Introduction
The problem of this study is the challenges for nurse practitioners associated with pain management in primary care settings. The topic of pain management and the difficulties associated with it are underexplored. Pain is the primary reason for individuals to seek care providers’ help. Nahin, Boineau, Khalsa, Stussman, and Weber (2016) note that in 2012, more than 125 million adults reportedly experienced pain.
The role of nurse practitioners in the improvement of individuals’ health is vital as most of these patients receive help in primary care units. However, there are several barriers to providing high-quality care in this setting. For example, caregivers may have to work long hours, experience patients’ abuse and violence, as well as feel pressured and guilty to manage pain with opioids (Kawi, 2016). This study discusses the problems nurse practitioners may have with pain management in the primary care setting. It summarizes the existing literature on the topic and proposes solutions to the problem. The study concludes that nurse practitioners should advocate for change in treatment policies and implement alternative methods of pain management.
Literature Review and Topic Description
Although the challenges primary care nurse practitioners may encounter in pain management are underexplored, some studies provide the overview of the problem. For example, Dorflinger et al. (2014) suggest that the primary difficulty associated with the issue is the limited access to healthcare services, which is often caused by the lack of public knowledge about appropriate services for individuals with varied pain histories.
More than 40% of consults to pain specialty services are cancelled because the patients are wrongly determined inappropriate for these services (Dorflinger et al., 2014). Another difficulty is the lack of multimodal plans for pain management. Such treatment programs may utilize the principles of pain medicine, health psychology, psychiatry, and physical therapy to provide treatment in primary care units. Finally, care providers also report the challenges associated with opioid management (Dorflinger et al., 2014). These issues suggest that there is a need for the provision of interdisciplinary care, as well as for the improved access to pain-related services.
Opioid Management
The problem of opioid management and prescription is addressed in many studies as well because nurse practitioners can have a significant impact on the policies that regulate their use. Recently, prescribed opioids have become a considerable concern as they have caused an epidemic of overdose deaths and substance use disorders (Marie, Arnstein, & Zimmer, 2018). Nurse practitioners encounter challenges to pain management due to the limited number of available treatment options that mostly include opioid monotherapy and do not consider nonpharmacologic and multimodal therapies.
Vacalis (2016) notes that the guidelines for opioids prescription present unreasonable recommendations, such as the use of short-acting opioids instead of long-acting ones, which can result in the worsening of patients’ conditions. To eliminate the adverse outcomes of opioid use, nurse practitioners should consider its risks and benefits, identify other alternative therapeutic options for each individual, and educate themselves about the methods of pain management.
Possible Solutions and Action Plan
The reviewed studies propose several solutions to the challenges associated with pain management in the primary care units. The validity and reliability of the studies are proven by their findings collected during randomized controlled trials and evaluation projects. For example, to eliminate the adverse outcomes of opioid use in treatment, Marie et al. (2018) suggest the investigation of patients’ personal and family substance use history.
They also insist that nonpharmacologic types of treatment, including psychosocial, spiritual, and physical therapies may have a positive impact on patients’ health. Nahin et al. (2016) advocate for the use of alternative practices, such as acupuncture, spinal manipulation, and yoga as the method of pain management. Owen et al. (2018) suggest the utilization of nonopioid pharmaceuticals along with therapeutic exercises and psychological therapy and stress the risks related to the use of opioids in treatment. These solutions can be the basis of the development of an action plan that will promote change.
Action Plan
The proposed action plan considers several challenges primary care nurse practitioners may encounter. The first step is the elimination of the risks of inadequate care and medical errors as results of caregivers’ burnout, busy shifts, and patients’ violence. To manage these issues, it is necessary to educate nurse practitioners on stress-management techniques and communication strategies. The second step is the study of the recommendations on opioids use and their limitations that present barriers to implementing change.
As nurses work with patients in pain directly and can assess the effectiveness of pain management techniques, they should advocate for changes of those official policies or guidelines that can potentially harm patients or result in adverse health outcomes. The third step to eliminate challenges associated with pain management in the primary care setting is to ensure the utilization of multimodal care plans.
The implementation of this action plan can bring positive changes in the results of nurse practitioners’ work. To evaluate them, the statistical data about treatment-related mortality rates can be collected, and personal interviews with patients and caregivers may be conducted to analyze the improvement in individuals’ conditions. The possible barriers to implementing change may include nurse practitioners’ inability to advocate for adjustments of treatment guidelines, and the lack of awareness of the problem.
Conclusion
The challenges for nurse practitioners associated with pain management in primary care settings may result in severe patient outcomes. These difficulties include the prescription of opioids, the lack of multimodal plans, patients’ violence, and work-related stress. To eliminate these challenges, it is necessary to take several steps aimed to change the existing pain management policies, develop techniques to reduce burnout, and create comprehensive care plans.
References
Dorflinger, L. M., Ruser, C., Sellinger, J., Edens, E. L., Kerns, R. D., & Becker, W. C. (2014). Integrating interdisciplinary pain management into primary care: Development and implementation of a Novel Clinical Program. Pain Medicine, 15(12), 2046-2054.
Kawi, J. (2016). Managing chronic pain in primary care. The Nurse Practitioner, 41(3), 14-32.
Marie, B. S., Arnstein, P., & Zimmer, P. A. (2018). Pain and opioids: Call for policy action. The Journal for Nurse Practitioners, 14(1), 40-44.
Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016). Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proceedings, 91(9), 1292-1306.
Owen, G. T., Bruel, B. M., Schade, C. M., Eckmann, M. S., Hustak, E. C., & Engle, M. P. (2018). Evidence-based pain medicine for primary care physicians. Baylor University Medical Center Proceedings, 31(1), 37-47.
Vacalis, S. E. (2016). Leave no patient behind – Educating primary care providers on pain relief. Physician’s Weekly. Web.