3. Summary
“Energy and persistence conquer all things.”
-Benjamin Franklin
(1706 - 1790)
Two years ago, a group of committed individuals and organizations gathered in
Austin at the Texas Pain Summit, an historic meeting dedicated to addressing
legal regulatory barriers to pain management for the residents of this State. A
major goal of the Summit was to foster dialog between healthcare
professionals and the state’s licensing and regulatory bodies in order to create
a “balanced” regulatory system. Such a system fosters the appropriate medical
use of opioid analgesics and other controlled substances that are essential for Larry C. Driver, MD
pain control while preventing their diversion and abuse for inappropriate, non- Chairman
medical purposes.
A year ago, the Texas Pain Summit issued its formal report, The Politics of
Pain: Balancing Vigilance and Compassion. The report, containing survey
results of Texas households and healthcare practitioners, supporting science
and research, and policy-related perspectives, presented a five-year strategic
plan for improving pain management for all Texans. The plan conveys strategies
that address a full complement of issues and barriers to pain care.
Today, the Texas Pain Advocacy and Information Network, also known as
TxPAIN, has begun the work of implementing the Texas Action Plan to Relieve
Pain.
We are proud to present to you our first annual report detailing our progress,
our triumphs, our successes, and, yes, even our frustrations over the past year.
We also look forward to next, for each New Year brings us closer to our goal,
a pain-free future for all Texans.
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2008 Annual Report
4. About TxPAIN
The Texas Pain Advocacy and Information
Network (TxPAIN) is an active
multidisciplinary volunteer collaboration
Mission
involving more than twenty members and
organizations representing healthcare Ensure high quality pain management for
professionals, researchers, educators, and people of all communities & cultures in Texas
patient advocates. An affiliate of the Alliance through public policy initiatives, public
of State Pain Initiatives (ASPI), TxPAIN serves
awareness campaigns, & patient & provider
as the statewide initiative dedicated to
improving pain management for all Texans. education
The TxPAIN Steering Committee develops
strategies and identifies resources to Strategies
implement its five-year strategic plan outlined I. Public Policy Initiatives for Consumer
in the Texas Action Plan to Relieve Pain.
Protection
TxPAIN is supported through the generosity
of the American Cancer Society High Plains II. Provider Education and Empowerment
Division. The American Cancer Society High III. Advocacy for Better Patient Care
Plains Division is an active member of
TxPAIN. IV. Public Awareness and Media Relations
V. Law Enforcement and Regulatory Agency
Collaboration and Education
Crosscutting Issues
Access
The Texas Action Plan to Disparities
Relieve Pain
The Texas Action Plan to Relieve Pain spans a Support
full complement of issues and barriers to
quality pain management. This multi-faceted,
multi-year plan includes public policy
initiatives, provider/professional education,
advocacy, public awareness, media outreach,
and collaboration with law enforcement and
regulatory bodies. Importantly, the plan
addresses access to care, disparities in care,
and support for implementation as
crosscutting issues.
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2008 Annual Report
5. 2008 Steering Committee
Larry C. Driver, MD, Committee Mary Beth Kean, MSN, RN-C, Linda Schickedanz, RN, MSN,
Chair CRRN, CNS CNS
Professor of Anesthesiology and Pain Clinical Nurse Specialist/Pain Chairman of the Board
Medicine Management Texas Partnership for End-of-Life
UT MD Anderson Cancer Center Baylor University Medical Center Care
Houston Dallas Weatherford
Krisha Cook, BS, RN, OCN Brenda McCoy, PhD Scott A. Strassels, PharmD, PhD,
Oncology Nurse Information Assistant Professor, Department of BCPS
Specialist Sociology Assistant Professor, Pharmacy
American Cancer Society University of North Texas Practice
National Cancer Information Center College of Public Affairs and University of Texas at Austin College
Austin Community Service of Pharmacy
Denton Austin
Kristi Dover, PharmD
Sr. Area Director, Medical Liaisons Andy Miller, MHSE, CHES Daniel Still, PharmD, BCPP
Medical Liaison Alliance Outreach Vice President, Programs and Policy Medical Science Liaison
Purdue Pharma L.P. Lance Armstrong Foundation Cephalon, Inc.
