Pain Medicine: An Emerging Specialty for Nurse Practitioners

LAS VEGAS—The ever-changing healthcare paradigm suggests nurse practitioners (NPs) in pain management may be the best hope for dealing with time constraints, increasing healthcare costs, or reluctance of primary care physicians to provide care for pain patients.

Pain education is a necessity for NPs because pain is the most frequent reason for a visit to primary care providers nationwide. All NPs, whether in adult medicine, acute care, geriatric, pediatric, or family medicine or palliative care medicine, need some expertise in pain management, she said.

The role of the pain management NP is to function “as an autonomous provider within a collaborative network of healthcare providers to resolve the needs of patients with acute and chronic pain,” said Cynthia F. Knorr-Mulder, MSN, BCNP, NP-C, Clinical Director, Pain Management and Wellness at Englewood Hospital and Medical Center, Englewood, New Jersey.

The primary goal is to develop a therapeutic relationship with patients who are looking to be considered a partner in planning their healthcare and managing their pain. Knorr- Mulder said on average, physicians interrupt patients only 18 seconds after they begin to speak. As a result, the patient “is deprived of a chance to tell their story,” and withhold their real reason for the visit until the end or subsequent visits, compromising the physician's ability to gather important information for a proper diagnosis.

One role for NPs is to decrease opioid abuse within the chronic pain environment. This includes use of screening tools and opioid contracts as well as ongoing assessment and documentation of the 4 As: analgesia, activities of daily living, adverse effects, and aberrant behavior.

Although degree of autonomy and scope of practice differs in accordance with the state in which the NP practices,in general, NPs are advanced practice registered nurses who take on many medical responsibilities traditionally performed by their physician counterparts. This includes obtaining a history and physical; medical diagnoses, treatment, and evaluation; management of acute and chronic diseases; ordering and performing diagnostic studies; performing or assisting in minor surgeries and procedures; and prescribing medications, including opioids. Practice sites include acute, chronic, critical care, specialties, private practice, and long-term care.