1. 1 NoPAIN Retreat David Liebovitz, MD

2. 2 Multi-disciplinary approach beneficial »Diabetes, CHF, cancer, geriatrics and palliative care »Practice change »Unintended benefits versus harms »Align goals for practice and research

3. 3 Multi-dimensional attention to pain is problematic in clinical care  Physical, psychological, social, spiritual  Contextual assessment inadequate  Linear scales are limited

4. 4 Many barriers to effective assessment  Policy  Clinician knowledge and skill  Patients’ attitudes  State of research available on best approach

5. 5 Many potential approaches  Measurement sciences  Clinical practice experience  Modeling  Informatics…

6. 6 Information technology may improve pain management  Acquisition  Presentation  Guidance  Feedback

7. 7 Many options for patient information acquisition  Prompted nursing documentation  Patient prompted recording »Wireless »Large fonts »No fonts?

8. 8 Focused presentation facilitates action  Diagrams: blinking body parts  Automatic escalation  Acknowledgement required

9. 9 IT can provide a pain management corridor  Consensus approach integration  Interruptive: Required steps  Guiding: Responses monitored within parameters

10. 10 An iterative process is required.  Defined outcomes for APGF  New tactics may be required  The job is never complete.