Colleyville Austin San Antonio
Gloria J. Duke, PhD, RN Anne K. Moore, LMSW Karen Torges
Associate Dean Executive Director Director of Strategic Collaborations
Office of Nursing Research & Texas Partnership for End-of-Life American Cancer Society High Plains
Scholarship Care Division
The University of Texas at Tyler Sugarland Austin
College of Nursing & Health Sciences
Tyler Kristynia Robinson, PhD, FNP- Joni Watson, RN, MSN, OCN
bc, RN Program Director
Michael Fitzpatrick, MD Associate Professor and Assistant Nurse Oncology Education Program
Southwestern Medical Association Dean Graduate Education Texas Nurses
Dallas University of Texas at El Paso School Association/Foundation
of Nursing Austin
Stephanie Gonzalez, MHA El Paso
Program Director Matthew Wieman, MD
Physician Oncology Education Helen Ross Petty Clinical Affairs Manager
Program Principal Endo Pharmaceuticals
Texas Medical Association MMIP & Associates Kingwood
Austin Austin
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2008 Annual Report
6. TxPAIN: An Historical Perspective
Where We Began & Three Back… History Repeats Itself
1989 – Texas passes first 2002 – Last Acts® rates Texas’ 2006 – PPSG issues 3rd policy
Intractable Pain Treatment pain policies a “D” evaluation & 2nd progress
Act in the nation 2003 – PPSG publishes 2nd policy report in September
– Texas regulatory boards evaluation – Texas rates “C” - again
update rules – PPSG issues 1st progress
1991 – Texas American Cancer report & compares state Building Momentum for
Society (ACS) forms Pain “grades” for 2000 and Change
Control Subcommittee 2003
2006 – Initiative polls Texas
1994 – UT M.D. Anderson – Texas rates “C” both
households
Cancer Center and the years
2006/7 – Texas Medical Board &
Alliance of State Pain
Texas Pain Society
Initiatives (ASPI) Making History collaborate to revise rules
collaborate with ACS to 2004 – The Federation of State 2007 – Initiative surveys Texas
present the Role Model Medical Boards updates its pharmacists
Program in Texas Model Policy for the Use – US Congress considers
– The Texas Pain Initiative of Controlled Substances National Pain Care Policy
formalized operations for the Treatment of Pain Act of 2007
under M.D. Anderson 2005 – Texas Comprehensive
Cancer Center umbrella Cancer Control Coalition
1996 – Texas hosts ASPI Annual Making Lemonade
revises the State Cancer
Meeting 2007 – Texas Legislature passes
Plan and includes pain
SB1879 establishing all
2006 – National ACS adopts pain
Two Steps Forward… schedules monitoring
as a priority
– ACS produces How You
1998 – Texas ACS adopts pain – ACS, Komen for the Cure,
Measure Up report
initiative as a program and the Lance Armstrong
– PPSG issues 4th policy
2000 – The Pain & Policy Studies Foundation (LAF) award
evaluation and 3rd
Group (PPSG) publishes funding to PPSG to
progress report
first evaluation of state produce annual policy
– Texas rates a “C” – again
pain policies reports
2001 – Congress declares Decade 2006 – Texas conducts
of Pain Control and knowledge, attitude and Springboard to the Future
Research practice surveys of Texas 2007 – Initiative prepares findings
– Joint Commission issues physicians & nurses & develops strategic plan
pain management – The American Cancer – Holds stakeholders
standards Society, Lance Armstrong meeting
– Texas Board of Pharmacy Foundation, Texas Medical – Initiative renamed – Texas
issues position statement Association, Texas Pain Pain Advocacy &
on pain Society and Texas Information Network
Partnership for End-of-Life – Publishes Pain Patient Bill
Care host the Texas Pain of Rights
Summit
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2008 Annual Report
7. Stakeholders Meeting –- The Politics of Pain: Balancing Vigilance and
Compassion
Healthcare professionals from across Texas Department of Public Safety Narcotics Regulatory Program discussed
representing all major disciplines, recent changes in statute, SB 1879. Texas Representative Ruth Jones
academicians, regulators, legislators, and law McClendon shared how SB1879, establishing a Pain Study Committee was
enforcement officers gathered in Austin on accomplished in the 80th Legislative Session in May. The American Cancer
September 10, 2007 to address the central Society presented Rep. McClendon with an advocacy award for her efforts
principle of balance in pain policy, regulation supporting this issue.
