An Interview with Carol Curtiss, MSN, RN-BC
Wendy L. Williams, BSN, M.Ed.:
You have recently returned from the 2012 American Society for Pain Management Nursing’s (ASPMN) annual conference held in Baltimore. Please share some highlights from the meeting.
Carol Curtiss, MSN, RN-BC: While there were many unique topics covered in the sessions, the overarching message was clear: each person with pain is unique and there must be an individualized approach to pain care and management. Patients and providers are best served when they form partnerships to manage pain and to help a person with pain live as full a life as possible. We’ve heard it before, but it bears repeating: there is no cookie-cutter approach to pain management. Responding to pain and pain treatments is an individual path, and it takes time and care to make a difference. At the conference in Baltimore, the topics ranged from managing opioid-induced constipation to helping patients develop self-management skills using non-pharmacologic approaches. The variety of session topics highlights the importance of interdisciplinary, multi-modal approaches to pain management.
WW: Individualized care takes time. Primary care providers are challenged to find that time, aren’t they?
CC: While I agree that lack of time is a real challenge, there really is no other way to effectively know what will work than to individualize care. At the conference, we heard about system changes and innovations from the keynote speaker, Kevin Galloway, COL, AN, the Program Director for the US Army’s Comprehensive Pain Management Campaign Plan. His keynote, Lessons Learned – Military Medicine’s Pain Management Journey, provided insight on the steps the military is taking to implement wide-scale systems change to improve pain care. If the US Army and other branches of the military, which are large and complex organizations with a very mobile population, can successfully make pain management a priority, other organizations can also learn from their experiences and make systems changes that work. Colonel Galloway mentioned several areas of emphasis: treating acute pain adequately at the outset to avoid developing chronic pain – a progression from symptom management to disease management to be avoided; utilizing a multi-disciplinary and multi-modal approach to manage pain and taking personal responsibility as health care providers to both lead and follow as needed to improve outcomes. From my view, this comprehensive approach is grounded in valuing the perspective of individualized care. This takes relationship-building, which nurses naturally do through their sustained contact and interactions with patients.
WW: There are pressures on providers from many constituencies when treating people with pain, as they must balance regulatory, insurer and legislative directives with what the patients and families want. Have you found an approach that works to make actual practice of pain management a priority?
CC: Clearly, we must have a balanced approach to managing pain aggressively while taking steps to address the problem of prescription drug misuse and abuse in our country. We must also advocate for our patients when rules and regulations have unintended consequences that place obstacles in the paths of individuals with pain to find care or get what they need for relief. When people are hurting, their ability to advocate for themselves diminishes – they have all they can do to handle everyday life. It’s easy to feel overwhelmed. Working in partnership with patients and families to set achievable goals and evaluate progress toward attaining those goals is vital. Stratifying risk for abuse and misuse and establishing monitoring and follow-up based on risks is a necessary part of care planning. Advocating for effective pain care is the responsibility of every health care provider.
WW: Finally, would you share some of your insights from the conference about multi-modal approaches?
CC: There were sessions on a variety of multi-modal approaches. Examples included information about the effects of light exposure on mood, pain and sleep/wake patterns, Reiki, cognitive-behavioral interventions for pain, the concurrent use of multi-modal acting medications, treating people with pain in methadone maintenance programs and many others. A running theme at the conference was balancing the need for pain management with the concerns around opioid abuse, misuse and addiction. One helpful way to approach opioid management is to use screening tools like Inflexxion’s Screener and Opioid Assessment for Patients with Pain (SOAPP®) or the patient self-assessment, Current Opioid Misuse Measure (COMM)®. There are many people developing approaches and tools to ensure safe and efficacious practice while aiming for optimal, pain management. I encourage providers to use all the tools available to them. When substance abuse diagnoses are uncovered with screening or simply in the opinion of the provider, there is an ethical responsibility to offer help with substance use disorders. While some providers are not equipped to address addiction or substance use disorders, they must make appropriate referrals. Withholding treatment for pain is not an effective treatment for addiction.