Theresa is an Adult Nurse Practitioner with over 25 years’ experience at Stanford Health Care in Palo Alto, California. She received her graduate degree from University of California, San Francisco.
Theresa’s current clinical practice within the Division of Pain Medicine, focuses primarily on evaluation and treatment of individuals suffering from acute and chronic pain conditions in both the hospital and outpatient settings.
As part of her commitment to education and professional development, she lectures extensively on topics surrounding pain management both locally and regionally. She has authored and co-authored numerous articles, abstracts, and book chapters on topics pertaining to pain assessment and management. Theresa is a clinical preceptor for NP and PA students in the greater Bay Area; she also mentors and instructs the fellows and residents on the Stanford Pain Service.
Theresa is actively involved in multiple professional organizations including: The American Association of Nurse Practitioners, California Association of Nurse Practitioners, American Society of Pain Management Nursing and American Academy of Pain Medicine. As part of her commitment to safety and ethical treatment of patients with pain; Theresa has provided services as an independent expert witness on issues related to pain management and treatment.
- Nurse Practitioner
- Pain Management
Honors & Awards
Nurse Practitioner of the Year (Pain Management), Point of Care Network (2022)
Nurse Practitioner of the Year (Pain Management ), Point of Care Network (2021)
Advanced Practice Provider of the Year, Stanford Health Care (2015)
Nurse Practitioner of the Year (Pain Management), Point of Care Network (2019)
Board Certification: American Nurses Credentialing Center, Nurse Practitioner (2014)
Professional Education: UCSF School Of Nursing (2002) CA
Additional Clinical Info
Efficacy and safety of tanezumab, NSAIDs, and placebo in patients with moderate to severe hip or knee osteoarthritis and a history of depression, anxiety, or insomnia: post-hoc analysis of phase 3 trials.
Current medical research and opinion
Objective Treatment outcomes for chronic pain can be poor in patients with depression, anxiety, or insomnia. This analysis evaluated the efficacy and safety of subcutaneous tanezumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and placebo in patients with osteoarthritis (OA) and a history of these conditions using data from three phase 3 studies. Methods: A post-hoc analysis of data from two pooled placebo-controlled studies and one NSAID-controlled study of subcutaneous tanezumab. All patients had moderate to severe knee or hip OA that was inadequately controlled with standard-of-care analgesics. Efficacy outcomes were least-squares mean change from baseline to Week 16 in Western Ontario McMaster Universities OA Index (WOMAC) Pain, WOMAC Physical Function, Patient's global assessment of OA, and EQ-5D-5L scores. Results were summarized for patients with and without a history of depression, anxiety, or insomnia at baseline. Results: 1545 patients were treated in the pooled placebo-controlled studies (history of depression, 12%; anxiety, 8%; insomnia, 10%; any, 23%) and 2996 in the NSAID-controlled study (16%, 11%, 13%, 28%, respectively). In groups with positive histories, 38-80% took antidepressant or anxiolytic medications at baseline. Within treatments, largely similar improvements in efficacy outcomes were observed in patients with and without a history of depression, anxiety, or insomnia; the types of treatment-emergent adverse events were similar. Conclusions: Patients with OA and a history of depression, anxiety, or insomnia did not appear to experience reduced efficacy outcomes or an altered safety profile in response to tanezumab or NSAID treatment as compared with those without. NCT02697773; NCT02709486; NCT02528188.