and practice. TxPAIN leadership presented
findings of the Texas Pain Summit with its
formal report, The Politics of Pain:
Balancing Vigilance and Compassion. The
report contains survey results of Texas
households and healthcare practitioners,
supporting science and research, policy
perspectives, and a five-year strategic plan for
improving pain management for all Texans.
A generous gift from the Lance Armstrong
Foundation underwrote the cost of producing
the report into a 4-color, 40-page bound
book. The Lance Armstrong Foundation is an
active participant in TxPAIN.
This resource is posted on the Alliance of
State Pain Initiatives website at
http://www.aspi.wisc.edu/acstxpi/ and at the
TxPAIN webpage at Media coverage included KVUE (ABC Affiliate), KTBC (FOX Affiliate),
http://www.cancer.org/texaspain. News 8 (Austin Cable News Station), the TX State Radio Network, and
Meeting participants received updates on how the Long News Service. Interviews were conducted with the following:
Texas compares to the nation, regulatory and Larry C. Driver, MD, Summit Chair, 2006 Mayday Pain Fellow
law enforcement issues, a report on the 80th
Regular Texas Legislative Session, and Allen W. Burton, MD, President-Elect, Texas Pain Society
discussed next steps for implementing the Samuel Hassenbusch, MD, PhD, Past President, Texas Pain Society,
plan. Past President, American Academy of Pain Medicine
Donald W. Patrick, MD, JD, Executive Scott A. Strassels, PharmD, PhD, BCPS, Co-Chair, American Pain
Director of the Texas Medical Board, Society Pharmacotherapy Special Interest Group
reviewed revisions to Chapter 170, the
Regina Fabian, 35-year-old mother of five, diagnosed with Stage IV
Medical Board Rules on pain management.
breast cancer in 2003, suffering with chronic pain due to
B.C. Lyon from the Texas
metastasis to the spine for the past four years
Nationally recognized pain expert, June Dahl, PhD, Senior Advisor to the
Alliance of State Pain Initiatives, in Madison, WI commented, “This is a
landmark report…that serves as the first of its kind in the nation.”
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2008 Annual Report
8. Empowering Healthcare Professionals through Continuing Education
and Curriculum Development
Physician Education
The Texas Medical Association (TMA) formed the Physician Oncology
Education Program (POEP) in 1987 to carry out the recommendations of the
Texas Cancer Plan regarding physician education. The POEP is funded in large
part by the Cancer Prevention and Research Institute of Texas and is directed
by a steering committee of experts interested in and knowledgeable about all
facets of cancer prevention and control. The POEP has provided more than
100,000 Texas physicians and other professionals with cancer prevention and
screening training since its creation.
The Physician Oncology Education Program of the Texas Medical Association is
an active member of TxPAIN.
POEP hosts a Cancer Pain Resource Center for Physicians on its website
which can be accessed at www.poep.org.
The July 2008 issue of Texas Medicine featured a pullout continuing medical
education piece. Authored by TxPAIN Chair, Larry Driver, MD; Brian Bruel,
MD; and Diane Novy, PhD, the Pain Primer for Primary Physicians: Essential
Concepts is accredited for 1.5 AMA PRA Category 1 Credits™, including
ethics.
More than 170 physicians have completed this activity to date. The article
assists physicians in outlining a systematic approach to pain assessment and
evaluating outcomes, defines potential adverse outcome issues, summarizes
physical and procedural interventions for managing pain, and identifies
categories of medications useful for pain management. This resource is available
at www.poep.org.
