Pain Management

Formerly Position Statement Number 2.11
 

It is estimated that as many as 76 million Americans over 20 years old have experienced pain of some sort that persisted for more than 24 hours.1 This incidence of pain has resulted in approximately $61 billion dollars of lost productivity.2 These figures demonstrate the prevalence of pain as well as the personal and societal costs that may occur if pain is left untreated. Recognizing that it is a patient’s right3 to have pain treated in a timely and effective manner in order to carry out normal activities of daily life in as pain-free a state as possible, Certified Registered Nurse Anesthetists (CRNAs) acknowledge that it is their professional and ethical responsibility to participate in the management and treatment of a patient’s pain. The professional registered nurse is educated to consider the unique and holistic needs of each patient. Nurses, therefore, are uniquely prepared to assess, identify, and manage the care of patients suffering from acute and/or chronic pain. As advanced practice registered nurses, CRNAs are uniquely skilled to deliver pain treatment in a compassionate and holistic manner.

Pain is generally accepted to be a multifactorial process that has both objective and subjective components.1,4-7 It often is characterized as either acute or chronic, with this distinction frequently based upon the pain’s duration or physiological changes that may have occurred. There is not one universally accepted definition for acute or chronic pain; however, it is generally accepted that if left untreated, or inadequately treated, acute pain will lead to the development of chronic pain over time.4,8 As the understanding of the pain experience and its corresponding transmission processes have evolved, the role of the healthcare professional (e.g., CRNA, physicians, psychologists, physical therapists) in treating pain has seen a similar evolution. Likewise, pain treatment modalities change over time. As new knowledge is discovered and technologies emerge (e.g., the use of image-guided devices)4,9-14 these advancements will logically translate into clinical practice with the goal of improving patient outcomes.

CRNAs have a long-standing history of delivering anesthesia services, and CRNAs reportedly deliver approximately 32 million anesthetics annually.15 A critical component in the delivery of anesthesia care is pain management. As part of their educational preparation, CRNAs are required to learn and demonstrate competence in the management of pain. The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) standards mandate nurse anesthesia programs provide content within, but not limited to, the following areas: anatomy, physiology, pathophysiology, pharmacology, and pain management.16 These areas of study provide the foundation for understanding pain and pain treatment. Similarly, the COA requires that nurse anesthesia students obtain clinical experiences in regional anesthetic techniques (i.e., spinal, epidural, and peripheral). These techniques (e.g., epidural, peripheral) are employed to alleviate both acute pain and chronic pain. The knowledge and skills obtained during a nurse anesthesia educational program, therefore, serve as the foundation for a CRNA’s engagement in treating either acute or chronic pain.

Providing acute and chronic pain management and treatment is within the professional scope of practice of CRNAs. CRNAs employing pain management techniques is neither new nor unusual and has long been a part of CRNA practice. By virtue of education and individual clinical experience, a CRNA possesses the necessary knowledge and skills to employ therapeutic, physiological, pharmacological, interventional, and psychological modalities in the management and treatment of acute and chronic pain.  The AANA believes that it is incumbent upon the individual CRNA to assure his or her competency when delivering anesthesia services, including pain management and treatment.

References

  1. National Center for Health Statistics. Health, United States, 2006 with Chartbook on Trends in the Health of Americans. Hyatsville, MD: 2006. 
  2. Stewart WF, Ricci JA, Chee, E. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003; 290: 2443-2454.
  3. American Pain Foundation. Patient Care Bill of Rights. 2007.  Available at: http://www.painfoundation.org/learn/publications/pain-care-bill-of-rights.html. Accessed on March 16, 2010.
  4. Faut-Callahan M, Hand Jr WR. Pain management. In: Nagelhout JJ, Plaus KL eds. Nurse Anesthesia. 4th ed. St. Louis, MO: Saunders; 2010:1239-1267.
  5. Dunwoody CJ, Krenzischek DA, Pasero C, Rathmell JP, Polomano RC. Assessment, physiological monitoring, and consequences of inadequately treated acute pain. J Perianesth Nurs. Feb 2008;23(1 Suppl):S15-27.
  6. Marcus DA. Tips for managing chronic pain. Implementing the latest guidelines. Postgrad Med. Apr 2003;113(4):49-50, 55-46, 59-60 passim.
  7. Boyd RS. Treatment of pain lacking, data show. Houston Chronicle. October 30, 2008.  Available at: http://www.chron.com/disp/story.mpl/headline/nation/6084910.html. Accessed on March 16, 2010.
  8. McCarberg B. Chronic pain management: a clinical overview. Manag Care. Jul 2002;11(7 Suppl):19-22; discussion 22-13.
  9. Chin KJ, Chan V. Ultrasound-guided peripheral nerve blockade. Curr Opin Anaesthesiol. Oct 2008;21(5):624-631.
  10. Hadzic A, Vloka JD. Peripheral nerve blocks: principles and practice. New York, NY: McGraw-Hill; 2004.
  11. Buckenmaier C. Military advanced regional anesthesia and analgesia handbook.  Washington, DC: Borden Institute; 2009.
  12. Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. Mar 2007;54(3):176-182.
  13. Mordecai MM, Brull SJ. Spinal anesthesia. Curr Opin Anaesthesiol. Oct 2005;18(5):527-533.
  14. Huntoon MA. Ultrasound in pain medicine: advanced weaponry or just a fad? Reg Anesth Pain Med. Sep-Oct 2009;34(5):387-388.
  15. American Association of Nurse Anesthetists. 2009 Practice Profile Survey.
  16. Standards for Accreditation of Nurse Anesthesia Educational Programs. Park Ridge, Illinois: Council on Accreditation of Nurse Anesthesia Educational Programs: 2010.
 

Adopted by AANA Board of Directors June 1994.
Revised by AANA Board of Directors June 1997, February 2005, and August 2010.