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15 Articles in Volume 21, Issue #4
Advanced Practice Matters: Needs Assessment in Pain Management Training
Analgesics of the Future: Novel Capsaicin Formulation CNTX-4975
Ask the PharmD: How to Improve Medication Adherence in Chronic Pain Management
Behavioral Medicine: Applying Mindfulness-Based Stress Reduction for Comorbid Pain and PTSD
Case Report: Multimodal Management of Osteoarthritis
Commentary: The PCP's Role in Preventing Chronic Back Pain
Guest Editorial: Structural Racism in Pain Practice and How to Combat the “Hidden Curriculum”
Hypermobile Ehlers-Danlos Syndrome: An Update on Therapeutic Approaches for Pain Management
Male Clinicians as Allies in Women’s Leadership: What Your Female Peers Want You to Know
Meet the Women Changing Pain Medicine
Perspective: It’s Time to Advocate for Early Interventional Pain Management
Research Insights: Is Spinal Fusion Surgery Being Overused in Back Pain Care?
Tips from the Field: Treating Pain in an Under-Resourced State
Utilizing Music Therapy to Manage Chronic Pain
Woman to Woman: Leaders Share Advice for the Next Generation of Pain Medicine Clinicians

Advanced Practice Matters: Needs Assessment in Pain Management Training

Nearly 20% of nurse practitioners point to pain management as a continuing education gap. Here, Theresa Mallick-Searle, MS, PMGT-BC, ANP-BC, calls for a system overhaul.

I completed my graduate degree in nursing and became an adult nurse practitioner in 2002. By that time, I already had more than 5 years of nursing practice under my belt and did not think too much about the need for focused training in pain assessment and management in my graduate training. Most of my nursing career after all had been in perioperative medicine, so I knew how to assess and manage acute pain – or so I thought.

Upon graduation, I had no idea that circumstances would direct me toward a career in chronic pain management. When I started my job with the Stanford Pain Clinic in 2003, it became apparent how much I still needed to learn about chronic (and acute) pain management.

There is well-documented evidence of the need that exists for increased pain management education for physicians. (Image: iStock)

Pain Management Education is Lacking

There is well-documented evidence of the need that exists for increased pain management education for physicians.1-6 Both the National Academy of Medicine7 (formerly the Institute of Medicine) and the National Pain Strategy8 have called for better training for all healthcare clinicians. Despite articulating the pain education needs for physicians, little research has focused on similar needs for advanced practice registered nurses (APRNs) and physician assistants (PAs).

A recent American Association of Nurse Practitioners (AANP) member educational needs assessment distributed in February/March 2020 received more than 6,000 responses, and found that about 1 in 5, or 19%, of clinically practicing NPs indicated pain management was an area they would like additional continuing education in pain management. In fact pain management ranked in the top 10 (specifically 8th) areas member requested additional resources on.9

Data from the 2016 Physician Assistant Education Association’s Support to Advance Research grant, of the 209 programs surveyed, 14% reported that pain management is not included in the curriculum, and 3% reported that it is a stand-alone module.10

Chronic Pain Management Training Needs an Overhaul

Last year I got to thinking about this issue in earnest. I, along with my colleague and co-contributor to this column, Jeremy Adler, PA-C, have spent the past decade providing continuing education to and advocacy for APRNs and PAs in the specialty of pain medicine, as well as countless hours raising awareness to the unique needs of patients who struggle with chronic pain. I started asking myself the real question of what is truly needed in APRN/PA education in regard to pain management, what are students learning in their graduate studies, what do they bring to the table from prior professional experience, where are they receiving their continuing education, and how prepared do they feel going into entry-level practice?

My query was not focused solely on APPs entering the specialty of pain management, but more universally focused on all graduates – both generalists and specialists. As many readers of this column know, the need for pain management knowledge and skills is universal to all healthcare clinicians.

More on “pain specialists” and current certification and on being a woman in the pain management field.

A review of the current literature could not give me the answers I was looking for, so I decided to undertake a pilot survey to start the discussion and create a foundation for further inquiry. I presented findings at the spring 2021 American Academy of Pain Medicine (AAPM) annual meeting, and an encore poster will be presented at American Association of Nurse Practitioners annual conference this summer).

View a full-size PDF.

Results – based on responses to a 10-question national survey by 368 participants –revealed a low confidence and low perceived competence in providing pain management in both the acute and chronic pain settings, in APRNs and PAs during their first year of practice. Most clinicians either could not remember receiving focused pain education or reported less than 5 hours provided throughout their advanced practice training. This research is a first attempt to look at the educational need for pain management at a national level, from the perspective of perceived readiness to practice, from individual APRNs and PAs, looking at both the novice and more advanced clinicians.

Future Considerations

This pilot study is a call to action –  even initial findings call for a transformation within APRN and PA education and training in pain management. For those who focus their careers on pain management as a specialty, a system of certification would help to facilitate a metric of quality control, and further delineation of competency in practice.

Although evidence overwhelmingly supports that APRNs and PAs consistently provide high-quality care,11-13 my ultimate goal is to raise the level of awareness of the perceived need and to expand offerings on pain management beyond what is currently being offered in all graduate-level APRN and PA programs. It is to advocate for internships and fellowships in pain medicine for those interested in focusing their careers on pain management. Finally, continuing education in advanced practice needs to include pain management.

See also, needs in geriatric pain management. Email your thoughts and ideas to ppmeditorial@remedyhealthmedia.com

Last updated on: July 7, 2021
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Advanced Practice Matters with Theresa & Jeremy: Mentorship
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