Through this active collaboration with the Texas Medical Association and the
POEP, TxPAIN is able to extend its reach and message to more than 26,000
physicians across Texas.
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2008 Annual Report
9. Nursing Education
The Nurse Oncology Education Program (NOEP) is a project of the Texas
Nurses Association/Foundation (TNA/F) funded by the Cancer Prevention
and Research Institute of Texas. TNA/F is accredited as a provider of
continuing nursing education by the American Nurses Credentialing Center's
Commission on Accreditation.
The Nurse Oncology Education Program is an active member of TxPAIN.
Nurses can earn 1.0 continuing education contact hours FREE through
Nursing Principles of Pain Management, an independent study authored by
Linda Schickedanz, RN, MSN, CNS, and developed by the Nurse Oncology
Education Program (NOEP). The evidence-based study includes an overview
on prevalence of pain in the cancer patient, defines and distinguishes acute and
chronic pain, describes nursing assessment of pain, and discusses the
pharmacologic and non-pharmacologic management of pain and barriers to
pain management. This resource is available through NOEP at
www.noep.org/ce/onlinece.asp.
Nurses can earn FREE contact hours through NOEP's new four-part slidecast
Every Nurse's Guide to Pain Management. Topics include: an introduction to
pain management and nursing assessment, pharmacological and
nonpharmacological management of pain, pain management for culturally
diverse, elderly, and substance abuse populations, and pain management at the
end-of-life and ethics. This resource is available at
www.noep.org/ce/onlinece.asp.
NOEP offers continuing education programs at the community level on a
variety of topics for nurses. Pain Management and Palliative Care, a one-day
workshop is being presented by Hill Country Memorial Hospital System and
NOEP on November 8, 2008 at the Hampton Inn, Fredericksburg. Nurses
who attend will earn 4.25 contact hours through the Texas Nurses
Association/ Foundation provider unit. Speakers include two nurse members
of the TxPAIN Steering Committee. For more information, or to register go
to ACTEVA online registration at: www.acteva.com/go/noeptexas or call 866-
462-2838.
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2008 Annual Report
10. Multidisciplinary Approaches
The Texas Partnership for End-of-Life Care (Texans for Compassionate
Care) in collaboration with the American Cancer Society and the Nurse
Oncology Education Program will host its fifth annual continuing education
Texas Partnership conference, A Common Thread 2008: Clinical and Practical Tools for
for End-of-Life Care Supporting Human Resilience at the Westin DFW Hotel in Dallas,
December 5-6, 2008.
A Common Thread has become the premiere palliative and end-of-life
The Texas Partnership for End-of-Life Care care conference synonymous with quality educational experience for the
(Texans for Compassionate Care) advocates estimated 200 health professionals expected to attend. Its innovative
for quality healthcare and works to remove content focuses on current information about palliative and end-of-life
barriers. The Partnership’s pacesetting Let’s care, pain management and oncology.
Talk, Texas! campaign, funded through a
Continuing education credits are offered for nurses, social workers and
generous grant from the Aetna Foundation,
licensed professional counselors. For additional information, contact the
will revolutionize advance care planning in
Texas Partnership for End-of-Life Care (Texans for Compassionate Care)
Texas. The Partnership educates consumers,
at www.txpec.org or call (512) 453-9600.
healthcare professionals and systems about
healthcare choices, pain/symptom
management, ethical decision-making, and
compassionate communication. Its website,
www.txpec.org, is cited as the Texas
authority on advance care planning.
The Texas Partnership for End-of-Life Care
(Texans for Compassionate Care) is an active
member of TxPAIN.
