In a new video series, How I Practice, ANPF examines important clinical issues with real-world tips from NP experts. The first installment, with pain management specialist Laura Rooney, DNP, APRN, FNP-BC, DCC, BC-ADM, FAANP, deals with treating and referring patients with chronic pain. Here, Dr. Rooney answers some commonly asked questions about chronic pain.
How do patients present differently with acute pain as opposed to chronic pain?
Patients with acute pain generally present with the common symptoms of increased heart rate and blood pressure, grimacing and guarding, moaning/ perhaps even nausea or vomiting if the pain is severs. Patients with chronic pain generally do not have these types of physical symptoms. They do not exhibit outward signs of pain as the acute pain sufferer does.
What are some of the effects of chronic pain on patients?
Chronic pain may potentiate depression and hopelessness. If they are on narcotic analgesics they may also experience tolerance to medications over time, along with drug seeking behaviors should they run out of medications, as they try to avoid withdrawal. Generally patients with chronic pain may also suffer from problems in relationships, or other interpersonal issues.
How does the OPQRST Clinical Tool apply to patients with chronic pain?
Although this tool may still help in the initial interviews, particularly if a chronic pain complaint has changes over time, often times only segments of the tool may be reliable. Think of chronic pain as something that is present all the time and therefore the body begins to adapt to its presence. It is often difficult to recall the onset or duration, as it is always present. Quality may also change over time. Quality describes what the pain feels like: numb, tingling, sharp, stabbing, etc.
When should providers consider referring patients to a pain management specialist?
Providers should consider referral when the pain complaint worsens without cause, or medications no longer seem to control the pain when previously they did. You should also consider referral if there are concerns about addiction vs tolerance, or the provider is becoming uncomfortable with the amount of medication a patient is requesting. Also refer if you feel there may be more to offer a patient than what your practice is set up to do. For me, if a patient requires ongoing pain medications, particularly if it is daily, I generally refer to see if there are options for better control. Pain specialists can help patients get their life back.
What options are available to patients in a pain management practice that might not be available in a primary care practice?
Options might include stronger medications, behavioral therapy (to help the patient deal with the diagnosis of chronic pain), procedures such as injections, nerve blocks, spinal cord stimulators (which are sort of like pain signal interrupters), pain pumps (which are implantable devices that deliver pain medication to a specific level in the spinal cord allowing for smaller doses to control pain).
For more information and insights about treating and referring patients with chronic pain, watch full videos below.