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Pain Management

Do we need to rethink how we educate healthcare professionals about pain management?

30 Apr, 17 | by atwycross

Do we need to rethink how we educate healthcare professionals about pain management?

This week’s EBN Twitter Chat on Wednesday 3rd May between 8-9 pm (UK time) is taking place live from the British Pain Society’s (@BritishPainSoc) Annual Scientific Meeting in Birmingham. The chat will focus on whether we need to rethink how we educate healthcare professionals about pain management. The Twitter Chat will be hosted by Dr Ameila Swift (@nurseswift) and Professor Alison Twycross (@alitwy). This Blog provides some context for the Chat.

Participating in the Twitter Chat

Participating in the chat requires a Twitter account; if you do not have one you can create an account at www.twitter.com. You can contribute to the chat by sending tweets with #ebnjc included within them.

Current approach to pain education

The International Association for the Study of Pain (IASP) have published curricula for pre-registration training for healthcare professionals (see: http://www.iasp-pain.org/Education/CurriculaList.aspx?navItemNumber=647). These consist of lists of topics specifying the knowledge students need to obtain about pain management during pre-registration courses. This reflects the traditional approach to curriculum design where learning outcomes focus on theoretical knowledge and pay little attention to application in practice. Indeed, research in this area has tended to focus on knowledge and curricula deficits (Briggs et al. 2011, Twycross & Roderique 2013). As patients of all ages continue to experience unnecessary unrelieved pain (Twycross & Finley 2013; Meissner et al. 2015) there is a need to explore ways of ensuring knowledge is used in practice. This is timely because the International Association for the Study of Pain (IASP) has named 2018 the Global Year for Excellence in Pain Education (see: http://www.iasp-pain.org/GlobalYear).

Is part of the problem the way we evaluate the education provided?A literature review of research into pain education, conducted for this blog, suggests the impact of educational interventions does not look beyond three months with most studies only assessing pre- and post-intervention knowledge gain. Students and junior staff feel powerless and might ‘shy away from their incompetence’ in treating patients when management is not straightforward (Tellier et al. 2013), demonstrating the gap between increased knowledge and increased competence.

more…

Treating pain during pregnancy and breast feeding

16 Apr, 17 | by josmith

This week’s EBN Twitter Chat on Weds 19th April at 8-9pm UK time will focus on pain during pregnancy, how important and difficult is to treat pain during pregnancy and breast feeding.

The Twitter Chat will be hosted by Dr Massimo Allegri, Assistant Professor in Anesthesia Intensive Care and Pain Medicine at the University of Parma (Italy),@allegri_massimo. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward, You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The Pain Department of University Hospital of Parma is one of the biggest pain clinic in Italy and it is the most important research centre about acute ad chronic pain in Italy and one of the most important in Europe.

Furthermore, next year a new PhD Position in Pain will be settled up together with Alborg University and Prof Lars Arendt Nielsen about chronic pain and central sensitization. Furthermore, University of Parma organizes one of the most important translational pain meeting in the world: SIMPAR (www.simpar-pain.com).

Pain affects 20% of adult population worsening not only quality of life, but also outcome of patients who refer it. Unfortunately, pain continues to being undertreated and under-recognized. Chronic pain is not just a symptom but it is a real disease that needs an accurate diagnosis and appropriate therapy against the pain generator pathophysiology.

This problem is even more important during pregnancy and breastfeeding. The fear to give drugs that can hurt foetus/neonate can drive the physician to a “wait and see” approach that cannot solve the problem to the mother. Furthermore, during pregnancy there are several physiological changes that can worsen previous pain or generate new one. Finally, all the drugs are obviously off label and it is difficult to know exactly their real toxicity.

On Wednesday 19th April during the twitter chat we will continue the conversation to consider how to drive the therapy for patients during pregnancy and breastfeeding. We will discuss all together which multidisciplinary approach could be useful and how important is to diagnose the right pathophysiological mechanism that triggers the acute or chronic pain:

  • Which are the classifications of the drugs that could drive clinicians to use the drugs to alleviate pain?
  • When is more harmful to use some specific drugs?
  • Which concerns do we have to consider when we give a drug to a breastfeeding mother?
  • How to perform the right pathophysiological diagnosis?
  • Do we have to stop some drugs if the women would like to become pregnant

Please join us to discuss this important medical, nursing and public health challenge.

