Nurses who regularly see patients with chronic pain help discern the best course of treatment by looking at the whole person, including their mental state and risk for drug addiction. Medication is not always the answer, some nurses say.
Fifty to 75 million Americans experience pain annually, including nearly half of those undergoing cancer treatment, according to some estimates. But pain is subjective; it cannot be documented by an X-ray or a blood count.
"It sort of forces you to walk in the gray while you're in a black-and-white system," explains Margaret Kellar, a clinical nurse specialist at Courage Center Chronic Pain Rehabilitation Program in Golden Valley (www.couragecenter.org).
"Pain management is so important for nurses and nurse practitioners," adds Amy Krenzer, a nurse practitioner at Twin Cities Pain Clinic in Edina (www.twincitiespainclinic.com). "It is considered the fifth vital sign."
Pain Management History
Medical practitioners in the United States began to take pain management seriously when the hospice movement began in the 1980s, according to Kellar, who began her career in hospice. Some health professionals consider patients who ask for help with pain to be drug-seekers, according to Krenzer. "The reality is they may not be getting the right kind of pain medication or enough of that medication," she says. "However, medication isn't always the best treatment for everyone. Treatments should be individualized."
The staff at Twin Cities Pain Clinic (www.twincitiespainclinic.com) helps patients manage pain through physical therapy, injections and medication, monitoring them for chemical dependency. "We try to get to the bottom of why they're having pain," Krenzer says. "Some patients we only see once and we can prescribe something that might work and we don't see them again. Most of our patients have chronic pain and come in once a month or every couple of months."
Chronic pain may also cause anxiety or depression. "Assessment of the patient's mental health is ongoing," Krenzer adds. "We often recommend seeing a psychiatrist or a psychologist."
Other Pathways To Pain Management
Patients with chronic pain may need to find other ways to manage it, according to Kellar, who also teaches yoga and tai chi chih to clients discontinuing pain medication. These disciplines help rebalance the neurotransmitters affected by opioids, she says.
"I do a lot with the weaning and helping them with the withdrawal. I teach classes, and if they have other health conditions like diabetes and blood pressure, I monitor all ofthat," Kellar adds. "I get to work with the clients and teach them strategies that focus on life and what they can do rather than the pain and what they can't do."
Nurses in pain management need patience, an open mind and good listening skills, according to Krenzer. With the aging of the baby boomers, these nurses will probably be busy far into the future, she says. "I don't see that our specialty will slow down at all."