CRNAs Seeking New Best Practices in Pain Management
Many people across the United States rely on certified registered nurse anesthetists (CRNAs) for pain management, and the anesthesia and analgesia 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, the 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 soldiers before they are transported to a tertiary hospital for definitive care.
Bruce Schoneboom, Ph.D., 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 from chronic pain. There are no easy solutions.
Many patients rely on certified registered nurse anesthetists as their primary pain specialists.
An estimated 6 to 12 percent of patients treated with opioids develop an 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 have issued guidelines for managing chronic pain. It recommends non-pharmacologic therapy for chronic pain and the 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 assignments.
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 an 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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