Pat Muccigrosso 516 Pennsgrove Road Linc Univ, PA 19352 Word Count = 1259 Pain is a universal experience It affects more Americans than diabetes, heart disease and cancer combined.1 Chronic pain – pain that persists for more than 24 hours - drives more people to the doctor’s office than any other medical problem In 2006, more than 75 million people sought medical advice for chronic pain Yet, chronic pain remains very poorly managed according to Judith A Paice, PhD, RN, the Director of the Cancer Pain Program at Northwestern University’s Feinberg School of Medicine “There are a variety of reasons starting with basic science We still don’t fully understand the underlying mechanisms of a variety of pain syndromes.” Dr Paice is uniquely positioned to know all about the topic of pain not just because of her current position but also because she is the immediate past President of the American Pain Society, a multi-disciplinary educational and scientific organization dedicated to serving people in pain Dr Paice says there are a number of other reasons why pain is not managed well “There is a lot of stigma associated with the treatment of pain and there are biases about people in pain,” Dr Paice explains “They don’t really have pain, they have psychological issues They are malingering They are looking for secondary gain.” “One of the things the patients go through when they are experiencing chronic pain is that they are drug-seeking They are addicts trying to get a fix They are everything but a patient with chronic pain,” says Enid Erdman, RN, BSN, CNOR Erdman is one of Registered Nurses who are part of the inter-disciplinary team at the Richard Barrett Pain Management Center in Lebanon, New Hampshire For people in pain, the bias, the stigma and the lack of understanding of the underlying medical conditions mean weeks, months and sometimes years before anyone hears their pleas for treatment, for relief “It’s hard to even fathom but we see people here who have been 5, 10, 20 years, even 30 years in chronic pain,” says Louella Snide, RN, another member of the Richard Barrett Pain Management Center team “That’s a really difficult situation to be in – chronic pain that just won’t go away.” “It does take a while for chronic pain to be teased out,” agrees Sherry Creighton, RN, BSN, Nurse Manager, Richard Barrett Pain Management Center “By the time patients get to us they are quite exhausted and feel frustrated that they have had to deal with these pain issues for some time that have not been addressed.” Frequently viewed as a byproduct of another condition, chronic pain can move quickly from a syndrome that affects a patient’s body to one that affects mind, spirit and behavior Something as simple as persistent low back pain can reduce activity, affect overall health National Center for Health Statistics Health, United States, 2006 With Chartbook on Trends in the Health of Americans Hyattsville, MD: 68-71, American Pain Society http://www.painfoundation.org/page.asp? file=Newsroom/PainFacts.htm Chart #1 9/17/2008 Pat Muccigrosso 516 Pennsgrove Road Linc Univ, PA 19352 Word Count = 1259 and cause psychological distress.2 For nurses, that means looking beyond the medical issue, being able to see the whole patient For these three highly-skilled nurses, that was an easy hurdle to clear Each has more than 30 years of experience; each made a conscious decision to move from the Operating Room, the Delivery Room and the Emergency Room into the specialty of pain management In April of 2008, the nurses' paths crossed Dr Paice’s when the center they work in won the American Pain Society’s Clinical Centers of Excellence in Pain Management Award, one of only such awards to be handed out that year The nurses were not surprised The Richard Barrett Pain Management Center is no ordinary medical facility This tertiary care center, which is located in a rural community, provides support to upstate New York and New England and offers multi-modal treatment options that include pharmacotherapy, psycho-social interventions, rehabilitation and behavioral modification along with injection and infusion therapies For Center Director, Gilbert J Fanciullo, the interdisciplinary team and treatment approach are important but it is the nurses who work at the Richard Barrett Pain Center that helped the Dartmouth-Hitchcock program win “We have the best nurses working here They are caring They are scientists.” They are professional I think they are incredible.” Dr Fanciullo says nurses fill a niche on his interdisciplinary team that no doctor can “The care that doctors and nurses provide is different Doctors are more concrete, more scientific, more technology oriented That’s their focus The nurses have those skills as well but also bring a much more empathetic, humane and caring aspect to the patients’ care.” There is one other skill that Dr Fanciullo says sets these nurses apart from doctors – their ability to listen “If a patient comes in to see a doctor, the average doctor will interrupt the patient after 16 seconds They just don’t have the time or the patience to listen That is not the case with our nurses They see more clearly the importance of listening to someone than the doctors do.” What the nurses say it takes to be successful in a pain management center like Richard Barrett? ”You have to have strong communication skills – listening and speaking, to be successful.” Louella Snide agrees then adds, “If you are a good nurse in other areas of specialty practice, if you have good nursing background, IV skills, assessment skills, you can be successful as a member of the pain management team.” Another skill that these nurses use to help them work with patients who are in pain is, “Observation It is so important in this job,” says Sherry Creighton “Non-verbal cues, affect – are they depressed or happy Sometimes we can tell that people are feeling better just by their appearance, their interaction with us.” Basic nursing skills, excellent communication skills, the ability to assess and an aptitude for observation are the minimum job requirements Enid Erdman says there is one more skill a nurse has to have to succeed in pain management “Compassion We can’t take away pain for everybody There is no silver bullet or magic pill The challenge is to help people find ways to deal with the pain, live with it, change their thinking about pain, change their lives.” 2 Ibid - Chart #3 9/17/2008 Pat Muccigrosso 516 Pennsgrove Road Linc Univ, PA 19352 Word Count = 1259 Education plays a big part in helping people to make lifestyle changes It is one of the primary tools that nurses use to help people manage their pain “In nursing, we play into the patient s education,” says Sherry Creighton, “ reinforcing the care plan, helping them understand the medical jargon, supporting them through a procedure, explaining and educating them on treatments or just pain in general.” Because it is a chronic medical condition, for some patients, all that work has little or no effect “Sometimes, no matter how good the treatment plan is or how well the nurses educate, support or care, patients don’t find any relief “People die of cancer and we can’t help them,” says Dr Fanciullo “People have severe, uncontrolled pain and we can’t help them It is so hard to try to help them and their families.” For the nurses, that can make this, “ the best and worst job you will ever have,” says Enid Erdman “You laugh with them You cry with them You will live with these patients These are the people that will help you realize why you went into nursing.” If patients are lucky, they will find themselves in the care of women like these three extraordinary nurses who work in this extraordinary program, part of the award-winning team at the Richard Barrett Pain Management Center Charts for Possible Use: All charts are from Highlights from the National Center for Health Statistics Report: Health, United States, 2006, Special Feature on Pain - National Center for Health Statistics Health, United States, 2006 With Chartbook on Trends in the Health of Americans Hyattsville, MD: 68-71 Chart #1 9/17/2008 Pat Muccigrosso 516 Pennsgrove Road Linc Univ, PA 19352 Chart #2 Chart #3 9/17/2008 Word Count = 1259