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2008 Annual Report
11. Contributing to the Body of Knowledge about Pain
Professional Publications Patient Studies
Four poster abstracts were accepted for the 27th Annual Scientific The American Cancer Society’s (ACS)
Meeting of the American Pain Society in May 2008 where more than National Cancer Information Center (NCIC)
1,300 professionals attended. Three of the abstracts address results of conducted a two month nationwide pain pilot
Texas-specific surveys of physicians, nurses and pharmacists in study in 2008 in an effort to understand the
contributing to inadequate pain care. The fourth concentrates on results underreporting of cancer-related pain and the
of a general household poll. current level of uncontrolled pain among
cancer patients contacting the NCIC. The pilot
A fifth abstract, Knowledge, Attitudes and Practices of Texas Healthcare
tracked the pain reporting trends among
Professionals May Contribute to Inadequate Pain Care, comparing data from
callers and identified those who could benefit
all the health professional surveys, was accepted for a poster at the
from education on how, when and to whom to
International Association for the Study of Pain 12th World Congress on
report their cancer-related pain. Phase II of the
Pain held in Glasgow, Scotland in August 2008, where there were more
Pain Project will begin in about November
than 6,000 professionals in attendance. This abstract also was accepted at
2008 and will continue to collect data from
the Alliance of State Pain Initiatives Annual Meeting being held in Austin,
callers and to offer specific resources or
Texas, October 30 – November 1, 2008.
recommendations to assist callers with pain
The posters were authored by Scott A. Strassels, PharmD, PhD, BCPS, The management needs. Texas-specific data will be
University of Texas at Austin College of Pharmacy; Helen Ross Petty, available at the completion of this project.
MMIP & Associates; Karen Torges, American Cancer Society High Plains
TxPAIN is interested in examining the pain
Division; and Larry C. Driver, MD, The University of Texas M.D.
experience for those in other than oncology
Anderson Cancer Center.
settings and is developing a survey for use
Poster production was underwritten by The University of Texas at Austin among chronic pain patients in settings other
College of Pharmacy, an active participant in TxPAIN. than oncology.
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2008 Annual Report
12. Public Awareness and Media Relations
The patient education brochure, Your Pain Treatment Bill of Rights, was
created as a simple three-fold pamphlet intended to clarify what patients
should expect from their healthcare providers. It includes a sample pain
log denoting date/time, activity, pain scale, description of what action the
patient took to relieve the pain and results. It is available at no charge in
print format from your American Cancer Society High Plains Division, or
electronically at the webpage noted below.
When Your Body Hurts… Fears, Myths & the Truth About Pain. This
35 slide-deck PowerPoint presentation includes a simple overview of pain,
scope of the problem, causes and barriers, assessment and treatment
concepts, consequences of unrelieved pain and sources of qualified pain
When Your Body
management resources. It is intended for qualified healthcare professional
When Your Body
Hurts…
Hurts… presenters’ to use with lay audiences and includes speaker notes for
presentation aid purposes.
Fears, Myths & the Truth
Fears, Myths & the Truth
about Pain
about Pain For September’s Pain Awareness Month, TxPAIN approached a group of
30 public health/academic librarians in Harris County about collaborating
Texas
Texas
on a public awareness pilot. The Library Project presents a resource
PPain
ain
A dvocacy &&
A dvocacy
package that includes the below mentioned resources, along with a press
Information
Information
Network
Network
release and speakers bureau request application. Although Hurricane Ike
affected initial implementation; additional sites will be included in the next
phase.
A simple one page Q&A, Fast Facts about Pain, includes succinct
information on pain prevalence, pain management, and an information
about the Texas Pain Advocacy and Information Network and the Alliance
of State Pain Initiatives.
The Pain Resource Guide is an alphabetical listing of pain management
resources including brief explanation and contact information intended for
use by healthcare professionals, persons in pain, and their caregivers.
These resources are available electronically
http://www.cancer.org/texaspain.
