Pain management

I told two different NP's [one FNP and one ACNP] about my plans to include pain management subspecialty/rotation in clinicals for NP school and neither one of them had ever heard of an NP in this field. Neither of them thought it would be in the scope of practice for an IL or MO FNP but might possibly work under the ACNP standards. One of the major concerns was that this is an anesthesia specialty - especially in the areas of intrathecal injections and continuous epidurals. My research shows that NPs can do lumbar punctures -- why would an epidural be out of scope? There was also a question about whether NPs could do intraarticular injections.

Management of chronic and acute pain has always been an area where I felt NPs could really advocate for patients. We have the skills to listen and the time to teach -- sounds like my idea of a great opportunity. Any one have any experience or knowledge to share?

This is painful on so many levels:chuckle:

Many problems with this.

1. CRNAs have made inroads into this area in many states which the ASA is trying to prevent. If the ASA doesn't want a CRNA to do these procedures are they going to be more willing to let an NP?

2. Some states have prohibitions on RNs using C-arms. This prohibits NPs (and CRNAs from using them). At least one state has prohibited CRNAs from using flouro.

3. Pain management has two components. Long term management of chronic pain conditions with medication. Procedural management of chronic or acute pain. The first reimburses very poorly. The second reimburses very well. The physicians that run these practice either refuse to do medical management (the physiatrist is the current choice) or hire someone to do this. They rarely hire someone to do the procedures since this cuts into their income. On the PA side there are probably 5x as many PAs doing medical management as do procedures. Out hospital uses NPs in pain management. They do not do procedures however.

4. As far as procedures go, one APN has already claimed this area. This usually means that it cannot be claimed by another APN domain with proving equal training as part of the certification.

Bottom line if you want to do medical management then ACNP or even ANP would probably work (FNP in many states). If you want to do procedural pain management you should go CRNA (and be prepared to fight).

David Carpenter, PA-C