Advanced Pain Management Fellowship Addresses Addiction Issue

Every day it seems, news about the opioid crisis is in the headlines. By some estimates, more than 2 million Americans are addicted to prescription pain killers, and each day there are more than 100 opioid-related deaths in the United States.

These details can be alarming, leading many patients to feel helpless when it comes to pain management.

One program that is leading the way in combating these startling statistics is the Advanced Pain Management Fellowship offered by the University of South Florida College of Nursing. With both online and onsite instruction, this innovative, high-quality, low-cost certificate program was created for Certified Registered Nurse Anesthetists (CRNAs), who are uniquely qualified to confront this health issue.

CRNAs are advanced practice registered nurses with graduate level education. They are trained to provide anesthetics to patients in a variety of practice settings—and for every type of surgery or procedure. In rural areas, they are often the only anesthesia providers in hospitals. They also are frequently the main providers of anesthesia to the men and women serving in the U.S. military.

In the Advanced Pain Management Fellowship, CRNAs learn guidelines for understanding and treating both acute and chronic pain. They also explore nontraditional approaches in managing pain.

Acute pain is defined as pain that can be temporary. Once it is treated effectively, a patient can likely go back to life as usual. In contrast, chronic pain is ongoing and normally lasts more than six months. Even after the cause of the pain (such as illness or injury) is treated, chronic pain can remain and have long-lasting stress on the body.

“Acute pain can become chronic if it is not addressed timely and appropriately,” explained John Maye, PhD, CRNA, professor and pain management education coordinator. “And to an extent, chronic pain can be eliminated if it is treated correctly with multimodal approaches. Our curriculum encourages fellows to break out of the old way of thinking. Acute and chronic pain are essentially on a continuum.”

The advanced pain management fellowship urges preventative approaches to pain management prior to surgery, as well as multimodal approaches during surgery. “Not all anesthesia has to involve opioids. We can use a variety of techniques to disrupt pain signals from the periphery to the central nervous system. Ultrasound-guided regional anesthesia has revolutionized pain management in the perioperative setting. Opioids have many known detrimental effects to include respiratory depression and immune system modulation. As we move forward, decreasing the dependence on opioids for acute pain management will be critical,” Dr. Maye said.

In addition, “there is a strong link between inflammation and pain. Health care providers who attempt to prevent or diminish the release of inflammatory mediators will ultimately be reducing the severity and longevity of the pain experience.”

In May 2019, the third advanced pain management fellowship cohort completed the program. There were 28 fellows in this cohort; previous years had 27 (2018) and 20 (2017).

Upon completion of the fellowship, the graduates will have met the academic and cadaver course requirements to sit for the Non-Surgical Pain Management (NSPM) exam. To date, 41 CRNAs have successfully completed this examination. Of the 41 CRNAs, 15 are graduates from the USF pain fellowship. 

The 2019 class is already full. However, those who are interested in applying for the fellowship program should visit this site for instructions. Those interested in the Fall 2020 class are advised to begin the application process in January 2020.

According to Dr. Maye, CRNAs manage pain on a daily basis in the operating room. Traditionally, CRNAs manage acute pain in the perioperative setting. However, patients with chronic pain often present for surgical procedures that may or may not be related to their chronic pain condition. The surgical experience is complicated by the complexity of the chronic pain syndrome and the number of medications these patients are prescribed. Those managing pain should understand the physiology and pharmacology of the pain experience. Advanced pain training is critical for rural environments.

“In rural America, there is a lack of specialized health care providers, which limits access to care in a timely manner. In some regions, it may take two to three months to get an appointment with a specialist. The opioid epidemic has been particularly devastating to rural America,” Dr. Maye said. “When CRNAs are properly prepared in advanced pain fellowships, they will help fill and address a critical need. Improving access to care and providing options other than opioids will help diminish the impact of the opioid epidemic.”

Story by Lucia Raatma, USF College of Nursing