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2008 Annual Report
13. Protecting Consumer Interests: Advocacy, Public Policy, and
Collaboration with Regulatory and Law Enforcement Agencies
Eliminating Treatment pain control and management and to controlled substances in
examine how the statutes affect Schedules II-V
Barriers
public health needs, the professional
TxPAIN Chair and Texas Pain Recommend which data should be
medical community, and persons
Society member, Dr. Larry Driver provided to the DPS
affected by acute, chronic, or end-of-
collaborated with the Texas Medical life pain. Monitor and develop
Association (TMA) Committee on recommendations regarding
Cancer to propose a TMA resolution The committee was to have issued its
implementation and enforcement
to eliminate the use of special final report by September 1, 2008. As
of the system
serialized Government Issue of October 2008, full committee
appointments have not been made Recommend procedures necessary
prescription forms for Schedule II
and no quorum could be established. for real-time access for
controlled substances. Texas is the
authorized practitioners
only state in the nation to maintain
such a requirement long thought to Recommend procedures for how the
be a barrier to appropriate pain Electronic Monitoring department shares information
management. The TMA reference related to drug diversion with a
SB1879 establishes a mechanism for
committee prepared a report to the licensing authority or a licensing
monitoring all controlled substances,
TMA House of Delegates which was authority shares information
expanding the Department of Public
accepted unchanged in May 2008. related to diversion of controlled
Safety’s authority to monitor
The TMA legislative department is substances with the department
Schedules III-V. Moreover, SB1879
reviewing this for consideration as a
gives the director authority to
priority for the 81st Regular Texas
determine the length of prescription
Legislative Session which begins
validity for Schedule II prescriptions Limitations on Pain
January 2009.
the intent being that the then 7-day Clinics
rule may be too short a time frame
The Texas Pain Advocacy and
and may present unintended barriers
Information network is your
Pain Treatment Review to pain patients receiving needed
proactive advocate for better patient
Committee medications. TxPAIN members
care. We are monitoring an
advocated for extending the time
During the 80th Texas Regular interagency taskforce currently
frame, and ultimately the director
Legislative Session, TxPAIN working to establish guidelines and
extended prescription validity to 21
collaborated with Texas regulations on limited pain
days. Furthermore, the bill
Representative Ruth Jones management clinics. While the intent
established an advisory committee to
McClendon to propose a bill is to control diversion of pain
the Texas Department of Public
establishing a Pain Treatment Review medicines to the illicit market, we
Safety to:
Committee. Attached to SB1879, the remain concerned that the
measure passed. The committee’s Develop recommendations regarding unintended effect will present
purpose is to study relevant improvement of the official barriers to legitimate pain patients in
provisions in Texas law that relate to prescription program need of treatment.
the administration of prescription Develop recommendations regarding
medication, controlled substances, implementation of an electronic
and the needs of patients for effective monitoring system that would be
used for prescriptions of
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2008 Annual Report
14. Special Populations (Access & Disparities)
Quality Improvement in Long-Term Care Primary Care Practice
Patterns
TxPAIN is developing a strategy to
interview primary care physicians (and
possibly advance nurse practitioners) to
gain baseline knowledge of pain specialist
referral using three case studies – patients
with no history of pain medication abuse,
those with a history of abuse, and those
with active abuse issues. This would help
identify practice pattern needs of primary
care physicians and resources available to
Texas Partnership
for End-of-Life Care patients who have complex pain care
needs regardless of insurance coverage.
As of October 2008, IRB approval is still
being sought for the primary care study
TxPAIN, the Texas Partnership for End-of-Life Care (Texans for pilot.
Compassionate Care) and the Alliance of State Pain Initiatives are collaborating
to implement the ASPI’s Pain Improvement Partnership project in Dallas and
the greater Austin area in the next eighteen months. The Pain Improvement
Partnership (PIP) is an evidence based quality improvement project aimed at
assisting long term care facilities, home care agencies, and small community
hospitals in improving pain management practices. This seven-month project is
a demonstrated effective quality improvement process that will equip facilities
for long-term success. Support for the program has been received from the
following organizations.
Alliance of State Pain Initiatives
Baylor Healthcare System, Dallas
Endo Pharmaceuticals
Purdue Pharma, L.P.
