A Q&A with Chronic Pain Specialist, Brett Snodgrass

Brett Snodgrass is a Family Nurse Practitioner and Certified Pain Educator practicing at LifeLinc Pain in Memphis where she is the Director of Clinical Operations. Brett is board certified with the American Association of Nurse Practitioners (AANP), where she is currently the Tennessee State Representative.

How do I help my patients identify and treat their chronic pain?

If you’re familiar with treating patients with chronic pain, you know that no two patients are alike. Chronic pain can manifest itself in extremely different ways. Whether it’s arthritis, joint pain, lupus, or migraines, it is important that we as healthcare providers identify chronic pain for what it is, and help our patients treat it.

As a chronic pain specialist and family nurse practitioner, I tell my patients that chronic pain is defined as pain lasting longer than three months on average. It has to do with the period during which you experience symptoms, but also whether it has an expected end. Most chronic pain does not have an expected end. For example, if you have a patient who is healing slowly after a surgery, that pain wouldn’t necessarily be considered chronic, because it is expected to end once healing is complete.

Here are some of the most common chronic pain conditions I see in my practice:

  • – Arthritis, especially osteoarthritis and rheumatoid arthritis
  • – Joint pain
  • – Low-back pain
  • – Lupus
  • – Results of failed surgery, or multiple surgeries (commonly back and neck)

What are the most important things to discuss with my chronic pain patients?

Treatment for chronic pain will of course depend on the condition your patients have, but no matter which symptoms they are experiencing, there are a few basic facts to know before discussing appropriate treatment options. Before recommending or prescribing any medications, always remember to ask your patients:

  • – What risk factors or conditions they have that they’re aware of
  • – What medications or other therapies they’ve already tried
  • – Which of those they feel worked and which didn’t
  • – What medications they’re currently taking, including over-the-counter (OTC) medicines and supplements. Don’t let them leave anything out!

 

What do I take into consideration when recommending over-the-counter medicines for chronic pain?

Some OTC medicines can provide safe and effective relief for mild to moderate pain, but they aren’t meant to treat the chronic pain conditions on a consistent, long-term basis—though they may play a part in a more comprehensive treatment plan for chronic pain. So I often recommend that my chronic pain patients try a combination treatment: safely combining prescription pain medications, neuropathic medications, or SNRIs, when appropriate, with OTC analgesics like acetaminophen, ibuprofen, aspirin, or naproxen sodium.

For example, some chronic pain conditions include inflammation. While opioid pain relievers are not routine therapy for chronic pain, I may need to prescribe an opioid pain reliever or another pain medication in combination with an OTC or prescribed anti-inflammatory. This approach requires that I know and consider the whole patient and urge them to take everything as prescribed. There are some patients who can’t take anti-inflammatory medicines due to kidney disorders, cardiac disease, or gastric disorders, or can’t take acetaminophen due to liver dysfunction. Everyone’s a little bit different!

When it comes to prescriptions and OTCs, everyone should always read and follow the label every time, and, it bears repeating: before taking any medications, remind your patients to talk with their healthcare providers about what’s right for them. You can guide your patients to learn more about OTC pain relievers here.

 What else do I keep in mind when discussing medicines with my patients?

With the use of pain medicine, unfortunately also comes intentional misuse. When it comes to high-risk pain medicines such as opioids, it’s easy for an appropriately prescribed medicine to end up in the wrong hands. Here are some easy tips I give my patients to prevent their medicine from being used or abused by others:

  • Safe disposal. Sometimes when you change treatments or you no longer need a medication, you end up with medicines in your house that are no longer needed for the intended purpose. I tell my chronic pain patients that safe disposal is a huge part of preventing diversion. Patients can do it right at home by following these four easy steps with most medications:
  1. – Take medication out of the packaging and remove and shred label.
  2. – Mix medicine with an unpalatable substance such as kitty litter, dirt, or used coffee grounds.
  3. – Place the mixture in a container such as a sealed plastic bag.
  4. – Throw the container in your household trash.

Your patients can learn more about safe medicine disposal here, including other options like disposal programs at local pharmacies where available and community take-back days.

  • Safe storage. Always keep medicines you’re still using stored up and away where someone who’s looking for medicines can’t find them. The best place is in a medicine lockbox, which can be purchased at your local pharmacy. It’s important never to keep pain medications on counters between doses. You never know—unfamiliar people and regular guests who come to your house may be looking for medicines.