Barbara St. Marie

Core competencies for pain management: Results of an interprofessional consensus summit

Objective The objective of this project was to develop core competencies in pain assessment and management for prelicensure health professional education. Such core pain competencies common to all prelicensure health professionals have not been previously reported. Methods An interprofessional executive committee led a consensus-building process to develop the core competencies. An in-depth literature review was conducted followed by engagement of an interprofessional Competency Advisory Committee to critique competencies through an iterative process. A 2-day summit was held so that consensus could be reached. Results The consensus-derived competencies were categorized within four domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain management. These domains address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models. A set of values and guiding principles are embedded within each domain. Conclusions These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of learning activities across health professions designed to advance care that effectively responds to pain.

An Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Physical Therapy

Core competencies in pain management for prelicensure health professional education were recently established.1 These competencies represent the expectation of minimal capabilities for graduating health care students for pain management and include 4 domains: multidimensional nature of pain, pain assessment and measurement, management of pain, and context of pain (Appendix 1). The purpose of this article is to advocate for and identify how core competencies for pain can be applied to the professional (entry-level) physical therapist curriculum. By ensuring that core competencies in pain management are embedded within the foundation of physical therapist education, physical therapists will have the core knowledge necessary for offering best care for patients, and the profession of physical therapy will continue to stand with all health professions engaged in comprehensive pain management. One hundred million adults in America have chronic pain.2 This statistic is greater than the number of individuals affected by diabetes, cancer, and heart disease combined.2,3 Chronic pain management costs the United States more than

American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

600 billion per year in health care costs and lost wages2 and creates major human and economic costs for patients, families, and society.1 Inadequate treatment or mismanagement of pain can cause delays in healing as well as long-lasting changes to the peripheral and central nervous systems.4 The Institute of Medicine published a report on pain in 2011 that highlighted it as a national challenge and recognized the need for a cultural transformation to effectively prevent, assess, treat, and understand pain of all types.2 This report addressed the deficit in pain education across all professions and promoted the inclusion of standardized information about pain within an “interprofessional setting.”2 Specific to physical therapy, a faculty survey of accredited physical therapist education programs in North America revealed 4 hours of pain education …

Coexisting Addiction and Pain in People Receiving Methadone for Addiction

The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

An Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Nursing

The aim of this qualitative study was to examine the narratives of people who experience chronic pain (lasting 6 months or more) and were receiving methadone for the treatment of their opiate addiction through a major methadone clinic. This paper featured the pathway of how the participants developed chronic pain and addiction, and their beliefs of how prescription opioids would impact their addiction in the future. Thirty-four participants who experienced chronic pain and received methadone for treatment of opiate addiction were willing to tell the story of their experiences. The findings in three areas are presented: (a) whether participants experienced addiction first or pain first and how their exposures to addictive substances influenced their experiences, (b) the significance of recreational drug use and patterns of abuse behaviors leading to chronic pain, and (c) participants’ experiences and beliefs about the potential for abuse of prescription opioid used for treatment of pain.

Primary care experiences of people who live with chronic pain and receive opioids to manage pain: A qualitative methodology

BACKGROUND Ineffective assessment and management of pain is a significant problem. A gap in prelicensure health science program pain content has been identified for the improvement of pain care in the United States. METHOD Through consensus processes, an expert panel of nurses, who participated in the interdisciplinary development of core competencies in pain management for prelicensure health professional education, developed recommendations to address the gap in nursing curricula. RESULTS Challenges and incentives for implementation of pain competencies in nursing education are discussed, and specific recommendations for how to incorporate the competencies into entry-level nursing curricula are provided. CONCLUSION Embedding pain management core competencies into prelicensure nursing education is crucial to ensure that nurses have the essential knowledge and skills to effectively manage pain and to serve as a foundation on which clinical practice skills can be later honed. [J Nurs Educ. 2015;54(6):317-327.].

Referrals and Treatment Completion for Prescription Opioid Admissions: Five Years of National Data.

