Pain management nursing gains higher profile as a specialty

Practitioners find a broad range of options

Ask Lisa Hartman about pain management, and she’ll tell you nurses remain the ones on the front lines. This doctor of nursing practice has the firsthand experience to prove it.

“Nurses have been managing pain for as long as we’ve had hospitals,” Hartman said.

Today Hartman works across the age spectrum, from helping mothers of healthy newborns troubleshoot potential pain issues to aiding elderly patients in hospice.

The specialty of pain management nursing includes assessing a patient, tracking down the cause of pain, determining if it’s chronic or acute, and helping determine the right medicinal and or non-medicinal treatment. They work alongside doctors, surgeons and other medical team members.

Pain management nurses can be found working in a variety of areas, because most medical specialties battle pain issues. For instance, neurologists manage neuropathic pain, rheumatologists face arthritic and inflammatory pain, and sports medicine and rehab doctors deal with muscle and bone pain. Although specialists know how to handle pain in their respective area, a pain management nursing specialist has a breadth of knowledge of techniques and drugs to deal with a laundry list of pain.

According to the Joint Commission, an estimated 76 million people suffer from pain. This type of nursing sounds like an obvious concentration since pain is arguably the most frequent reason people seek healthcare. But this wasn’t always the case.

“The specialty of pain management came about in the 1970s when medical profession started recognizing that pain was not just a symptom, but it could be a problem itself,” said pain management specialist, Cindie Lou Roger.

As early as 1968, American pain management nursing pioneer Margo McCaffery saw a need. Her quote, “Pain is what the person says it is and exists whenever he or she says it does,” serves as a mantra to those in the field.

In the late 1980s, with the specialty still exploring a new frontier, an Atlanta-based nurse helped blaze its trail. At the time, Barbara Reed was working as a nurse at Emory Hospital, serving as a clinical specialist for surgical services. This meant she needed to have serious knowledge of all general surgeries taking place at the facility.

Faced with the overwhelming task of knowing all there was to know about 40 different types of surgeries, Reed decided to start by looking for commonalities. Pain management, a topic that had already piqued her interest, rose to the top.

So Reed asked an anesthesiologist if she could join him on his rounds, as he made post-op visits to patients and dealt with their pain management. Instantly fascinated with the process of pain management, Reed told the doctor she thought he needed a nurse with him each time he made those rounds. And she wanted to be that nurse.

As Reed began her journey she saw the advent of a new era. With the help of patient-controlled analgesia pumps (PCA), patients now had the ability to control their own pain with the press of a button.

“I have vivid memories of the first few patients using PCA pumps and how thrilled they were,” Reed said, “because they didn’t have to wait for hours and hope that somebody had time to give them an injection. It was right there at their fingertips, and it was safe.”

Reed eventually discovered other nurses around the country dedicating themselves to pain management and using PCAs. A core of seven nurses, including Reed, began exchanging information and asking questions. In the process, they decided they needed a way to be on the same page with each other, find out what other healthcare facilities were doing, and learn how to solve pain management problems.

“We needed a network,” she recalled, “because this was brand new.”

In March of 1990, the seven RNs gathered in Atlanta for a two-day pain management pow wow. They came to the decision to organize a professional group of nurses with an interest in pain management. The nurses agreed on a title: American Society of Pain Management Nurses (ASPMN). This would eventually transform into the American Society for Pain Management Nursing, Reed says, reinforcing the fact all nurses handle pain management.

The group wrote bylaws, mapped out objectives and enlisted volunteers. Less than a year after that initial meeting, the first ASPMN Conference took place in 1991 in Coral Cables, Fla. Approximately 70 nurses attended and listened as surgeons and nurses spoke on pain management, and discussed new methods such as PCAs and epidurals.

Today the ASPMN has 1,355 members, and they expect between 300 and 400 attendees at this year’s conference, which celebrates its 25th year anniversary September 16-19 at the Marriott Marquis in Atlanta. Although she’s since retired from nursing, Reed plans on being there.

She’ll likely catch up with Roger, who she helped as Roger embarked on her own pain management nursing path.

While attending graduate school at Emory University in 1996, studying a combination of its masters and nurse practitioner programs, Roger gravitated toward pain management. Her advisor, she says, seemed less than thrilled. Roger’s focus was oncology, and her advisor wanted her to do cancer-based rotations.

“So they more or less said that if I could find someone to precept under, I could do it,” she remembered.

And that person was Barbara Reed.

Reed, who was working as the main practice nurse in pain management service at Emory’s main hospital at the time, took Roger under her wing. According to Roger, Reed exposed her to opportunities she says she wouldn’t have had otherwise. She rubbed elbows with key people in the pain management field and spoke at conferences alongside her mentor.

After working 28 years in the Gwinnett hospital system, and having the distinction of serving as its first pain management nurse, Roger now works as an independent contractor and consultant in pain management. When the Joint Commission began issuing pain management standards for hospitals in the early ’00s, Roger would visit different facilities and help them set up their pain management policies and procedures. Today she continues working with hospitals on pain management standards and practices, teaching classes there, and visiting nursing homes and other medical venues.

Hartman took her own individual pain management journey. While studying at Emory and getting board certified in psychiatry and family practice, a professor told her she’d be a good fit in hospice. Even though the idea of working in hospice didn’t appeal to Hartman, she gave it a shot and wound up falling in love with the field.

After venturing into in-patient hospice, she found that her psychiatric background served her well. It gave her the ability to listen intently to patients. While spending 17 years in palliative care working with patients experiencing a wide range of pain, she honed her skills in pain management.

For the last eight years, Hartman has been working at Embracing Hospice. She also works with Moms On Call, a service that assists new mothers with all aspects of infant care. Her pain management skills, however, come into play there too. If a child is having trouble sleeping at night, she often puts on the detective cap to see if the infant may be experiencing pain, be it teething, a sore throat or an earache.

Although pain management nursing continues to be a comparably small specialty in the medical world, it has come a long way since Reed and her colleagues first got together in Atlanta. Among the changes, pain management nursing now has its own certification through the American Nurses Credentialing Center.

“In 40 years you do a lot of nursing,” Reed said, “and this has been the most important thing that I have done. …25 years ago there were just seven of us thinking about how we could improve pain management. Now we expect every nurse to know that it’s part of her job and responsibility. And nurses have rallied to it, because nurses are the first ones to see if a patient isn’t getting pain relief.”