Developing Expertise in Pain Management Nursing

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By Megan M. Krischke, contributor 

November 9, 2012 - Nearly every person who seeks medical attention experiences pain as one of his or her symptoms. Beyond asking standard questions such as “Where does it hurt?” “What kind of pain is it?” and “Where would you rate your pain on a scale of 1-10?” there is a significant need for health care providers across specialties who can help patients assess and manage that pain.

There are also opportunities including research, consulting, and managing acute and chronic pain--in both inpatient and outpatient settings--for nurses who specialize in pain management.

Pain Management Nursing
Jackie Rowles, CRNA, MBA, FAAPM, pain practitioner at the Meridian Health Group in Indianapolis, says it is very rewarding to help people experience less pain and do more with their families.

“Nurses, patients and the public need to understand that chronic pain is a disease process and there are many factors involved in treating it,” began Jackie Rowles, CRNA, MBA, FAAPM, past president of the American Association of Nurse Anesthetists (AANA) and board member for the American Academy of Pain Management (AAPM). “Pain is best helped with a multimodal approach. We don’t adequately treat plain with medication alone. Patients often also need occupational or physical therapy and help from pain psychology to develop coping skills.”

Cindy Jo Allen, RN, staff nurse in anesthesia and pain management at Virginia Mason Medical Center in Seattle, recommends that nurses invest the time in learning to do a thorough pain assessment.

“This is an often overlooked skill, but it is where you need to start in order to know how to treat patient pain. Also, keep in mind the nursing foundation of treating the whole patient. It has been shown that patients’ perceptions of their caregivers’ active listening, emotional support and expressions of empathy increase the effectiveness of pain treatments.”

There are pain resource training courses and a pain management certification through the American Nurses Credentialing Center available to nurses of all specialties. Rowles recommends that nurses interested in learning more about pain management attend the AAPM’s annual conference, which is open to providers from a variety of specialties. Nurses with a strong interest in pain management can also pursue becoming a certified registered nurse anesthetist (CRNA), which is one of the most highly compensated fields of nursing.

“As CRNAs, we are trained in anesthesia and the management of pain. We treat pain from surgery, both during and after, and treat any anxiety before surgery. We can also do sedation for outpatient procedures,” explained Rowles. “There are CRNAs who are seeing patients in clinics, doing assessments, evaluations, establishing treatment plans, and some have prescription authority and can manage long-term pain.”

“One of the things I like most about working in pain management is being able to chronicle a patient during their treatment plan and see them get better,” she said of her outpatient clinic work. “There are many patients who will never be pain-free, but who are trying to manage it. I like working with them to achieve their greatest possible quality of life.”

Pain Management Nursing
Cindy Jo Allen, RN, encourages all nurses to learn the skills involved for doing a thorough pain assessment.

Allen, a staff nurse for an acute pain consulting service, says she spends about half her day rounding with inpatients who are post-op and consulting on patients who are having difficulty with their pain management. This typically involves doing pain assessments, making treatment recommendations and educating patients about their treatment plans.

Allen spends the other half of her day involved in pain management research, collecting data and serving as a liaison between the nursing staff and physicians. She also works with continuous process improvement, including developing protocols and providing nurse education regarding pain management.

“I see patients at the bedside, but I am not a bedside nurse. I do a lot of talking with patients, but I don’t do a lot of intervening. It is an adjustment from my previous role in the emergency department where I was intensely involved with a patient and everything that is going on with them,” remarked Allen. “I also work primarily with physicians and that has a different feel than working on a nursing team.”

“There is a lot of research on pain management happening both from a medical and a nursing standpoint. The most challenging aspect is that it is a subjective symptom,” Allen said. “There is nothing we can use to measure pain besides the patient’s report.”

Rowles also noted that a recent Institute of Medicine report, “Relieving Pain in America,” indicated that providers need more training in managing pain.

“It is complicated to treat pain because many patients have more than one pain generator and multiple causes can result in the same symptom,” she said.

The AANA recently applauded the Centers for Medicare and Medicaid Services (CMA) ruling to preserve patient access to chronic pain care delivered by CRNAs.

“It is important to reaffirm that CRNAs are qualified providers for pain management. If you cannot be reimbursed for your services, those services stop and then there is less access to care for patients, especially in rural areas,” stated Rowles.



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