VNA provides pain management

By Susan Vaughn - February 15, 2007

In recent years, home health care providers nationwide have found that the number of patients living with acute and chronic pain is increasing, but the health care workers have not been equipped to deal with the problem.

Acute and chronic pain were once viewed in the context of end-of-life pain and hospice care, and only hospice nurses were trained and certified in pain management techniques. The American Nurses Credentialing Center decided to do something about the situation. In October 2005, it added another specialty beyond hospice certification, called pain management certification.

The Vineyard Nursing Association, which made 15,000 home health-care visits last year, got involved in the new specialty more than two years ago, starting with an in-house pain-management training program for its nurses.

Recently at Suffolk University in Boston, all seven VNA nurses who took the pain management certification test passed it. They are among only 50 nurses statewide who have the special certification.

"We're on the leading edge of this," said Bob Tonti, Vineyard Nursing Association director. VNA has invested a good deal of time, energy, and money in educating its nurses in this new interdisciplinary approach to managing patients with acute, chronic, and non-curable pain, he said.

VNA brought in Cathy Schutt of Pain Management Resources Inc., a leader in the field, to train the nurses on site. During the past two years, the nurses have been learning and practicing the techniques, said Sandie Corr-Dolby, a board-certified RN and clinical director of VNA, now also certified in pain management. The certification required the nurses to have 30 hours of training each year for two years, half in pain management techniques, and twice as much as is needed for nursing re-certification.

"The last few years we have seen some great improvement," in the patients, Ms. Corr-Dolby said. Some of the common causes of chronic pain include back and neck injuries, which are often sustained on the job, Lyme disease, arthritis, and fibromyalgia. People with Lyme disease, for example, often suffer neurological impairment, she said.

VNA is using an interdisciplinary team approach to managing patients with acute, chronic, or non-curable pain. Each patient is given a pain-management assessment, which identifies the type and source of pain and includes recommendations for the best treatment, Ms. Corr-Dolby explained. The entire team of professionals may get involved in the assessment, including physical therapists, nurses, social workers, physicians, family members, and sometimes spiritual counselors.

The treatments may include physical therapy, drug and non-drug therapies such as acupuncture or massage, and spiritual counseling, among others. The VNA makes the referrals for all levels of treatment to the appropriate professional.

"It's about improving their function," Ms. Corr-Dolby said. The VNA providers also have noticed that people suffering from chronic pain are "younger and younger," she said. They are no longer dealing with just the elderly for home care.

Mr. Tonti said the agency was already a leader in pain management for the elderly before the recent efforts. Medicare recognized VNA in the first quarter of 2004 as the No. 1 in the state in the area of pain management and most recently it surpassed the 2004 score, he said.

On a consultant basis, the VNA plans to offer its nurses' new expertise locally to the hospital, clinics, doctors, and other health-care providers. They also accept referrals from all health-care providers, potential patients, families, senior centers, and other social service agencies.

In addition to Ms. Corr-Dolby, the other registered nurses who earned the pain-management certification are Laura Murphy, Sally Kallmann, Cheryl Kram, Susan Burton, Elizabeth Holcomb, and Michele LeBlanc.