View details for DOI 10.1080/03007995.2022.2113689
View details for PubMedID 35980115
- Professional Pain Societies Have Value, But Need to Do More. Practical Pain Management 2022; September/October (5)
- Holistic Pain Management in Pregnancy: What RNs, APRNs, Midwives and Mental Health Professionals Need to Know edited by Mallick-Searle, T. Springer International . 2022
Naloxegol Accelerates Time to First Spontaneous Bowel Movement (SBM) and Complete SBM (CSBM) With Predictable Efficacy in Patients With Extreme Opioid-Induced Constipation (OIC): A Pooled Analysis of Two Phase 3 Trials
LIPPINCOTT WILLIAMS & WILKINS. 2021: S221
View details for Web of Science ID 000717526100496
Naloxegol Achieved Rapid and Sustained Improvement of Opioid-Induced Constipation (OIC) Symptoms in Patients With Extreme OIC: A Pooled Analysis of Two Pivotal Phase 3 Trials
LIPPINCOTT WILLIAMS & WILKINS. 2021: S227
View details for Web of Science ID 000717526100507
Efficacy of Subcutaneous Tanezumab for the Treatment of Osteoarthritis of the Knee or Hip: A Post Hoc Subgroup Analysis of Patients from a Randomized, NSAID-Controlled Study with a History of Depression, Anxiety, or Insomnia
WILEY. 2021: 1467-1469
View details for Web of Science ID 000744545202237
- Pharmacotherapy for Pain Management Advanced Pharmacology for Prescribers, 1st ed. Springer Publishing. 2021; 1st: 533–548
Pain and Function in Chronic Musculoskeletal Pain-Treating the Whole Person.
Journal of multidisciplinary healthcare
2021; 14: 335–47
Chronic pain is often associated with functional limitations that have a huge impact on patients' lives. However, despite being relatively common, chronic musculoskeletal pain is still viewed by some as a symptom of another disease rather than its own condition, and is therefore poorly addressed. This is compounded by other challenges in the field, including education gaps for both healthcare professionals and patients, a lack of universal and comprehensive assessment tools, poor societal perceptions of chronic pain, and the current stigma around the use of opioids. Here, we review the current chronic musculoskeletal pain management landscape in the United States and offer professional insight into emerging methods that can be used to improve patient outcomes, in particular, the achievement of meaningful functional goals. This perspective incorporates our combined multidisciplinary (psychiatry, psychology, nursing, physical therapy, and general medicine) experience and insights. We believe that chronic pain is a multifactorial experience and treatment requires an integrated, multidisciplinary approach from a range of healthcare providers. For the best patient outcomes, this team should work together to assess and treat the patient as a whole, addressing their pain and also providing education, empowerment, and support to enable patients to set and achieve meaningful functional goals that will provide real improvement in their quality of life. We believe that the healthcare community should elevate the conversation around chronic musculoskeletal pain management beyond that of just pain, to encompass the meaningful benefits that improvement in functional outcomes brings to patients.
View details for DOI 10.2147/JMDH.S288401
View details for PubMedID 33603392
Unmet needs in the acute treatment of migraine attacks and the emerging role of calcitonin gene-related peptide receptor antagonists: An integrative review.
Journal of the American Association of Nurse Practitioners
BACKGROUND: Migraine is a prevalent and chronic disease associated with high rates of disability and significant financial and socioeconomic burden. Current acute treatments for migraine attacks include both migraine-specific (e.g., triptans, ergotamines) and nonspecific (e.g., nonsteroidal anti-inflammatory drugs) medications; however, significant unmet treatment needs remain.OBJECTIVES: The authors sought to characterize the nature and drivers of unmet treatment needs in the acute treatment of migraine attacks and describe emerging migraine-specific treatments, that is, calcitonin gene-related peptide (CGRP) receptor antagonists.DATA SOURCES: PubMed searches were conducted using search terms for studies of unmet migraine treatment needs and CGRP receptor antagonists. Additionally, studies presented at recent headache-focused congresses were included.CONCLUSIONS: Forty percent of people with migraine report at least 1 unmet treatment need. Many people are unable to use migraine-specific or nonspecific agents because of contraindications, precautions, and tolerability issues. Disease burden (disability, headache severity/frequency) remains high even in those receiving migraine-specific medications. The oral CGRP receptor antagonists, ubrogepant and rimegepant, demonstrated efficacy in reducing migraine pain, migraine-associated symptoms, and disability, with a low adverse event profile, similar to placebo.IMPLICATIONS FOR PRACTICE: The availability and use of CGRP receptor antagonists may help reduce the extent of unmet needs in the treatment of migraine attacks, resulting in more patients receiving treatment and better outcomes for people with migraine. Nurse practitioners are well positioned to increase rates of migraine diagnosis/treatment (another key unmet need), using consensus guidelines to guide their approach.
