[paindoc]

Family physicians without fellowship training in pain medicine have no business performing interventional pain procedures. They are far better at medication management for chronic pain than CRNAs will ever be due to vast experience in residency and beyond. Nonetheless, FPs doing interventional procedures is no different than a geneticist suddenly deciding to start a chronic pain practice with fluoroscopically guided injections....it is beneath the standard of care, demonstrates a callous arrogance regarding their own abilities, and unnecessarily places patient lives at risk due to the lack of education.

[stanman1968]

Yet I do not hear any hue and cry over these providers, the big concern seems to be over "nurses" providing care. It seems to me that this is not an oversight but just an acknowledgment that no medical organization will censure or police itself they will only attempt to police other organizations and attempt to mandate the scope of practice for others. I am sure that the AMA, ASA, or any other body of physicians would not appreciate their scope of practice to be determined by any nursing organization. In the end these organizations are attempting to regulate nursing practice not by education or training but by legislation the exact same thing they accuse CRNA's of doing.

[paindoc]

I disagree. The lack of education of CRNAs providing interventional or comprehensive pain management is exactly the issue. While there are similarities between anesthesiology and nurse administered anesthesia, there are profound differences between the two above specialties and interventional pain medicine. The tacit assumption that CRNAs may treat pain, any pain, providing they have a weekend course in anything, is based on an outdated view of pain medicine that existed in 1994. If the few CRNAs practicing interventional pain medicine do not recognize these differences, they will end up fighting a war with the 1,000,000 physicians in this country. The overwhelmining political and numerical advantage will result in an extreme setback to CRNAs as a whole, not only to those that are playing in a field of medicine in which they have no background, no CRNA school education, no substantial post CRNA training other than a weekend course in order to learn an entire medical specialty with very few similarities to CRNA practice or training, and perform no research. If it is really all about patient safety, I cannot think of a more poignant example of substandard care than to have untrained uneducated individuals from CRNAs to FPs performing interventional pain procedures.

[Qwiigley]

Out of all of the CRNAs in the USA, how many actually do pain without a pain MD?

[paindoc]

Nearly all are in rural areas at this time, so most are without a pain physician available, supervising, or for consultation.

[APNgonnabe]

I would like to know the answer to Qwiigley's question. And please excuse me if I'm off base but it seems, at least to me, that Paindoc problems seems to be w/ those few(I hope) CRNA's who have started surgeries (are we talking actual making cuts). Im sure he has several other points and honestly I do not have a lot of knowledge of the post, only my observations.

Be Kind...at least educational

[NRSKarenRN]

Prior to 1960's RN's rarely took blood pressures routinely on patients yet along perform EKG reading or interpret it---province of the physician. Today it is expected standard of practice along with many advanced skills like changing tracheostomy tubes and entire vent circuits for homebound patients.

As scientific advances occur along with education programs dedicated to providing training, both physicians and nurses add practice skills to their repetore. Since OB/GYN MDs in my area are now providing "medical aesthetics" ie laser hair removal and treatments, CRNA's who's education includes extensive pharmacology training should be able to expand their practice into pain mgmt.

NAPES recognizes, reinforces and supports the AANA Position Statement on Pain Management which states: “The management of pain is the central component of total anesthesia care. Recognizing the individual patient's right to the treatment of pain, nurse anesthetists acknowledge that it is their professional and ethical responsibility to participate in the management of pain.”

“By virtue of education and individual clinical experience, CRNAs possess the necessary knowledge and skills to employ therapeutic, physiological, pharmacological, and psychological modalities in the management of acute and chronic pain. CRNAs adhere to a total patient care philosophy directed at the promotion and maintenance of health and well being with special emphasis on the alleviation of pain.”
http://napeseminars.com/pages/mission.html

[paindoc]

CRNAs have extensive pharmacology training in IV drugs used for anesthesia and a peripheral working knowledge of other drugs that may interact with anesthesia. They are completely untrained during CRNA school in the use, pharmacokinetics, pharmacodynamics, side effects, idiopathic reactions, and drug interactions of nearly all medications used in the clinical practice of pain management OR pain medicine. Attempting to acquire this knowledge by reading throwaway journals or attending a little weekend course is inadequate preparation for clinical practice and endangers patient safety due to an extreme overexpansion of a AANA position statement developed prior to 1994. A nurse practitioner is far better situated to treating pain than a CRNA because their training is relevant to the field of non-interventional pain medicine while that of a CRNA is not. CRNAs perceive their scope of practice to encompass the treatment of pain, all pain, with whatever fly-by-night knowledge they can acquire since the appropriate patient-safety oriented formal training programs in pain management do not exist for CRNAs.

[jwk]

Originally Posted by NRSKarenRN

Prior to 1960's RN's rarely took blood pressures routinely on patients yet along perform EKG reading or interpret it---province of the physician. Today it is expected standard of practice along with many advanced skills like changing tracheostomy tubes and entire vent circuits for homebound patients.

As scientific advances occur along with education programs dedicated to providing training, both physicians and nurses add practice skills to their repetore. Since OB/GYN MDs in my area are now providing "medical aesthetics" ie laser hair removal and treatments, CRNA's who's education includes extensive pharmacology training should be able to expand their practice into pain mgmt.

There's far more to pain management than sticking a needle in someone's back. To compare it to laser hair removal (performed by office staff, not the physician) is an amazing oversimplification of the issue. You simply can't take what is literally a weekend course and claim that you are a pain management specialist. The only way you do that is lie to the patient - either lying by claiming you're something you're not, or lying by omission, not telling the patient the true level of your training. "I'm an expert after taking a class over the weekend. That's just as good as a physician with a full year fellowship in pain management".

[Biotechnology]

I just thought that I should give my on the issue. Now I understand where CRNA's feel like they should have a say in pain management, because I believe there is a place in pain management that they could be part of...especially when you are giving pain meds during procedures. That makes total sense!!! I gotcha on that.....What I DON'T understand is where CRNA's feel that they should bring a patient to radiology or the OR/.. make a lumbar cuts into a patients back, placing spinal leads for pain stimulators using C-arm, placing Baclacin Pumps (sp?) into patients etc. etc.....ya'll get my drift all after a weekend course. These are the things that separate pain physicians from anesthetist....the physicians do an extra 2-3 years to learn this stuff. Now I understand what nurseKaren is trying to say, that things are evolving...but they are evolving with the proper education to back it up! Now maybe in the future, it will change but for now, at least the part of pain management that I am refering to should remain in the physicians court. (Now I should also note that I am referring to what pain management does in my state and what they do in the OR that I work in....)