References

1 Coluzzi F, Valensise H, Sacco M, Allegri M Chronic pain management in pregnancy and lactation. Minerva Anestesiol. 2014 Feb;80(2):211-24.

2  Narayan B, Nelson-Piercy C. Medical problems in pregnancy. Clin Med (Lond). 2016 Dec;16(Suppl 6):s110-s116.

3 Tepper D. Pregnancy and lactation–migraine management. Headache. 2015 Apr;55(4):607-8.

Chronic Pain Management: Moving Beyond Pharmacotherapy

23 Oct, 16 | by rheale

By Roberta Heale, Associate Editor EBN, @robertaheale @EBNursingBMJ

Pain is an essential part of life.  It tells us when and where we’ve sustained an injury.  This acute pain ensures that we seek out and address the problem at hand.  However, some pain continues for much longer than necessary. Pain signals remain active, muscles tense in response, energy is lowered and there are changes in appetite.  People often experience depression, anxiety or anger as a result of living with these ongoing effects.

Treatment of chronic pain can be complex. There are a whole host of medications ranging from opioids to antidepressants to medications addressing neuropathic pain.  Although useful in many cases, medications are not without side effects and there can be negative outcomes, including addiction.  More and more we see alternative therapies being implemented to help in the management of chronic pain such as yoga, massage and acupuncture.  In recent years, attention has turned to treatments that address mental and psychological coping of patients, such as cognitive behavioural therapy (CBT).

One such therapy is acceptance and commitment therapy (ACT).  ACT is a form of therapy that falls into the umbrella of CBT.  ACT is defined by the Association for Contextual Behavioural Science as:

…a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behaviour change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behaviour in the service of chosen values.1

EBN published a commentary on research that explored the use of ACT for chronic pain management in older adults and the small study showed some promise. http://ebn.bmj.com/content/19/4/123.full.pdf+html

Chronic pain is ubiquitous in health care and in life.  Given this, we, ourselves, need to make a commitment to continue in this trend of exploring alternative, non-pharmacological methods to help our patients cope with and thrive despite chronic pain.  Encouraging them to try CBT or ACT may be a first step.  Conducting research to better understand the complexity of chronic pain and viable treatment options is another essential step.

1.  ACBS. (n.d.)  ACT. Acceptance and Commitment Therapy.  Retrieved from:  https://contextualscience.org/act

 

 

Mission Possible – Putting Neonatal Pain Knowledge into Action

14 Aug, 16 | by josmith

Dr Denise Harrison (RN, PhD), Associate Professor, Chair in Nursing Care of Children, Youth and Families, University of Ottawa &  Children’s Hospital of Eastern Ontario (CHEO) Research Institute dharrison@cheo.on.ca OR denise.harrison@uottawa.ca

This week’s EBN Twitter Chat is being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), between 1900-2000 (British Summer Time) and is a joint venture with the Council of International Neonatal Nurse (COINN) conference 2016 being lead by Dr Densie Harrison. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

We have the knowledge how to reduce pain in sick and healthy newborns during routine, frequently occurring painful procedures – breastfeeding,1 skin-to-skin care2 or very small volumes of sweet solutions, either sucrose3 or glucose.4 Evidence from randomized controlled triaAlice Englishls – synthesized into systematic reviews – further distilled into clinical practice guidelines and finally concentrated into usable evidence; YouTube videos showing these strategies during bloodwork (BSweet2Babies & Power of Parent’s touch) give us ample knowledge and tools to inform our practice and help us translate the knowledge into action. Yet, studies of newborn pain practices around the world continue to show that neonatal pain in under-treated We do not consistently facilitate parents to breastfeed or hold their babies skin-to-skin during procedures, and sweet solutions are not always made available.5 Ultimately, the babies we care for in our Neonatal Intensive Care Units, Special Care Units, other hospital wards and even our healthy newborn babies suffer from pain that is easily preventable.

