Interview with Pamela Bennett
Pamela Bennett is Executive Director of Healthcare Alliance Development for Purdue Pharma L.P., where she develops and manages relationships with patient advocacy and professional associations. In this role, Ms. Bennett is responsible for a number of educational initiatives addressing proper pain management and the public health issue of prescription drug abuse. She develops and maintains alliances with national thought and key opinion leaders and she serves as a spokesperson for Purdue on pain management to health care providers, advocacy groups, and the media. Ms. Bennett earned a Bachelor of Science degree from Grand Canyon University and a Bachelor of Science in Nursing from Texas Women’s University. She is currently attending Tufts Medical School to obtain a Masters of Science degree in pain research, education and policy.
Q: Why does so much misinformation exist about pain management in our society?
A: Historically, pain has been a silent disease. Social stigmas exist around pain. Everyone is familiar with the saying, “no pain, no gain”--yet those living with pain can actually lose their jobs, their financial resources, and their independence. People with pain feel uncomfortable talking about it. There have been studies of cancer patients where it has been shown that patients are hesitant to talk about their pain, because of the fear that it will take away from a focus on cure. Unfortunately, health care professionals do not always receive adequate training on how to assess and treat pain. The undertreatment of pain is a significant public health problem in this country. And the situation is complicated, in that pain is different for each person; each person’s situation requires individual attention and treatment.
Q: Clearly there is work to be done in both the professional arena and on the part of consumers. What initiatives does Purdue have that focus on training health care professionals?
A: Personally, I firmly believe that all health care providers should be pain managers! Purdue has been a leader in pain management Medical Education. Our Medical Education department supports CME initiatives in pain management through a variety of organizations, reaching a wide range of professionals. [Note: see interview with Dr. Lisa Miller for more information on these programs.] The foundation for any professional treating someone with pain is to conduct a good pain assessment, and I would encourage all professionals to learn how. In 2000, JCAHO (Joint Commission on Accreditation of Healthcare Organizations) mandated the importance of pain assessment and management, which was a great step--but would that have been necessary if good pain management was already taking place? Focusing on assessment is not enough; pain continually needs to be re-assessed, the appropriate interventions provided and then re-assessed again as the situation changes. An additional role that professionals can play is to help empower people with pain to understand that they have a right to have their pain assessed and treated.
Q: In what other ways can people with pain, and their caregivers, become stronger advocates for themselves?
A: Because of recent changes in our health care systems, patients and family members are going to be required to be advocates for their own self care as well as for better pain management. At Purdue, we recently merged the Professional Relations and Advocacy functions to create a new department called Healthcare Alliance Development. We did this because it made sense to coordinate our resources, and connect the dots among all professional associations and patient advocacy organizations serving the pain community. At the same time that professionals are becoming more educated about pain, consumers also need education. They need to know how to gather information from credible sources; the American Pain Foundation is a great example of this type of resource. Something else that patients and caregivers can do is “speak up, and speak out!” People with pain need to know that they can ask their providers questions about their care, and their options; they should even be able to ask that doctor to help them find another specialist if the course of treatment is not succeeding. Things will not change for the long term until both consumers and professionals get involved.
Q: What specific issues may arise when dealing with pain at the end of life?
A: From my clinical experience, family members may inadvertently create barriers to good care at the end of life. So many uninformed concerns exist about opioids and addiction; there is an enormous need to educate the public on what substance abuse is, and is not. So often family members are not ready to emotionally accept that their loved one is facing the end of life. Hospice can be such a great place to turn to answer these questions and help deal with these issues; I have seen that both professionally and personally. It is so difficult for a caregiver to watch a loved one suffer while dying; having a good practitioner to alleviate pain and other symptoms can be such an act of compassion. But a fear of hospice does still exist for many, so hospice services are not accessed as often as they should be.
Q: One of your recent e-newsletters focused on “looking ahead” in pain management. But if you look back, what strides do you see that has been made in this field?
A: The year 2000 was a fabulous year for pain management. We were at the beginning of the Decade of Pain Control and Research, and the Joint Commission Standards on pain management were implemented. Shortly thereafter, the abuse of pain medications began to gain attention. This created a tension between two significant public health problems: the undertreatment of pain and the illegal trafficking and abuse of pain medications. As a society we must address both of these important issues; it is not an either/or situation. Both of these problems must be confronted, and for the benefit of all patients suffering from either problem, a balance must be found. The past two years have shown encouraging progress in both areas. Because of the work of David Joranson at the University of Wisconsin Pain and Policy Studies Group and others, we’re seeing changes in regulatory barriers at the state level. Policy leaders like W. Drew Edmondson, the Attorney General of Oklahoma, have done great work in educating law enforcement officials about the need for balance in addressing these important public health issues. Pain management legislation has been introduced at the federal level in addition to some states. Also of significant importance has been the positive coverage in the media in the last year. This media attention to the science and plight of those who suffer pain has provided validation and often vindication for those who suffer silently for too long.
Q: What other messages would you like to convey, to see that this progress continues?
A: For me, this is more than a job, it is personal. As an ICU/Trauma nurse I could put a breathing tube in someone, shock their heart back to life, and yet when it came to treating the pain associated with my grandfather “Bumpa’s” head and neck cancer I felt helpless. The training I had received did little to prepare me to help this man I dearly loved. Fortunately, I had a guest lecture by a hospice worker while in nursing school. I asked my Bumpa’s physician for the hospice consult and he reluctantly agreed. I watched the skilled nurse do a pain and symptom assessment and was amazed not only by the expertise but by the recommendations he made. My Bumpa was comfortable and the act of competent compassion led to him living the rest of his life in comfort and dignity. This impacted not just my grandfather, but my family. This experience showed me the need for professional education in pain assessment and management. It also showed me the need and the value of self-advocacy and advocating for others. Change starts with each one of us.
