Micke Brown, BSN, RN, director of communications for the American Pain Foundation and past president of the American Society for Pain Management Nursing, discusses the survey results and how providers can deliver better care in the future.
1. Working with primary care physicians. The bulk of pain care is handled by primary care physicians or professionals such as nurse practitioners because there aren’t enough trained pain management physicians to handle every pain case, says Ms. Brown. Many primary care professionals don’t have adequate knowledge about how to treat pain cases, which means patients may not receive the best care available. “Since most providers aren’t educated on persistent pain management, they become frustrated and concerned because the patient isn’t improving,” she says. “These results can sometimes breed fear and primary care physicians decide they don’t want to take care of these patients. Some try to do a really good job, but feel they don’t have the tools and support they need.”
Pain management physicians and specialists who are trained to deal with chronic pain management could help solve this problem by imparting basic knowledge to primary care specialists who deal with less complicated pain cases. Specialists in treating chronic diseases such as diabetes or cancer have been able to work with primary care physicians to provide better care for their patients, and in these fields primary care specialists have become the cornerstone of care.
2. Reducing stigma for pain patients. There are some non-pain specialist providers who refuse to work with pain patients because these patients are often described as “difficult” or “needy.” Other times, providers who aren’t experienced with pain medication or management might over or under prescribe medication to patients, which can result in undesireable side effects and possible safety concerns or needless suffering from unrelieved pain. Patients are aware and often believe misconceptions about people with pain and don’t want to be labeled a “difficult patient” or “drug addict.” The survey showed that 14 percent of adults with chronic pain don’t try to reach out to their providers because they are afraid of being labeled as a “complainer” or a “drug seeker.”
“I work with people who have pain every day and I’ve grown to learn that these are some of the strongest people I’ve ever met,” says Ms. Brown. “I cannot imagine what it must be like to wake in the morning with pain, live with pain and go to bed with pain. We have a tough journey ahead of us to improve care; there are more people living with pain than we speculated and the cost to our society is almost five fold of what we knew before. I think it will require a cultural change and transformation in our society about pain management and healthcare in general.”
If pain professionals can help each other and their patients better understand how to treat and manage pain, the continuum of care will improve, says Ms. Brown. “We’ve outgrown the acute-care model of healthcare in our system,” she says. “The success of our medical system over the past few years has brought us to a place where people are living longer. What we aren’t doing well is maintaining wellness and managing chronic diseases. We need to prevent them from becoming burdensome for the individual and the healthcare system.”
3. Communicating better with patients. Pain management physicians and primary care specialists dealing with pain patients may have difficulty communicating with some patients because chronic pain is so volatile. The American Pain Foundation has been trying to devise tools to bridge the gap between patients and providers, such as the Targeting Chronic Pain Notebook. The pain notebook was created by pain patients and professionals for people to plot out what their pain is like throughout the week and the different tactics they use to relieve the pain. With this record, patients can recall what does or doesn’t work for them and share with providers their daily ups and downs instead of how they feel only during their visit.
“You might feel different on the day you see the provider than you do on other days, so the notebook is like a window into your day to day problems as a person who lives with pain,” says Ms. Brown. “We want to provide those types of opportunities so there is a true partnership between the provider and patient. You want to know that there is someone on your side to work through the pain with you.”
4. Answering patient questions. According to the survey, the most common questions patients have after visiting their providers are about the side effects from their medication. Slightly more than half of the patients had questions about the duration of treatment and nearly 41 percent also had questions pertaining to the cost of care.
Some patients call the provider’s office to ask questions as their pain develops, and are often met with voice messaging services or an “on-call” specialist who isn’t familiar with their specific case. “On off-hours or on weekends, patients who call with a question leave a message and must wait in pain until someone is able to return their call,” says Ms. Brown. “Even then, the clinician who calls back might not know that patient or their pain and co-existing medical conditions.”
While the situation might not be ideal, the survey showed that patients who reached out to healthcare providers reported receiving a response 99 percent of the time, with 83 percent of those responses occurring on the same day. Additionally, nearly all respondents said they found the responses at least somewhat helpful.
5. Devising plans for emergency pain situations. Pain patients are susceptible to emergency situations with their condition, even if they are able to manage their pain most of the time. When patients don’t have a clear plan to handle emergency situations, they end up at urgent care clinics or in the ER and are often met with skepticism about their true intentions.
“If patients have a pain flare and their pain management techniques don’t help, we need to figure out what they can do to reach a provider,” says Ms. Brown. “I’ve heard of some practices that don’t believe in pain emergencies, but there are times when patients might injure themselves and need extra assistance. If they go to the ER, the physicians there might think they are drug abusers. We need to think more about the patients with chronic pain and help guide them on how to manage their pain when their provider isn’t easily accessible.”
Ms. Brown suggests providers and patients discuss these types of situations from the beginning and devise a plan for reaching the provider or appropriate care during emergency situations.
About the American Pain Foundation
Founded in 1997, the American Pain Foundation (APF) is an independent, nonprofit 501(c)3 and the largest national advocacy organization that serves people affected by pain. APF speaks out for people living with pain, caregivers, health care providers and allied organizations, working together to dismantle the barriers that impede access to quality pain care for all. The mission of APF is to educate, support and advocate for people affected by pain. For more information, visit www.painfoundation.org.
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