In our COINN pain panel titled Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coMotherSCCVideoinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and live Twitter Chat (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), we will work together as neonatal pain champions in our organizations, to work at best ways to put our neonatal pain knowledge into action. Our panel includes our audience @COINN2016, as well as Dr Linda Franck, Dr Bonnie Stevens, Dr Marsha Campbell-Yeo (‏@DrMCampbellYeo),and myself, as the Session Chair (@dharrisonCHEO). Our discussion will include myths surrounding recommended pain care; effectiveness of maternal-led interventions to reduce procedural pain; ways we can support and empower parents and facilitate their role as partners in pain care, and improving practices at the organizational level.

I really look forward to our session, our speakers and, from our audience, ways to move forward to embed our knowledge into normalized pain management practices.

1         Shah PS, Herbozo C, Aliwalas LI, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2012. DOI:10.1002/14651858.CD004950.pub3.

2         Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2014. DOI:10.1002/14651858.CD008435.pub2.

3         Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2013 2016; DOI:10.1002/14651858.CD001069.pub5.

4         Bueno M, Yamada J, Harrison D, et al. A systematic review and meta-analyses of non-sucrose sweet solutions for pain relief in neonates. Pain Res Manag 2013; 18: 153–61.

5         Harrison D, Reszel J, Wilding J, et al. Neuroprotective Core Measure 5: Neonatal Pain Management Practices during heel lance and venipuncture in Ontario, Canada. Newborn Infant Nurs Rev 2015; 15: 116–23.

The Power of a Parent’s Touch on Newborn Procedural Pain

14 Aug, 16 | by josmith

Dr Marsha Campbell-Yeo PhD RN, Neonatal Nurse Practitioner, Associate Professor and Clinician Scientist, School of Nursing, Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University and IWK Health Centre marsha.campbellyeo@iwk.nshealth.ca

No parent wants toBaby SSC image for ebnjc see his or her child experience pain. Sadly, for parents of sick or preterm babies requiring hospital care, it’s a common event with preterm and sick babies ofte
n undergoing on average 12 painful procedures every day with the majority receiving little or no pain relief. In addition to the immediate pain and stress babies experience during these procedures, the
se babies may develop learning and motor delays, behavior problems, and lower academic achievement later in life. This has to change.

As a neonatal nurse practitioner and a researcher who has cared for mothers and babies for over 25 years, I decided to explore ways to minimize these negative outcomes. Historically, mothers have always been crucial to infant survival and wellbeing but they are not always involved in critical care settings. Over my time at the bedside, I noticed that the power of touch could have a positive impact on infants and mothers. So I decided to study this. We found that Skin-to-Skin Contact (SSC), sometimes called kangaroo care, where an infant lies directly on a mothers’ chest, between moms and infants has powerful benefits and can even significantly decrease pain responses in preterm and full term infants undergoing a single painful procedure such as blood collections and needle pokes. However, it is not just mothers that can provide pain relief – fathers, alternative care providers and co-bedding twins have been found to effectively reduce pain during procedures as well!

Despite these positive findings related to pain management in newborns, pain is still associated with regular procedures and continues to be undermanaged for these infants during their hospital stay. A significant challenge remains related to practice change in the NICU. We found that while nurses reported fewer concerns over time related to helping mothers provide SSC as a pain-relieving strategy in the NICU, the amount of the time SSC was actually used did not change.tumblr_maq3vwaULq1rog5d1o1_500

Knowing the positive impact that families can have on minimizing pain during painful procedures by simply asking for it is something that I felt I had to get into the hands of parents. Therefore, I created a parent friendly video titled “Power of a Parent’s Touch” that is meant to empower parents to help minimize neonatal pain in the NICU. Launched on December 2, 2014, it has received over 156,000 views so far in over 150 countries around the world!

It’s not just the one in ten babies that are born preterm worldwide that are adversely affected by untreated pain. Untreated pain is an issue for every baby, even those that are born healthy. Every baby in the world undergoes painful procedures in the first few hours and days after birth and many can receive up to 20 injections in their first years! Parents are one of our most underutilized resources to help relive this pain.

We need to change that. Parents can make a difference.

Join COINN live Twitter Chat – Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and (HashTag #ebnjc), to be held Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)

Let’s do it With Parents!