We need to acknowledge the truth and confront the attitudes and lack of knowledge that maintain the barriers to appropriate care and access to that care. Most significant changes in public health have occurred when the public has defined what is acceptable and what is not. What will bring the greatest change is when the public clearly voices to their families, communities, legislators, and the media that it is unacceptable for people to needlessly suffer. The power to change the system of care starts with each one of us. We each need to get busy and do what we can in our own way.
NOTE: Many of the resources discussed in the above interview can be found on Purdue’s Partners Against Pain website at www.partnersagainstpain.com Resources include the Medical Education Resource Catalog for health care professionals, as well as a Patient Advocacy Toolkit for consumers.
Interview with Dr. Lisa Miller
Dr. Lisa Miller, PharmD, is Executive Director of Healthcare Education and Liaison Programs for Purdue Pharma L.P., where she leads the Medical Education and Medical Liaison Departments. In this role, Dr. Miller is responsible for educational initiatives addressing proper pain management and risk minimization. The Medical Liaison department addresses education, managed care and payer concerns, as well as alliance outreach on a regional and state basis. With more than fourteen years experience working in health systems and ten years in the area of pain and symptom management, Dr. Miller was Pharmacy Manager for the Hospice of the Florida Suncoast and a clinical oncology pharmacist prior to joining Purdue Pharma in 2001.
Q: HFA’s upcoming teleconference will focus on “Pain Management: Bridging the Gap Between Knowledge and Practice.” As a health care professional and an educator, what gaps would you identify?
A: Pain patients do not fit into a mold. There is no one standard treatment that is effective or appropriate for all patients.
Gap 1: Assessment
Health care professionals must become comfortable and proficient at doing a
complete pain assessment (including physical, psychological, functional,
spiritual, cultural and environment factors). Only after such an assessment
is done can a unique treatment plan be developed for a given patient. Those
working in hospice and palliative care settings have demonstrated leadership
in this area by taking the time to provide thorough assessments and
communicating their findings to others on the health care team. These
settings are also ideal to ascertain the quality outcomes as a result of the
selected treatment plan and as they relate to the patient’s quality of life.
Gap 2: Reassessment
A second need that is often overlooked is that of reassessment--the
continual monitoring of the patient’s condition and pain management regimen.
Continuing the dialog, responding to changes, and keeping pain management as
a priority are effective ways to improve patient comfort and satisfaction
with their care.
Gap 3: Individualized treatment
While pain management has come a long way with collaborative treatment
guidelines and educational resources to assist health care professionals, it
is important to remember that the guidelines are just that, guides to assist
health care providers in employing the most appropriate therapeutic options
for an individual patient. Each patient needs an individualized treatment
plan that takes into account the physical, psychosocial, functional,
spiritual, cultural, and environmental needs. Cookie cutter medicine is not
the right treatment for patients with pain.
Q: In developing Purdue’s Medical Education programs, what requests or concerns do you hear most frequently from professionals?
A: The overarching request is to make sure that education is applicable and practical for today’s health care professional. Whether requests are for case-based learning, interactive formats, or opportunities to “meet the professors”, they all employ the principles of adult learning. Health care professionals want information that they can take directly from the education setting to the clinical health care setting. Education should continue to occur in those health care settings as we reflect, listen and learn from our patients. We are also seeing a growing trend in e-learning and the use of web-based tools.
Topics that seem to be the most useful are those that build skills such as pain assessment, reassessment, treatment planning, appropriate medication selection, dosing, administration, and adjustments, how to manage transitions in care; and even how to improve communication and documentation skills.
Q: What progress have you seen in pain management education in recent years?
A: Efforts in recent years by pain management advocates have created more awareness of the disparities that exist in pain care. With these problems revealed, it allows more emphasis to be placed on how to best address these concerns.
For hospice and palliative care, addressing the pain needs of patients with non-cancer diagnoses has evolved. The unique challenges of advanced cardiac and pulmonary disease, osteoarthritis and other conditions are being addressed.
Patient access to pain care and treatment is also an area that has received attention. As health care professionals collaborate on the best approaches on patient care, referrals to pain or palliative care specialists and the challenges of dealing with reimbursement, formularies, and health care systems, they teach one another how to thrive and survive in an ever changing health care environment.
In education, another area that we continue to work on is applicability. The sheer volume of lectures, monographs, and other written information can be overwhelming; finding ways of providing information that is tangible and applicable to practice is critical. Professionals like to know what is working for others and how a particular tool, medication, or document is being utilized with favorable results. By asking others and providing reports of “best practices” or “clinical pearls”, health care professionals are able to discern what may benefit their patients, colleagues, and practice.
Health care education is changing with evolving standards and guidelines. An important step is to conduct research on how teaching styles, content, and learning can have the positive impact of improving pain management for patients and job satisfaction for professionals. Addressing educational needs and evaluating educational outcomes are two ways to support and encourage success in patient care.
NOTE: The Healthcare Professionals section of www.partnersagainstpain.com includes a comprehensive Medical Education Resource Catalog, which includes both accredited and non-accredited course offerings for a range of professionals, as well as other resources in pain management.