View details for DOI 10.1097/JXX.0000000000000397
View details for PubMedID 32304480
Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion.
Pain medicine (Malden, Mass.)
OBJECTIVE: An expert panel convened to reach a consensus on common misconceptions surrounding buprenorphine, a Schedule III partial -opioid receptor agonist indicated for chronic pain. The panel also provided clinical recommendations on the appropriate use of buprenorphine and conversion strategies for switching to buprenorphine from a full -opioid receptor agonist for chronic pain management.METHODS: The consensus panel met on March 25, 2019, to discuss relevant literature and provide recommendations on interpreting buprenorphine as a partial -opioid receptor agonist, prescribing buprenorphine before some Schedule II, III, or IV options, perioperative/trauma management of patients taking buprenorphine, and converting patients from a full -opioid receptor agonist to buprenorphine.RESULTS: The panel recommended that buprenorphine's classification as a partial -opioid receptor agonist not be clinically translated to mean partial analgesic efficacy. The panel also recommended that buprenorphine be considered before some Schedule II, III, or IV opioids in patients with a favorable risk/benefit profile on the basis of metabolic factors, abuse potential, and tolerability and that buprenorphine be continued during the perioperative/trauma period. In addition, switching patients from a full -opioid receptor agonist to buprenorphine should be considered with no weaning period at starting doses that are based on the previous opioid dose.CONCLUSIONS: These recommendations provide a framework for clinicians to address most clinical scenarios regarding buprenorphine use. The overall consensus of the panel was that buprenorphine is a unique Schedule III opioid with favorable pharmacologic properties and a safety profile that may be desirable for chronic pain management.
View details for DOI 10.1093/pm/pnz356
View details for PubMedID 31917418
- Headaches Pharmacotherapeutics for Advanced Practice Nurse Prescribers, 5th ed. F.A. Davis Company. 2020; 5th: 1069–1099
- Monoclonal Antibodies to CGRP or Its Receptor for Migraine Prevention JNP-JOURNAL FOR NURSE PRACTITIONERS 2019; 15 (10): 717-+
Cannabinoids in Pain Treatment: An Overview
PAIN MANAGEMENT NURSING
2019; 20 (2): 107–12
The current landscape contains conflicting reports regarding the use of medical marijuana, creating fields of misinformation and lack of understanding by health care providers about cannabinoids. In this article we provide a dispassionate look at medical marijuana, while providing a clinical overview focusing on pain management. We examine the mechanisms of the endocannabinoid system, along with the pharmacology of cannabinoids. Current research on the use of marijuana for the treatment of pain is reviewed. Finally, recommendations for pain management nurses on integrating research, clinical practice, and U.S. drug policy are made.
View details for DOI 10.1016/j.pmn.2018.12.006
View details for Web of Science ID 000466100700058
View details for PubMedID 31036325
- International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering PAIN MEDICINE 2019; 20 (3): 429–33
International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering.
Pain medicine (Malden, Mass.)
View details for PubMedID 30496540
- The importance of nurse monitoring for potential opioid abuse in their patients JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH 2018; 23 (1)
- Physiology of Pain Core Curriculum for Pain Management Nursing Elsevier. 2018; 3rd: 132–169
An overview of abuse-deterrent opioids and recommendations for practical patient care
JOURNAL OF MULTIDISCIPLINARY HEALTHCARE
2018; 11: 323–32
Despite advances in the treatment of severe intractable pain, opioids remain a critical and appropriate component of treatment. However, abuse, misuse, and diversion of prescription opioids are significant public health concerns. Opioid abuse-deterrent formulations (ADFs) are one component of an opioid risk management plan to manage patient's pain relief and quality of life while offering some protection against potentially harmful consequences of opioids from misuse and abuse. Opioid ADFs are designed to make manipulation more difficult and administration via non-oral routes less appealing. There are currently nine extended-release and one immediate-release opioid pain medications with US Food and Drug Administration-approved ADF labeling. All use physical/chemical barriers or agonist/antagonist combinations to deter manipulation and abuse. Evidence suggests that opioid ADFs decrease rates of abuse and diversion of opioids in the USA; however, some opioid ADFs are not yet commercially available or have not been on the market long enough to undergo post-marketing data analyses. Opioid ADFs along with the use of prescription drug monitoring programs, clinical assessment tools, toxicology testing, and co-prescribing of naloxone are all tools that can be used to reduce opioid abuse. Patient education on the risks of abuse and diversion is vital and includes a discussion of appropriate use of medication and proper storage. Physician assistants and nurse practitioners are on the "front lines" in battling opioid abuse and serve a key role in recognizing and mitigating the risks of prescription opioid diversion, abuse, and misuse (intentional and unintentional) and in identifying patients at risk for abuse while still providing pain relief to patients.
