CRNAs and Pain Management

CRNA

Jackie Rowles, CRNA, MBA, MA, FAAPM
Meridian Health Group
Carmel, Indiana

Pain Practice

Management of a patient’s pain is a central component to anesthesia care.  During nurse anesthesia education and training, CRNAs learn and demonstrate knowledge, skills and competency in the management of pain.  The following excerpt is from the American Association of Nurse Anesthetist’s Position Statement on Pain Management and provides the basis and rationale for CRNA pain management practice:
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) standards mandate nurse anesthesia programs provide content within, but not limited to, the following areas: anatomy, physiology, pathophysiology, pharmacology, and pain management.  These areas of study provide the foundation for understanding pain and pain treatment. Similarly, the COA requires that nurse anesthesia students obtain clinical experiences in regional anesthetic techniques (i.e., spinal, epidural, and peripheral). These techniques (e.g., epidural, peripheral) are employed to alleviate both acute pain and chronic pain. The knowledge and skills obtained during a nurse anesthesia educational program, therefore, serve as the foundation for a CRNA’s engagement in treating either acute or chronic pain.
Providing acute and chronic pain management and treatment is within the professional scope of practice of CRNAs. CRNAs employing pain management techniques are neither new nor unusual and has long been a part of CRNA practice. By virtue of education and individual clinical experience, a CRNA possesses the necessary knowledge and skills to employ therapeutic, physiological, pharmacological, interventional, and psychological modalities in the management and treatment of acute and chronic pain. The AANA believes that it is incumbent upon the individual CRNA to assure his or her competency when delivering anesthesia services, including pain management and treatment.
CRNAs provide pain management services in all anesthesia care settings:  Pre-operative, intra-operative, post-operative, as well as chronic pain services.  A nurse anesthetist’s education and training makes them valuable members of any multidisciplinary pain practice.  As with any area of nursing or medical specialization, further expertise and training is required beyond the basic education in order to hone both skill and competency. CRNAs obtain additional pain management training via specialty classroom and laboratory training programs.  Depending on state licensing regulations and an individual CRNA’s education, a CRNA can provide a wide range of pain management services including:  administering ultrasound/fluoroscopy/CT guided peripheral or spinal blocks, IV pain medication, sedation services for pain procedures, physical assessment/evaluation, and medication management.   Some of the most commonly offered procedures are:  epidural steroid injections, sacroiliac joint injections and facet joint injections.

Resources

  • Certified Registered Nurse Anesthetists At a Glance.  aana.com
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