14 Aug, 16 | by josmith

Professr Family Health care, School of Nursing, Univisrt of California San Francico Linda.Franck@ucsf.edu @lfranck77 @UCSFnurse @UCSFPTBI

Joining together for COINN 2016 is a wonderful opportunity to reflect on how far we’ve come – and where we still need to do better – in preventing and treating neonatal pain. As I think about the role of parents as partners in neonatal pain management, we seem to be on a 15 year cycle of paradigm shifts in our thinking.

It wasn’t until the mid-1980s that neonatal pain was first recognized as a serious health condition, and parents played an important role in bringing public attention to the untreated pain of infants in neonatal intensive care units. Then, in the early 2000’s we started asking parents about their views on how we were managing infant pain and, guess what? – they had many questions, worried about how not being able to comfort their baby meant that they weren’t able to be a good parent, and parents wanted to be more involved, but didn’t know how.

This realization began a very fruitful era of research where we all discovered that parents were our best “medicine” for preventing or treating much of the day-to-day pain that infants experienced. We learned it was safe and effective – often more safe and effective than traditional analgesics. We also discovered that nurses were more attentive to infant pain assessment and management when parents were more actively involved. Involving parents in infant’s comfort care is a classic “win-win” example – reducing a serious adverse outcome of neonatal intensive care for infants, and promoting confidence and competence of new parents.94368575-4ABE-44D8-96B0-AFFCEF303AC3

And now in 2016, it is time to take the next big leap in knowledge and action to continue to improve infant pain prevention and manage. Let’s include parents as full partners from the very beginning of this next idea generation. I can’t wait to see what great new innovations our nurse-parent partnership will discover together!!

http://familynursing.ucsf.edu/resources-parents

 

Join the COINN live Twitter Chat:

Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and (HashTag #ebnjc), being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (British Summer Time)

Mission Possible – Prioritize Pain Prevention

14 Aug, 16 | by josmith

Professor Bonnie Stevens, Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada b.stevens@utoronto.ca

We hbabyskintoskinave heard repeatedly about the high numbers of painful procedures undertaken with hospitalized neonates and their potential consequences. We are also aware of insufficient practices to treat the pain associated with these procedures. This inadequacy is often attributed to lack of knowledge of care providers, when really it is a lack of organizational commitment to decreasing pain and changing behavior.

I have devoted my research career to studying pain in infants. However, even with 50 infant  pain measures and multiple systematic reviews synthesizing pain-DadSSCrelief strategies for health care professionals (e.g. sucrose [1]) and parents (e.g. skin-to-skin care and breastfeeding), effectively implementing these strategies remains challenging. Therefore, I have refocused my research within implementation science to determine how healthcare organizations can effectively change practice and influence practice, research and policy agendas.

I believe that evidence or champions alone cannot change behavior or outcomes. Institutions need to prioritize pain prevention and demonstrate their commitment at the point of care. They can facilitate dialogue amongst health care providers, support leaders and the efforts of local champions, and provide resources. Without organizational support for pain relief, the best evidence and individual efforts will go unnoticed.I have completed a large national study, funded through the Canadian Institutes of Health Research, where with strong leadership, committed resources and local champions, hospital units improved pain assessment and treatment and decreased procedural pain in children [2,3]. However, this approach, which supported an on-site research nurse was not feasible or sustainable [4].

We have now developed a multiplatform web-based infant pain resource that we will implement and evaluate. The resource consists of a 7-step evidence-based quality improvement strategy for changing behavior and enhancing outcomes. Initial evaluation indicates that health care professionals are highly satisfied and excited about this resource. It is my hope that this strategy will stop the conversation on inadequate procedural pain management and start the dialogue on successful change management.

