Montana Pain Initiative

2. Montana Pain Initiative Past and Present

3. MTPI Mission: The Montana Pain Initiative is a grassroots, interdisciplinary project of the American Cancer Society and American Cancer Society Cancer Action Network dedicated to improving the quality of life of Montanans with pain by removing the barriers to effective pain assessment and management through research, education, and advocacy.

4. MTPI Organizational Structure Staffing Advisory Council Executive Committee Standing Committees Ad-Hoc Committees (Work Groups) Membership (non-fee; donations accepted) Project of the American Cancer Society

5. MTPI Advisory Council 35 Members representing Oversite: American Cancer Society American Cancer Society Cancer Action Network Hospitals: Benefis Healthcare Bozeman Deaconess Hospice and Palliative Care; Bozeman Deaconess Hospital Community Medical Center St. Patrick Hospital and Health Sciences Center St. Peter’s Hospital St. Vincent Healthcare

6. Executive Committee Leadership of the MTPI Chair, Randale Sechrest, MD Vice Chair, Jean Forseth, RN Medical Director, Kathryn Borgenicht, MD American Cancer Society Liaison, Kristin Nei Program Director, Kaye Norris, PhD

7. How we started

8. Senate Joint Resolution 28 The Montana Pain and Symptom Management Task Force (MPSMTF) Montana Legislature in 2005 Senator Carolyn Squires

9. Senate Joint Resolution 28 For two years gathered national and local information on pain management Conducted a convenience sample Community Survey (329 participants, results can be found at www.mtpain.org)

10. Senate Joint Resolution 28 Developed a white paper with 10 recommendations focusing on policy, provider practice improvement, and advocacy (Mailed over 900 white papers to opinion leaders in Montana) Recommended the Development of the Montana Pain Initiative Move from information gathering to action

11. Strategic Planning RetreatSeptember 2007 2-day strategic planning retreat Developed MTPI Mission Statement Developed MTPI Vision Statement Created MTPI Governance Structure Thank you LAF and ASPI!

12. Getting the Work Done Standing Committees Public and Institutional Policy Patient and Public Education & Advocacy Provider Practice Improvement Work Groups Addressing Chronic Pain and Addiction

13. Grants Received

14. Grants Pain Improvement Partnership (Lance Armstrong funding through the Alliance of State Pain Initiatives) Strategic Planning (Lance Armstrong Foundation through the Alliance of State Pain Initiatives) State Pain Activity (American Cancer Society Cancer Action Network) Public Safety Program: Partnering to Improve Pain Management and Reduce Abuse and Diversion (Montana Attorney General)

15. Projects

16. Provider Practice Improvement Annual Conferences: Politics of Pain: Improving Pain Management Policy in Montana (Missoula, April 2007) Pain Management Policy and Practice: A Balanced Approach (Missoula, September 2008) Practical Approaches to Managing Pain (Bozeman, Sept 2009) Navigating the Complexities of Pain (Billings, October 2010) Special Conference: Addressing Chronic Pain and Addiction: A Community Network Approach (Missoula, May 2010)

17. Provider Practice Improvement Disseminated Scott Fishman’s book Responsible Opioid Prescribing: A Physician’s Guide to over 3000 practicing prescribers (partnered with Attorney General’s Office and Board of Medical Examiners)

18. Policy Improvement Montana Board of Medical Examiners adopted Model Pain Policy developed by Federation of State Medical Boards Board of Pharmacy revised pain policy based on national standards 13 Facilities (long term care, home health, and critical access hospitals) revised policy and structure to improve pain management

19. Policy Improvement In 2008-9 Assisted PMP Coalition in drafting Prescription Monitoring Program legislative language which focused on patient safety The bill was defeated in the Human Health and Services Committee Currently working with the Montana Attorney General’s Office: Legislation is drafted and has been approved by the American Cancer Society Cancer Action Network

20. Patient Advocacy Chronic Pain Support Groups Helena Missoula American Pain Foundation Statewide Leaders Nicole Dunn Kathryn Borgenicht Kaye Norris September Pain Awareness Month Media coverage (radio interviews & newspaper articles) Holistic Health Fair in Missoula Over 100 people attended MTCCC Quality of Life and Survivorship Committee Pain management a priority

21. National & Local Presentations

22. National: Advancing Pain Management Policy and Practice (joint presentation with the Georgia Pain Initiative; Alliance of State Pain Initiatives annual conference 2008) Improving State Pain Policy in Montana and Oregon (joint presentation with Pain Society of Oregon; American Pain Foundation annual Summit 2009) Local: Improving Pain Management: Using the Montana Pain Initiative to Tackle Barriers (3 presentations to American Cancer Society Advisory Councils in Butte, Great Falls, Missoula, 2008) Managing Cancer Pain: Successes and Challenges (MTCCC statewide meeting, Nov 2009) Pain Management and Medication Misuse (4th Annual Crime Prevention Conference, Oct 2010)

23. Research In August/September 2009 developed pain questions for the Behavior Risk Factor Surveillance Survey

24. BRFSS Questions Do you suffer from any type of chronic pain; that is pain that occurs constantly or flares up frequently?  How long have you been experiencing this type of pain?  About how often do you experience this pain? Would you say:  Using a 0 to 10 scale where 0 means no pain at all and 10 means the worst pain imaginable, when you experienced pain how severe would you say it was on average over the past 3 months? During the past 30 days, for about how many days did your pain keep you from doing your usual activities, such as self-care, work, or recreation?

25. BRFSS Questions What types of therapies does your health care provider recommend to manage your pain? over the counter medications; prescription medications; medical marijuana; complementary therapies such as massage, physical therapy or acupuncture Do you feel your pain is well managed?  Which of the following do you believe is the biggest barrier to treating your pain? No barriers; Cost of care; Health care provider is not helpful; I don’t ask for treatment for my pain

26. Provider Survey

27. Provider Survey Sauny Sewell (nursing student working on Master Thesis) Developed Provider Survey Pharmacological Pain Management Questionnaire knowledge of, perceived barriers to and educational needs Conducted a Delphi Analysis Small Group Content Validity Analysis When complete we will have a survey that with funding we could conduct

28. Current Projects

29. Projects in the Works Indian Health Service Pain Management Policy and Practice Program (grant submitted to MayDay Fund in 2009 was not funded/requesting to submit again) Pain Improvement Partnership Project Looking for Funding TriAd Services Coordination “TASC”: A Missoula Pilot Project Montana Mental Health Trust grant proposal Montana specific On-Line CME/CE modules

30. Thank you for attending the 4th Annual Montana Pain Initiative ConferenceYour ideas and contributions are greatly appreciated