State Pain Initiatives
An Interview with Amy Goldstein, MSW
| Amy Goldstein is a medical social worker at the American Cancer Society, New England Division, and is the coordinator of the Massachusetts Pain Initiative |
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Questions
1: What is a State Pain Initiative and how did Pain Initiatives start?
 2: What kind of advocacy may be taken by a Pain Initiative?
3: What kinds of people volunteer to work on a Pain Initiative and what do they do?
4: What specific groups in the community may be overlooked, and need more pain education?
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-------------------------------------------------------------------------------------------------------------------------- Evelyn Corsini:
What is a State Pain Initiative and how did Pain Initiatives start? Amy Goldstein, MSW: State Pain Initiatives are groups of people who work together to provide education and advocacy in their state to remove barriers that can impede pain relief. The Wisconsin Cancer Pain Initiative, started in the mid 1980’s, is the pioneer program that became a model for other states. It began as a response to a national proposal to make heroin treatment available to treat pain in terminally ill cancer patients. The Wisconsin Controlled Substances Board, the state agency that regulates drugs of abuse, analyzed this proposed legislation and determined that there were effective drugs for cancer pain already available, but they were not being used appropriately. They decided to develop a comprehensive program to reduce cancer pain in the State of Wisconsin. Over time, this idea for a program spread throughout the US. Information on the specific pain initiatives in individual states can be retrieved from the website of the American Alliance of Cancer Pain Initiatives at www.aacpi.wisc.edu.
Since state pain initiatives depend primarily on volunteers, activity is varied. In Massachusetts, as in many states, the initiative is sponsored by the American Cancer Society and was first called the Massachusetts Cancer Pain Initiative. After ten years of activity it became dormant, but new leadership at the American Cancer Society, believing that the number one fear people have about cancer is pain, secured funding to revitalize the program so that more staff time could be devoted to it. Like many pain initiatives, the one in Massachusetts, now called the Massachusetts Pain Initiative (MassPI) addresses all forms of pain, not just cancer pain. 
EC: What kind of advocacy may be taken by a Pain Initiative? AG: In Massachusetts we work a lot with issues of regulation and legislation, looking for anything that can impede pain management. For example, the Federation of State Medical Boards has a Model Policy for the Use of Controlled Substances for the Treatment of Pain and we worked to have the Massachusetts Board of Registration in Medicine adopt this policy. This also led us to have communication with the Boards of Registration for Pharmacy, Nursing, and Dentistry, to discuss the potential of a joint or similar position statement.
There has been recent proposed legislation in Massachusetts to ban oxycontin. Our pain initiative encourages a balanced approach to pain management, recognizing the risks of abuse and diversion as well as the risk of inadequate pain control. We do a lot of education of state legislators. In response to abuse and diversion of prescription medications, Massachusetts developed a State Drug Commission to look at the misuse of drugs. One of the members of the Massachusetts Pain Initiative was on the commission, and as hearings were held throughout the state, the MassPI helped find clinicians and patients to testify.
EC: What kinds of people volunteer to work on a Pain Initiative and what do they do? AG: Pain initiatives are very interdisciplinary and it is easy for any concerned person to become involved. Among our members are physicians, nurses, pharmacists, lawyers, clergy, as well as many patients. If interested, we can train a volunteer to do community education using our Power Over Pain presentation format. This form of education is welcomed by many different settings in the community, both lay and professional. Professionals may have as much misinformation about pain as the general public. We also recently partnered with the Massachusetts College of Pharmacy & Health Sciences for a day of pain education for pharmacists. In addition to providing education, volunteers who are interested in advocacy may be asked to attend meetings with legislators, testify at hearings, or write letters to the editor.
EC: What specific groups in the community may be overlooked, and need more pain education? AG: There are many groups that need more educational outreach effort. There are always those who because of language or culture don’t have the facts about pain and face barriers to treatment. Legislators always need more education and so do dentists. There is a huge need for education in the over 500 nursing homes in Massachusetts, as well as home health agencies, both of which can have high staff turnover. Our educational efforts have been very welcomed by Senior Centers and Councils on Aging. This constant need for education keeps us very busy and we always welcome more volunteer help.
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