Join the COINN live Twitter Chat:

Mission Possible – Putting Neonatal Pain Knowledge into Action, (http://coinn2016.neonatalcann.ca/panel-mission-possible-putting-neonatal-pain-knowledge-action) and (HashTag #ebnjc), being held on Tuesday August 16th from 1100-1200 (Pacific Daylight Time), 1900-2000 (Bristsh Summer Time)

References

  1. B. Stevens, J. Yamada, A. Ohlsson, A. Shorkey, S. Haliburton. (2016). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub3.
  2. B. Stevens, J. Yamada, S. Promislow, J. Stinson, D. Harrison and The CIHR Team in Children’s Pain. (2014). Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children. Implementation Science, 9, 120.
  3. B. Stevens, J. Yamada, C. Estabrooks, J. Stinson, F. Campbell, S.D. Scott, G. Cummings and CIHR Team in Children’s Pain. (2013). Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain. 155(1):60-68.
  4. B. Stevens, J. Yamada, S. Promislow, M. Barwick, M. Pinard, CIHR Team in Children’s Pain. Sustainability of pediatric pain outcomes following a knowledge translation booster intervention. Pediatrics (In Press).

Managing Pain in Children: Helping to Improve the Use of Evidence in Practice

18 Apr, 16 | by josmith

Alison Twycross (@alitwy), Head of Department for Children’s Nursing and Professor of Children’s Nursing, London South Bank University

I have been editor of Evidence Based Nursing since August 2010 and during that time I have worked with a team of associate editors to make the evidence to guide practice more accessible to nurses working in clinical practice. Alongside this I have also carried out research relating to managing pain in children. My current research focuses on the management of acute, post-operative and cancer-related pain in children and in particular on supporting parents to manage their child’s pain at home. I have also edited three books pulling together the evidence for managing pain in children. Details of the 2014 book can be found at: http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0470670541.html

more…

Issues in Neonatal Pain

4 Oct, 15 | by josmith

It is a great pleasure to introduce this week’s guess bloggers: Dr. Marsha Campbell-Yeo (@drmcampbellyeo) and Dr Denise Harrison (@dharrisonCHEO), will also be co-leading this week’s ENB twitter chat on Wednesday the 7th of October between 8-9pm UK time focusing on ‘Issue in Neonatal pain’. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create and send us a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ. Add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets. 

The Power of a Parent’s Touch on Newborn Procedural Pain

Today’s guest blog comes from Dr. Marsha Campbell-Yeo (@drmcampbellyeo), assistant professor in Nursing at Dalhousie University and a certified neonatal nurse practitioner and clinician scientist at the IWK Health Centre. She is a recognized world leader related to the impact of maternally-led interventions on the immediate health outcomes of at-risk newborns. Her work examines maternal driven interventions to improve outcomes of medically at risk newborns specifically related to pain, stress and neurodevelopment.

No parent wants to see his or her child experience pain. Sadly, for parents of sick or preterm babies requiring hospital care, it’s a common event. Did you know that preterm and sick babies often undergo on average 10 painful procedures every day with the majority receiving little or no pain relief? Only as recently as the late 1980’s, it was thought that newborns couldn’t feel pain at all and even surgery was done without anesthetic! We now know that untreated pain during early life has both immediate and long-term harmful outcomes. For example, in addition to the immediate pain and stress they experience, these babies may develop learning and motor delays, behavior problems, and lower academic achievement later in life. There is also emerging evidence that these poor outcomes may be made worse and also impact the relationship mothers have with their children due to the prolonged mother and baby separation often experienced during prolonged hospital stays in a Neonatal Intensive Care Unit (NICU).

Despite these negative outcomes, pain associated with regular procedures continues to be undermanaged for these infants during their hospital stay. As a neonatal nurse practitioner and a researcher who has cared for mothers and babies for over 25 years, I decided to explore ways to minimize these negative outcomes. Historically, mothers have always been crucial to infant survival and well being but I noticed that they were not always involved in critical care settings. I decided to research this more to explore how to involve mothers and families in the care of newborns to minimize pain and improve long term outcomes for preterm and sick newborns and their families. Skin-to-Skin Contact (SSC), commonly referred to as Kangaroo Care (KC), is the upright holding of a diaper clad infant on his or her mothers’ chest and has been associated with numerous immediate benefits in a non-pain context in both developed and developing countries..

As a clinician, I had seen firsthand the impact that human touch such as breastfeeding, facilitated tucking, massage and most notably SSC can have on infants and mothers. So I decided to see what research had already been done on the impact that mothers have in minimizing newborn pain through SSC. I co-led a review on “Skin-to-skin care for procedural pain in infants”. This Cochrane review found that SSC between moms and infants significantly decreased pain in preterm and full term infants for a single painful procedure. From this finding, I decided to expand and explore whether SSC could play a role in minimizing pain when used during all painful procedures of an infant’s stay in the neonatal intensive care unit (NICU).

