Unfortunately, patients face long wait lists for specialists, and opioid dependence continues to be a serious public health concern. As an increasing number of chronic pain patients turn to primary care clinics for help, researchers with Bruyère Research Institute and the University of Ottawa wondered how nurses could be empowered to help.
In collaboration with Bruyère’s Academic Family Health Team, Dr. Hillel Finestone, specialist in physical medicine and rehabilitation at Bruyère and Associate Professor in the Faculty of Medicine, worked with family physician Dr. Elizabeth Muggah to develop and implement a nurse-led chronic pain management program within the clinic, leveraging educational supports and resources for patients, such as the Pain Explanation and Treatment Diagram.
“Chronic pain interferes with so many facets of daily living,” explains lead investigator Dr. Finestone of uOttawa's Brain and Mind Research Institute. “It can often lead to depression, anxiety, and addiction. Family physicians, nurses, and allied health professionals are becoming the frontline for pain management, but they may not have the resources or expertise to deliver a multidisciplinary approach to care. Our new program gives them the tools they need.”
The nurse-led chronic pain management program assisted patients with behaviour modifications, initiated community service referrals, and facilitated access to additional services and resources that were available within the family health team clinic.
“I have been a really active person throughout my life,” said Linda Fritsch, a patient at the Bruyère Academic Family Health Team clinic who started the program in January. “Things that I really like doing seemed almost impossible; even going up the stairs was difficult. I don’t like this feeling of helplessness after always being so independent.”
Fritsch shared that since starting the program she was more cognizant of how pain was impacting her life, and that adopting recommendations from the nurse was already yielding positive results.
“It’s not only that my own thinking is more positive, but my family also feels relieved, “said Fritsch. “I don’t know where’d I’d be without the program. I feel like life is a little bit more pleasant now.”
Over the course of the program’s pilot, 21.6% of patient participants experienced reductions to their reported pain, and nearly half reported reductions in their pain’s interference with their daily living. By the pilot’s conclusion, 42.9% of patients had reduced their use of opioids, including a participant who had eliminated opioid usage completely.
“It was straightforward to implement, and we saw positive feedback from clinicians, the health administrators, and most importantly, our patients,” said Isabelle Leclerc, RN, who spearheaded the implementation at the clinic. “We consistently heard from patients that they had a better understanding of chronic pain and of their prescription medications. This can be a great model for other primary care practices to adopt.”
As patients continue to seek timely and accessible treatment for chronic pain, the research team and clinic see this new program as an effective model for family health teams across Canada to adopt in their practices.
The full study, “Chronic pain management: integration of a nurse-led program in primary care,” was published this month in Canadian Family Physician.
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