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June 11, 2009 Volume VI, No. 4

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

According to a national pain survey conducted for Ortho-McNeil Pharmaceutical, about 50 million Americans live with chronic pain caused by disease, disorder or accident, and an additional 25 million people experience acute pain as a result of surgery or an accident. This week's Disease Management Update looks at pain, from relief to education for PCPs.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Online Tools for Headache Relief
  2. New Pain Treatments
  3. Chronic Pain
  4. Educating PCPs in Pain Management
  5. Healthcare Trends
  6. Top Priority in Health Reform
  7. Healthcare Trends Mid-2009

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New Online Tool Helps People with Headache Take Control, Get Relief

The National Headache Foundation (NHF) is launching “Headache U: It’s all about YOU,” the first headache education program of its kind designed to help people with headaches take important steps toward getting relief. The program is offered on the NHF Web site at http://www.headaches.org/headacheu/.

This new education portal was developed under the guidance of an advisory panel of both physicians who specialize in headache care and people with headache. The first of Headache U's patient education resources and tools is “Chart Your Course to Relief: A Personal Headache Care Tool,” which asks people with headaches questions about their experiences and guides them toward relevant resources.

“No one has the same combination of headache pain, frequency, impairment or triggers,” says Roger Cady, M.D., vice president of the NHF board of directors, and director of the Headache Care Center in Springfield, Mo. “So, the approach to headache care needs to be as personal as the headaches. The sufferer needs to get involved in charting a course to relief based upon an understanding of their own personal headache patterns and getting connected with helpful, sometimes life-changing resources.”

To learn more about this research, please visit:

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FDA Approves Injectable Form of Ibuprofen

The FDA approved Caldolor, the first injectable dosage form of the common pain medication ibuprofen, to treat pain and fever. Caldolor will be available for hospital use only. It is approved to be administered in 400 milligram to 800 milligram doses, over 30 minutes, every six hours for acute pain. To treat fever, the drug is approved in a 400 milligram dose administered over 30 minutes, followed by 400 milligram every four to six hours, or 100-200 milligram every four hours, as necessary.

“Injectable ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are promising pain management options,” said Bob Rappaport, M.D., director of the division of anesthesia, analgesia and rheumatology drug products in the FDA’s Center for Drug Evaluation and Research. “But until now there were only oral forms of most NSAIDs. An injectable ibuprofen product can provide patients with relief from pain and fever when they cannot take oral products.”

In a clinical trial of 319 women who had undergone an elective abdominal hysterectomy, patients were less likely to request morphine for pain on an as-needed basis when administered Caldolor. Caldolor should be used with caution in patients with congestive heart failure, kidney impairment, at risk of blood clots and those who have a prior history of ulcers or gastrointestinal bleeding. When used in such patients, attention to using the lowest effective dose for the shortest time period is important to reduce the risk of serious adverse events. The drug has also been associated with high blood pressure, serious skin reactions, and serious allergic reactions.The most common adverse reactions reported in the controlled clinical trials were nausea, flatulence, vomiting and headache.

To learn more about this research, please visit:

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New Approach to Chronic Pain: Focus on Patient, Not Condition

Too often, pain management tends to focus on the conditions rather than the people experiencing the pain, says Dr. Agostino Villani, internationally recognized expert on chronic pain, CEO of Triad Healthcare, Inc., and author of Pain Is Not A Disease. According to Dr. Villani, this way of thinking depersonalizes the experience of pain and treats it as a disease instead of the complex, personal event that it really is. In Part 1 of this interview with Dr. Villani, he discusses his new book as well as pain management programs, pain level reduction strategies and side effects of pain medications. In Part 2, Dr. Villani discusses the importance of the physician-patient relationship, measuring the outcomes of pain management and med school curricula surrounding the topic of pain management.

To listen to this complimentary HIN podcast, please visit:

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Increasing Patient Engagement, Activation in DM

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Marilee I. Dononvan, Ph.D., R.N., regional pain management coordinator for Kaiser Permanente Northwest.

Question: How do we educate primary healthcare providers so they feel comfortable dealing with chronic pain and the outcomes are favorable?

Response: Patience and persistence. About five years ago, medical schools were doing a better job teaching physicians about pain. Our recent survey of physicians as well as one done in southern California indicate that less than two hours of pain management are included in most medical school curriculums. Also, most residents come out of medical school believing that 80 percent of pain patients are addicts that are seeking drugs. Our tools help them understand and assess the patient properly. Then it’s easier to trust the patient and do the right thing.

For more information on the costs and consequences of chronic pain, please visit:

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What's Working in Pain Management

Chronic pain can affect an individual’s financial well-being or create roadblocks in day-to-day life: many chronic pain patients lose an average of 4.6 hours per week, which costs employers $61.2 billion annually. To relieve the physical and fiscal suffering associated with pain, many healthcare organizations have implemented pain management programs. To discover how these programs work and who is using them, HIN conducted a non-scientific online survey in April 2008. In response, 186 organizations, including hospitals, nursing homes and health plans, shared their experiences with pain management programs.

To download this complimentary white paper, please visit:

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Disease Prevention is Top Priority for Americans in Health Reform

A public opinion survey released by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that Americans rank prevention as the most important healthcare reform priority and overwhelmingly support increasing funding for prevention programs to reduce disease and keep people healthy. The poll reflects the responses from 1,014 registered voters.

In the poll, 70 percent of Americans ranked investing in prevention between an eight and 10 on a scale of zero to 10, where zero means not at all an important healthcare priority and 10 means very important. Forty-six percent rated prevention as a 10 out of 10. Overall, prevention was rated higher than all other proposals, including providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status.

"For too long, healthcare has focused on treating people after they become sick instead of trying to help them stay healthy in the first place," said Jeff Levi, Ph.D., executive director of TFAH. "This poll shows the American public strongly believes it's time we shift from a sick care system to a true healthcare system that stresses disease prevention."

More than three-quarters of Americans (76 percent) support increasing funding for prevention programs that provide people with information and resources and creating policies that help people make healthier choices. Investing in prevention is popular across the political spectrum, with 86 percent of Democrats, 71 percent of Republicans, and 70 percent of Independents supporting investing more in prevention.

While 77 percent of Americans agree with the statement that "prevention will save us money," they strongly support prevention regardless of its impact on costs. Rather, they point clearly to keeping people healthy as the best reason to invest in prevention, with 72 percent agreeing with the statement that "investing in prevention is worth it even if it doesn't save us money, because it will prevent disease and save lives." Additionally, 57 percent agree more with the statement "we should invest in prevention to keep people healthier and improve quality of life" than the statement "we should invest in prevention to lower healthcare costs" (21 percent).

Americans believe the nation needs to put more emphasis on prevention (59 percent) rather than thinking there needs to be more emphasis on treatment (15 percent), by nearly a four to one ratio. This represents a significant shift toward prevention over the last two decades — in 1987, only 45 percent thought there should be greater emphasis on prevention.

To learn more about this research, please visit:

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Healthcare Trends Mid-2009

Suffering from project overload due to frozen resources? Adjusting decision-making, pricing, marketing and more to compensate for reduced revenues in a depressed economic climate? You are not alone. To learn how your healthcare colleagues are responding to the current economic and legislative environments, take HIN's Survey of the Month on Healthcare Trends in 2009: Mid-Year Adjustment by June 30. Nearly 50 healthcare organizations have responded so far. You'll get a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

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