, planning and group feedback. I-2 has completed two webinars: The Role of IPD-IDE and Grantee
C03 Economic Issues in Pain Management (263) A model to quantify potential medical events avoided and cost savings from abuse deterrent opioids A White, M Yenikomshian, M Carson, E Masters, and C Roland; Analysis Group, Inc., Boston, MA
A previously published model for estimating potential medical events avoided and cost savings to the United States (US) with the introduction of extended-release (ER) abuse-deterrent opioids (ADOs) was updated by incorporating new methods of estimating abuse deterrence from human abuse liability studies (HALs). An Excel model was developed to estimate reductions in abuse-related events and annual savings for the US. Model inputs included: opioid abuse prevalence, ADO cost and effectiveness and costs associated with opioid abuse-related events. Costs and prevalence were based on published administrative claims database analyses, substance abuse treatment center data, and national surveys. Differences in ADO and non-ADO positive subjective measures scores from HALs were used to estimate reductions in non-medical use (NMU) associated with ADOs. Direct (medical and drug) and indirect (work loss) cost savings (2014 USD) and abuse-related events were estimated assuming the entire ER opioid prescription (brand and generic) market is replaced by ADOs. Most (96%) ER opioid prescriptions (2Q 2013– 1Q 2014) are comprised of oxycodone, morphine, transdermal fentanyl, and methadone. Generics comprise 71.4% of all ER opioid prescriptions. Oxycodone consists almost entirely of a branded ADO, whereas others consist almost entirely of generic non-ADOs. Replacing the ER opioid market with ADOs is estimated to avoid annual abuse-related medical events by approximately 13-31% (e.g., 78,000–186,000 emergency department visits) and annual medical cost savings are approximately $550M-$1,300M, depending on ADO technology (physical barrier or agonist/antagonist). Total net savings vary depending upon ADO price relative to the non-ADO generics. Modeling the medical and economic impact of replacing the non-ADO ER opioid market with ADOs resulted in 13%-31% of abuse-related medical events avoided and annual medical cost savings of up to $1.3B. More events are avoided with the agonist/antagonist ADO technology. Total net savings are dependent upon the ADO price relative to non-ADO generics.
C05 Impediments to Opioid Use (264) Managing pain: the experiences of community dwelling Black elders S Robinson; University of Michigan Medical School, Ann Arbor, MI Black elders represent a disparate population that has been shown to consistently have unmet pain needs. These adults are less likely to report pain concerns to providers and generally receive poorer quality of care with less access to services as compared to White elders. To better understand the pain management experiences and concerns of Black elders, an ethnographic study was completed within an urban, low-income, elder housing facility. 106 participants completed a questionnaire comprised of a demographic tool, the PROMIS Global Health Scale (PROMIS), the Brief Pain Inventory (BPI), and the Psychological Stress Measure (PSM-9). Additionally, participant observation, informal interviews, and 20 formal recorded interviews with individuals identified as having pain were completed. Results indicate that 86 percent of the sample had an average pain rating of 7 on a 0 to 10 scale with 5 pain sites. Pain interference, was about 4, on a 0 to 10 scale. Specific areas of interference included general activity (5.59), walking