View details for DOI 10.2147/JMDH.S166915
View details for Web of Science ID 000438594400001
View details for PubMedID 30026658
View details for PubMedCentralID PMC6045950
- Commonly used nonopioid analgesics in adults. Nursing 2018; 48 (5): 61–63
The pathophysiology, incidence, impact, and treatment of opioid-induced nausea and vomiting
JOURNAL OF THE AMERICAN ASSOCIATION OF NURSE PRACTITIONERS
2017; 29 (11): 704–10
Opioid medications are integral in managing acute moderate-to-severe pain. Opioid analgesics bind to μ (mu), κ (kappa), or δ (delta) opioid receptors in the brain, spinal cord, and digestive tract. However, opioids cause adverse effects that may interfere with their therapeutic use. Some adverse effects wane over time, but patients using opioids for acute pain struggle with opioid-induced nausea and vomiting (OINV) the entire time they take the opioid. This article discusses the underlying mechanisms, clinical implications, and treatment strategies of OINV.Systematic search and review of Medline, PubMed, and Google Scholar for articles relating to OINV. In addition, package inserts provided pharmacologic data and dose recommendations as needed.Research suggests approximately 40% of patients may experience nausea and 15%-25% of patients may experience vomiting after opioid administration. Nausea often precedes vomiting, although they can occur separately. Many patients receiving opioids rate the nausea and vomiting as worse than their pain. Nausea and vomiting can lead to complications including electrolyte imbalances, malnutrition, and volume depletion, and can also negatively affect quality of life and postoperative recovery.There are several medications that can be used to treat OINV including serotonin receptor antagonists, dopamine receptor antagonists, and neurokinin-1 receptor antagonists. Healthcare providers should be proactive about discussing OINV with patients, as this may improve patient outcomes and pain relief.
View details for DOI 10.1002/2327-6924.12532
View details for Web of Science ID 000415011200009
View details for PubMedID 29131554
Diagnosis and treatment for chronic migraine
2016; 41 (6): 18-+
Migraine is a debilitating headache disorder that is underdiagnosed and undertreated worldwide, partially attributable to misdiagnosis and expectations of poor treatment outcomes. This article provides a review of chronic migraine, including pathophysiology, burden, diagnosis, and management, with special emphasis on the role of NPs.
View details for DOI 10.1097/01.NPR.0000483078.55590.b3
View details for Web of Science ID 000379375000003
View details for PubMedID 27203455
View details for PubMedCentralID PMC4876579
- Over-the-Counter Analgesics: What Nurse Practitioners Need to Know JNP-JOURNAL FOR NURSE PRACTITIONERS 2016; 12 (3): 174–80
Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
JOURNAL OF MULTIDISCIPLINARY HEALTHCARE
2016; 9: 447–54
Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin), tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine), or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence-based treatments; and monitoring treatment adherence, adverse events, responses, and expectations. Nurse practitioners are especially crucial in establishing communication with patients and encouraging the initiation of appropriate pain-relieving treatments.
View details for DOI 10.2147/JMDH.S106340
View details for Web of Science ID 000384261600001
View details for PubMedID 27703368
View details for PubMedCentralID PMC5036669