BACKGROUND AND PURPOSE The prevalence of chronic pain continues to rise and the majority of patients with chronic pain are managed in primary care. The purpose of this research was to provide the perspectives of patients who live with chronic pain and receive opioids to help manage their pain from primary care. METHODS In this qualitative study, 12 participants from a Midwest primary care clinic described their primary care experiences with receiving opioids for chronic pain. Thematic and interpretive analyses were used to understand the issues. CONCLUSIONS Participants receiving opioids for pain management through primary care feared losing access to opioids, wanted to protect sobriety when they had histories of substance use disorder, experienced stress at their jobs with frequent appointments, identified inconsistencies in health care prolonging their suffering and increasing substance misuse, and identified improvement in coping with pain when they had confidence in healthcare providers. IMPLICATIONS FOR PRACTICE Providing patient-centered care while managing patients with pain and unknown risk for prescription opioid misuse is possible. Understanding influences that create prescription opioid risk for misuse can help nurse practitioners improve their delivery of care by providing consistent and convenient healthcare encounters, and help patients protect themselves from risk of prescription opioid misuse.Background and purpose The prevalence of chronic pain continues to rise and the majority of patients with chronic pain are managed in primary care. The purpose of this research was to provide the perspectives of patients who live with chronic pain and receive opioids to help manage their pain from primary care. Methods In this qualitative study, 12 participants from a Midwest primary care clinic described their primary care experiences with receiving opioids for chronic pain. Thematic and interpretive analyses were used to understand the issues. Conclusions Participants receiving opioids for pain management through primary care feared losing access to opioids, wanted to protect sobriety when they had histories of substance use disorder, experienced stress at their jobs with frequent appointments, identified inconsistencies in health care prolonging their suffering and increasing substance misuse, and identified improvement in coping with pain when they had confidence in healthcare providers. Implications for practice Providing patient-centered care while managing patients with pain and unknown risk for prescription opioid misuse is possible. Understanding influences that create prescription opioid risk for misuse can help nurse practitioners improve their delivery of care by providing consistent and convenient healthcare encounters, and help patients protect themselves from risk of prescription opioid misuse.The prevalence of chronic pain continues to rise and the majority of patients with chronic pain are managed in primary care. The purpose of this research was to provide the perspectives of patients who live with chronic pain and receive opioids to help manage their pain from primary care.In this qualitative study, 12 participants from a Midwest primary care clinic described their primary care experiences with receiving opioids for chronic pain. Thematic and interpretive analyses were used to understand the issues.Participants receiving opioids for pain management through primary care feared losing access to opioids, wanted to protect sobriety when they had histories of substance use disorder, experienced stress at their jobs with frequent appointments, identified inconsistencies in health care prolonging their suffering and increasing substance misuse, and identified improvement in coping with pain when they had confidence in healthcare providers.Providing patient-centered care while managing patients with pain and unknown risk for prescription opioid misuse is possible. Understanding influences that create prescription opioid risk for misuse can help nurse practitioners improve their delivery of care by providing consistent and convenient healthcare encounters, and help patients protect themselves from risk of prescription opioid misuse.

The complex pain patient: interventional treatment and nursing issues.

This study examines sources of referral for prescription opioid admission to substance use disorder treatment facilities and their relative completion success rates using secondary analysis of an existing data set (treatment episode datasets-discharge). Five years of data from public and private treatment facilities were extracted for client discharges with no prior treatment (N=2,909,884). Healthcare professionals account for very few referrals to treatment (<10%). Prescription opioid clients referred into treatment had lower treatment success compared to other substance clients and when referred by healthcare providers had lower success rates (OR=0.72, 95% CI 0.70-0.75) than clients from other referral sources. Fewer treatment referrals for prescription opioid misuse by healthcare providers and lower success rates are significant and timely findings due to the prevalence of prescription opioid misuse. Healthcare providers are well positioned to refer early for prescription opioid misuse and continue support of their patients during treatment.

5E Development and Psychometric Evaluation of a New Clinical Pain Knowledge Test for Nurses

This article discusses interventional treatment for the complex pain patient, including intraspinal opioid administration, spinal cord stimulation, and commonly performed nerve blocks. The role of the nurse has grown to support these technological interventions, and nursing has provided a foundation to strengthen the success of these interventions through watchful monitoring and patient education.

Primary care experiences of people who live with chronic pain and receive opioids to manage pain: A qualitative methodology: Primary care of people using opioids

and minimizing risk factors for adverse events caused by pain management treatments. This presentation will provide background for the position paper and identify nursing, prescriber and institutional barriers to change. Presenters will discuss results of a survey that explored implementation of the recommendations in the position paper. Presenters will describe the development of a strategy for intentional implementation of range orders that includes identification of the current institutional state, necessary preliminary work, examples of implementation, and monitoring of safety strategies. Additionally, the presenters will give examples of successful range orders that participants may contemplate and plan for institutional change in prescribers’ practices, meets The Joint Commission standards, and improves the safety of all patients receiving opioid therapy in the hospital.