David Tauben

The purpose of this study was to develop a brief knowledge survey about chronic noncancer pain that could be used as a reliable and valid measure of a provider's pain management knowledge. This study used a cross-sectional study design. A group of pain experts used a systematic consensus approach to reduce the previously validated KnowPain-50 to 12 questions (2 items per original 6 domains). A purposive sampling of pain specialists and health professionals generated from public lists and pain societies was invited to complete the KnowPain-12 online survey. Between April 4 and September 16, 2012, 846 respondents completed the survey. Respondents included registered nurses (34%), physicians (23%), advanced practice registered nurses (14%), and other allied health professionals and students. Twenty-six percent of the total sample self-identified as "pain specialist." Pain specialists selected the most correct response to the knowledge assessment items more often than did those who did not identify as pain specialists, with the exception of 1 item. KnowPain-12 demonstrated adequate internal consistency reliability (α=0.67). Total scores across all 12 items were significantly higher (P<0.0001) among pain specialists compared with respondents who did not self-identify as pain specialists. The psychometric properties of the KnowPain-12 support its potential as an instrument for measuring provider pain management knowledge. The ability to assess pain management knowledge with a brief measure will be useful for developing future research studies and specific pain management knowledge intervention approaches for health care providers.

Recently, there has been a dramatic increase in the use of opioids to treat chronic noncancer pain. Opioids are also being prescribed in stronger potencies and larger doses for musculoskeletal injuries. In some cases, the use of opioids for work-related injuries may actually increase the likelihood of disability. Chronic opioid use is associated with increased risk for overdose morbidity and mortality and other nonfatal adverse outcomes. The risk of dependence and addiction is much more common than previously thought. This guideline provides recommendations for prudent opioid prescribing and addresses issues critical to the care and rehabilitation of injured workers.

Many delayed-type reactions contain large infiltrates of basophils whose function is unknown. We have studied these cutaneous basophil hypersensitivity (CBH) reactions in guinea-pigs to ascertain whether basophils that are recruited to delayed reaction sites could be triggered for immediate reactivity. We compared 24 h CBH reactions with nearby skin for immediate hypersensitivity by challenging each site with small amounts of antigen. CBH sites had augmented immediate increases in vascular permeability detected by extravasation of Evan's blue dye. The ability to elicit this augmented anaphylactic phenomenon correlated with the local presence of basophils, and light microscopy at CBH reactions 15 min after antigen challenge showed a 50% decline in basophil counts. Electron microscopy showed that progressive anaphylactic-type degranulation of local basophils occurred within minutes following reintroduction of antigen. There was fusion of vacuoles containing granules, exocytosis of...

Comprehensive pain management services are primarily located in urban areas, limiting specialist consultation opportunities for community healthcare providers. A community of practice (CoP) for pain management could create opportunities for consultation by establishing professional relationships between community healthcare providers and pain management specialists. A CoP is a group of people with a common concern, set of problems, or a passion for something they do. Members of a CoP for pain management increase their knowledge of evidence-based pain management strategies in a way that is meaningful and relevant. In this article, we provide evidence that TelePain, an interdisciplinary, case-based pain management teleconference consultation program through the University of Washington, qualifies as a CoP and present preliminary evidence of TelePain's effectiveness as a CoP for pain management. Specific behaviors and conversations gathered through participant observation during TelePain sessions were analyzed based on the 14 indicators Wegner developed to evaluate the presence of a CoP. To demonstrate preliminary effectiveness of TelePain as a CoP for pain management, descriptive statistics were used to summarize TelePain evaluation forms. TelePain is an example of a successful CoP for pain management as demonstrated by the presence of Wegner's 14 indicators. Additionally, evaluation forms showed that TelePain enhanced community healthcare providers' knowledge of pain management strategies and that continued participation in TelePain lead to community healthcare providers' increased confidence in their ability to provide pain management. TelePain, a CoP for pain management, facilitates multidisciplinary collaboration and allows members to develop interdisciplinary care plans for complex pain patients through case study discussions. Evidence-based pain management strategies gained through CoP membership could be disseminated to other healthcare providers in members' clinics, which has the potential of improving the care of chronic pain patients.