Questions about Pain management job

djmatte, ADN, MSN, RN, NP · Mar 8, 2018

If the practice is worth their salt, they will be utilizing multi-modal therapies to minimize or eliminate the use and need of opiates. Going from a hospitalist role to pain clinic is a bit different since you are likely (apologize if I am over-assuming) covering acute situations and maybe balancing their chronic needs. There are some important things you can cover in an interview. Understand what your state's current goals are in reducing opiates and be able to talk to them. Ask if they have protocols for opiate reduction and how successful they are at implementing them. Get a good understanding for the other therapies they have available on-site and what they need to refer out for.

Good clinics offer as many as they can in-house. A comprehensive pain model is an important part of pain management these days because pain is multifaceted. Having things like physical therapy, mental health, injection procedures, and an array of medication options are key. In Michigan, we have an online system and I believe you could run it on specific doctors to see how much they are prescribing. If your state has something similar, it could give you some insight on what you are in for.

FullGlass, BSN, MSN, NP · Mar 8, 2018

One of my clinical rotations was in pain management, also for a clinic considered the best in the city by other pain management doctors. The philosophy of this clinic is to treat the root causes of pain, which are physical, mental, and emotional. The practitioners do a very thorough history and physical, and provide treatment plans which address all dimensions of pain. Their goal is also to minimize opioid use and patients are sent to this clinic so they can be weaned off of opioids or tapered down to the lowest possible dose. One of the doctors owned this practice, so he was not under an administrator. As a result, he took his time with the patients.

The patients were very nice people. They were so grateful for having their pain reduced. We did have a couple of drug seekers - I think 3 in the 3 months I was there, but they were quickly refused and sent on their way.

My experience at this clinic was very positive and gave me a keen interest in pain management. There are a lot of people suffering from chronic pain, so this can be a very rewarding specialty, emotionally and financially, if you work for a reputable clinic. Given the push to reduce opioid use, there are many exciting developments in pain management, so this would also be an interesting specialty.

Good luck.

MidlifeNP · Mar 9, 2018

Thanks for the replies. Yes- I've checked it out and this office is reputable, been there for 20 years, the anesthesiologists on staff all have Pain fellowships, and do procedures at a nearby surgery center. I'll be trained on trigger point injections. The have a psychologist on the office, and even that new magnetic thing for depression treatments.

Here is my next question-- I am AGACNP. Am I within my scope to work chronic pain? I'm actually interested in this, and willing to pursue a post masters additional certificate if needed-- would it be AGPrimary? Did that replace the Adult Np? Even Psych certification interested me. I know I'll be under the watchful eye of the powers that watch pain Med, and just want to cover all my bases that my certification backs me up. Thanks so much for your answers. This never was my first, second or even 10th choice-- but I'm a little burned out on the long hours of Hospitalist life as well as the drama and politics in every group. At my age- I'm drawn to the good benefits and weekends and holidays off so I can enjoy my grandkids.

djmatte, ADN, MSN, RN, NP · Mar 9, 2018

Thanks for the replies. Yes- I've checked it out and this office is reputable, been there for 20 years, the anesthesiologists on staff all have Pain fellowships, and do procedures at a nearby surgery center. I'll be trained on trigger point injections. The have a psychologist on the office, and even that new magnetic thing for depression treatments.
Here is my next question-- I am AGACNP. Am I within my scope to work chronic pain? I'm actually interested in this, and willing to pursue a post masters additional certificate if needed-- would it be AGPrimary? Did that replace the Adult Np? Even Psych certification interested me. I know I'll be under the watchful eye of the powers that watch pain Med, and just want to cover all my bases that my certification backs me up. Thanks so much for your answers. This never was my first, second or even 10th choice-- but I'm a little burned out on the long hours of Hospitalist life as well as the drama and politics in every group. At my age- I'm drawn to the good benefits and weekends and holidays off so I can enjoy my grandkids.

I don't think a primary care background would be necessary for this position. You won't be in a position of managing the broad situations that can be expected of someone primary care trained. Having an understanding of the implications other disease processes have on the pain you are treating IMO is no different than what you probably already do as a hospitalist. The biggest hurdle is getting used to clinic routines that will be much different than you're used to. But that comes with time. Also be sure to ask if they will train you and our expect you to do injections. Many pain clinics utilise their pa/np staff to help in this. It's a useful skill that is worth knowing.

Tony1790, BSN, MSN, NP · Mar 13, 2018

I would not recommend a pain clinic job, having worked at a pain clinic as my first NP job, it can be rewarding, especially if you can help someone reduce their pain and hopefully their dependency on opiates. I would take into account, the national "war" on opiates and by circumstance, those that prescribe them. Most states (if not all) have a database to track who is getting prescription pain killers and who is writing them, this is to stop doctor shopping and the "candy man" syndrome. Many groups and many state boards are monitoring the providers and if they get out of whack with the job that they do, they get the attention of regulators.

As a result, many PCP are stopping writing for pain pills and referring the patients to the pain clinics, thereby transferring the risk to that provider. I would also gather, that any good PCP has already offered PT, Braces, Shoulder, Knee injections, etc. Which ultimately means that many of the pain clinics clientele just want the medication, every 30 days, that's just the way it is, you can't force patients to attend PT or do injections.

The most rewarding day I had at the pain clinic, was this lady came in because she was in severe pain and her PCP was too afraid to write for pain meds, I asked what was causing the pain and she pulled up her pant leg, she has these huge areas on her leg, all of the skin was gone, I was literally looking at her muscles, tendons etc. I about freaked, "why don't you have a wound vac" etc. So I wrote her something for pain, referred her to wound care and the next time she saw me, she hugged me and thanked me for helping to save her leg, but that was one of the few good times, there is much more conflict, the tension between the provider, wanting to do something, anything besides writing for a pill, and many, many patients not wanting anything but the pill.

Ultimately, the vast majority of pain clinics are either the last resort or only resort for employment of new grads or those wanting to change fields, I learned a good deal there as my very first job, lots about pain meds, using Cymbalta for Fibro, etc But I don't missing being in the top 50 of providers in the state at one point in the number of prescriptions written, I was scheduled up to 40 patients per day, crazy.

Good luck in whatever you decide to do, and as far as being "out of scope of practice" as long as you have your license and your DEA card, the rest really isn't rocket science :-) You'll be fine, but I'd think long and hard about it before you take the plunge, and if you like it, awesome, good luck!

Tony