Pain management: An emerging specialty for nurse practitioners
Nobody wants to experience pain. Whether it’s debilitating back pain due to degenerative spine disease, the constant ache of fibromyalgia, or the agony of terminal cancer, pain is terrible to endure — and it often is not well-treated. But an emerging nursing specialty — pain management — can help patients find relief. Nurse practitioners (NPs) are advanced practice nurses who are providing more primary patient care in the current health care environment, and many of them are providing pain management care.
While pain management is a relatively new practice area, it is one that offers opportunities for nurse practitioners who have the right skills and attitude, according to Erich Widemark, PhD, RN, FNP-BC and campus college chair at the Phoenix Main Campus. “Because of issues surrounding addiction, and some high-profile cases of unscrupulous ‘pill mills,’ this is a controversial practice area,” he explains. “But it appears to have many opportunities for nurses to help care for chronic pain patients.”
“A nurse practitioner working in pain management obtains additional education as it relates to the care of chronic and acute pain patients,” says Widemark. “There are opportunities to obtain optional advanced certifications in pain management as well. Pain management NPs evaluate patients for the sources of their pain, and also the underlying pathophysiology.”
Randy Hamilton, RN, MSN, FNP-C, is a nurse practitioner working in pain management and a College of Nursing instructor at the Phoenix Main Campus. He describes a typical day in the private pain clinic where he works as jam-packed — with a daily caseload of 30 patients, nearly 90 percent of whom have spine disease, while the rest have pain issues such as joint disease/arthritis, trigeminal neuralgia and neuropathies. After diagnosis, Hamilton prescribes the appropriate treatment, which often doesn't include heavy pain meds. “Treatment can include adjustment of pain medications, epidural/facet injections (for joint pain), or referrals to other providers for physical therapy, chiropractic care and so on,” he explains. Meditation, yoga, acupuncture, and music and art therapy are also alternative treatments recommended for chronic pain patients.
Because nurse practitioner licensing and practice requirements vary by state (especially regarding prescription of controlled substances and working relationships with physicians), Hamilton cautions that the level of practice independence for pain management NPs differs widely. “In Arizona, an NP can essentially work independently of physicians in diagnosing and treating patients,” he says. “But in some other states, or if an NP works in a pain management facility or a hospital, other restrictions or regulations may apply,” up to and including complete bans on controlled substance prescriptions by NPs in some states.
Widemark offers a word of caution to any nurse practitioner considering pain management as a specialty, however. “Pain management can be emotionally and physically demanding to any provider, and should only be selected by an NP who already has strong primary care experience.”