Texas Partnership for End-of Life Care (Texans for
Compassionate Care)
Texas Pain Advocacy & Information Network
American Cancer Society
Nurse Oncology Education Program
Texas Nurses Association/Foundation
Cancer Prevention & Research Institute of Texas
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2008 Annual Report
15. Texas Proud...
TxPAIN is “Texas Proud” of its members whose dedication to improving pain management for all merits national recognition.
2008 State Pain Initiative 2008-2009 Mayday Pain
Championship Award and Society Fellowship
Larry Driver, MD, Professor of Anesthesiology and Pain Scott Strassels, PharmD, PhD, BCPS, Assistant Professor of
Medicine at the University of Texas M.D. Anderson Cancer Pharmacy Practice at the University of Texas at Austin
Center, Houston is a 2008 recipient of the Alliance of State College of Pharmacy and Adjunct Assistant Professor of
pain Initiatives’ State Pain Initiative Championship Award. Public Health at the University of Texas School of Public
The award recognizes individuals who have made Health, Austin Regional Campus in Austin, is a recipient of a
outstanding contributions to the growth, development, and 2008-2009 Mayday Pain Fellowship.
accomplishments of a State Pain Initiative.
Since 2004, the Mayday Pain & Society Fellowship: A Media and
Dr. Driver also was a recipient of a 2006-2007 Mayday Pain Policy Initiative trains healthcare professionals, scientists, and
Fellowship. legal scholars to “become players in the pain field, and
ultimately have real impact on the lives of people in pain.”
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2008 Annual Report
16. By the Numbers: Report of Activities for 2008
Conferences/Symposia/Online Continuing
Education Participants Politics of Pain Report Distribution Hard Copy
Texas Medical Association Council on Scientific
Nurse Oncology Education Program (NOEP) Affairs 12
Nursing Principles of Pain Management
Independent Study Online 394 University of Texas at Tyler 10
Oncology Certified Nurse (OCN) Review American Cancer Society High Plains Division
Course, Tyler, Texas 48 Leadership Staff 15
Pain Management Plus Cancer Screening
Conference, Laredo, Texas 31 2007 Texas Pain Summit Stakeholders Meeting 95
Faculty Training Program, UT M.D. Physician Oncology Education Program
Anderson Cancer Center, Houston, Texas 10 Steering Committee 20
24th Annual Update Conference, Laredo, Nurse Oncology Education Program Steering
Texas 275 Committee 30
Texas Partnership for End-of-Life Care A National American Cancer Society Leadership
Common Thread 2007, Austin, Texas 175 Staff 5
American Pain Foundation Power Over Pain
Action Network Annual Leadership Training,
Baltimore, Maryland 30 2006 Texas Summit Participants 75
Poster Sessions Attendees Texas Pain Society Board 15
American Pain Society 27th Annual Scientific Texas Pain Summit Committee
Meeting Poster Session, Tampa, Florida 1,300 Members 60
International Association for the Study of Pain
World Congress Poster Session, Glasgow,
Scotland 6,000 Lance Armstrong Foundation 25
Newsletters, Newspaper Articles, University of Texas M.D. Anderson Cancer
Promotions Readership Center 50
Texas Nurses Association/Foundation Texas
Nurses Voice Newsletter 268,000 American Pain Foundation 40
Intercultural Cancer Council Board Members
Newsletter 30 Webpage Hits, Report Downloads
Physician Oncology Education Program, Texas
C-Change Newsletter 150 Medical Association Webpage hits/downloads 33,593
NOEP E-Newsletter 7,000 Other Exposure
Comprehensive Cancer Control State, Tribe &
Territory Coalition Chairs Newsletter 52 Purdue Pharma L.P. E-Newsletter
NOEP Pain Independent Study in Texas
Comprehensive Cancer Control Coalition Texas Academy of Palliative Medicine & Texas
Newsletter The Coalition Voice 300 Medical Directors Association
Office Visit with Hospice Medical Directors,
El Paso Times Article El Paso, Texas 100,000 Tyler, Texas
Politics of Pain Posted on ASPI Website
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2008 Annual Report