Currently, I am running a clinical trial called Trial of Repeated Analgesia in Kangaroo Care (TRAKC) which involves looking at how preterm babies who receive repeated kangaroo care differ developmentally at discharge from the hospital compared to babies who only get sweet taste, or sucrose, during all painful procedures. We will also be following up these babies to 18 months (TRAKC 18) to see if SSC provided during painful events in early life will influence if the children differ in their response to pain, the relationship they have with their mothers, and their behavioral development at 18 months of age.

Knowing the positive impact that mothers and dads too can have on minimizing pain during painful procedures that newborns experience is something that I felt I had to get into the hands of parents. Following my colleague Dr. Chambers in her “It Doesn’t Have To Hurt” video on managing needle pain in children, I decided to create the second parent friendly video titled “Power of a Parent’s Touch”. This video is meant to empower parents to help minimize neonatal pain in the NICU. Launched on December 2, 2014, it has received over 83,000 views.

https://www.youtube.com/watch?v=3nqN9c3FWn8

It’s not just the one in ten babies that are born preterm worldwide that are adversely affected by untreated pain. Untreated pain is an issue for every baby, even those that are born healthy. Every baby in the world undergoes painful procedures in the first few hours and days after birth and many can receive up to 20 injections in their first years. Parents are one of our most underutilized resources to help relive this pain. We need to change that. Parents can make a different.

Implementing Acupuncture in NP Practice

24 Aug, 15 | by rheale

By Roberta Heale, Associate Editor EBN, @robertaheale, @EBNursingBMJ

A few months ago I blogged about taking courses in acupuncture. At that time, I promised to blog again about my experience in implementing acupuncture into my primary healthcare nurse practitioner practice. I had been frustrated by the lack of options for people with chronic pain and had decided to learn acupuncture as a way to offer patients an alternative to medication. After completing an acupuncture program and practicing on a few family members and friends, I worked out a deal with the agency where I practice as a NP to offer the service to clinic patients. My schedule quickly filled up with patients who had been referred by other NPs at the centre. Finally, one warm and sunny day at the end of June, I put my kit together and got started.

The patients who had taken appointments with me each suffered from multiple pain issues as a result of fibromyalgia, osteoarthritis, previous injury and more. I took the time to explain acupuncture risk and benefits to each person. I showed them photos of me taken during my courses to demonstrate that I’d needled and been needled every point in the course work, including the one attached where I’ve been given shoulder points. Everyone asked me ‘does it work?’. I told them about research showing the effectiveness, but from my own experience I had to say honestly ‘I don’t know’. I worked out a plan of care for each patient based on their symptoms and the areas that they felt were the priority.

acupuncture course

With no expectations, I was amazed at both the immediate and delayed response to acupuncture treatment. I estimate that over 80% of the patients had some positive reaction and although I began by treating local pain issues, I was totally unprepared for the wide range of benefits experienced. Almost all patients indicated that their pain was reduced, but they also described lessened anxiety and increased relaxation. There were reports of better sleep, feeling happier and even less constipation. In one instance, a patient was treated for bilateral lower leg pain. The treatment reduced the pain significantly, but the extensive varicose veins on her lower legs faded to almost nothing during the treatment! We were both quite surprised and she was thrilled and even moreso when the effect lasted.

In the short time I’ve practiced acupuncture I’ve learned that it’s difficult to quantify a patients’ reaction to treatment. The pain scale of 1-10 just doesn’t seem to be appropriate in capturing a response. It appears that the tendency in western healthcare to compartmentalize diagnoses and treatments doesn’t work as well with acupuncture. The benefits are more ubiquitous, more indefinable. While I can’t honestly say to an individual patient that ‘acupuncture will work’ for them, I certainly feel much more confident in saying that they will likely have some benefit from treatment.

I’m excited to continue to offer acupuncture to my patients. I hope as I become more proficient, I’ll be able to provide them with even more benefit.

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