By Debra Wood, RN, contributor, updated Jul 01, 2020
Many people across the United States rely on certified
registered nurse anesthetists (CRNAs) for pain management, and the anesthesia
and analgesic specialists are moving to a multimodal approach to address pain
issues and the country’s opioid crisis.
“Patient safety is our priority, and we care for patients
across the continuum of life, whether it’s a neonate addicted to cocaine or
opioids at birth clear through taking care of patients in surgery or the
emergency room to resuscitate,” said Lynn Reede, DNP, MBA, CRNA, FNAP, former
chief clinical officer of the American Association of Nurse Anesthetists (AANA),
outlining the organization’s interest in addressing the opioid crisis.
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The role of nurse anesthetists in pain management
CRNA jobs may include placing epidurals or regional nerve
blocks with ultrasound guidance. Military CRNAs place blocks in wounded
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Bruce Schoneboom, PhD, CRNA, FAAN, former chief learning
officer of the AANA, was the organization’s appointee to the U.S. Health and
Human Services Pain Management Best Practices Inter-Agency Task Force, which
identified gaps in pain management protocols and made recommendations to
address those gaps, proposed best practices, and developed a strategy for
sharing that information with the public and federal agencies.
Schoneboom was the only nurse appointed to the task force.
He explained the role CRNAs play in pain management and access to care. He
indicated that AANA “believes that moving from a unimodal approach of using
opioid drugs to manage chronic and acute pain to a more patient-centered,
multidisciplinary, multimodal opioid-sparing treatment approach optimizes
patient engagement in their own pain care.” That will also reduce the risk of
patients developing substance use disorder.
Reede explained that engaging the patient prior to surgery
and educating the patient that he or she will have some pain but the patient
will be able to manage it helps with reducing opioid use.
“If we can prevent pain sensations from getting to the
brain, the [patient] can be more comfortable,” Reede said. Without opioids,
which only work in the brain, the patient will be less sleepy, and not suffer
other side effects associated with opioids.
“The real management is the partnership between the provider
and the patient,” Reede said.
Managing pain with and without opioids
Every year, millions of Americans experience acute or
chronic pain, according to the American Academy of Pain Medicine. An estimated
100 million suffer with chronic pain. There are no easy solutions.
Many patients rely on certified registered nurse
anesthetists as their primary pain specialist.
An estimated 6 to 12 percent of patients treated with
opioids develop addiction, said Michael D. McGee, MD, author of The Joy of Recovery: The New 12-Step Guide
to Recovery from Addiction.
Therefore, he said, it is “important to avoid opioids if at
all possible and use multimodal interventions for pain management.”
The Centers for Disease Control and Prevention has issued
guidelines for managing chronic pain. It recommends non-pharmacologic therapy
for chronic pain and use of opioids only with other methods of relieving pain.
Patients receiving opioids must be monitored.
McGee advised in treating chronic pain that clinicians work
to improve functioning, reduce pain and reduce psychological suffering.
“Integrate the treatment of pain and other comorbidities,
including addictions and other psychiatric illnesses,” McGee said. “Combine
nonopioid pharmacological and nonpharmacological therapies, collaborating as
part of a team with other caregivers.”
Removing barriers to CRNA practice
Despite CRNAs administering more than 49 million anesthetics
to patients annually, artificial barriers and restrictions exist, limiting
access to care.
CRNA jobs are plentiful, and the U.S. Bureau of Labor
Statistics predicts job growth will far exceed the average of other occupations
from 2018 to 2028, at a rate of 26 percent.
Recruiters at Staff Care report that nurse practitioner and
CRNA jobs are the most in-demand advanced practice specialties for locum tenens
During the COVID-19 pandemic, the Centers for Medicare &
Medicaid Services has temporarily
eliminated the requirements that a CRNA practice under the supervision
of a physician.
The marketplace is driving change to supervision, because
one-on-one supervision is not cost effective, Reede said.
“Employers are looking to provide optimal anesthesia and
pain-management services at a reasonable cost,” Reede added. “When a CRNA
salary is a half or sometimes a third of the cost of an anesthesiologist, and
we are expected to deliver the same care, which we do, it is expensive model
when you have an anesthesiologist staffing a CRNA."
AANA continues to push to remove barriers to practice.
“The goal is for all healthcare professionals, in particular
the advanced practice providers, to practice to the full scope of education and
licensure,” Reede said.
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