Pain Specialists Pen Guidebook for Rural Clinics

Two USF nurse anesthesia doctoral students have partnered to pioneer pain management efforts in rural America — beginning in their backyard. Their key?

Collaboration.

Minnesota pain specialists Bryan Hunter and Matthew Stokes, recent graduates of the College of Nursing’s Simulation-Based Academic Fellowship in Advanced Pain Management, alongside their academic advisor and pain management education coordinator John Maye, PhD, have penned The Pain Management Clinic: The Nurse Anesthetist’s Guidebook for Success.

The handbook aims to aid those opening pain management clinics, with an emphasis on starting treatment centers in rural communities similar to Hunter’s and Stokes’ home base of Moose Lake, MN, where the pair work alongside each other at Mercy Hospital.

“We’ll get phone calls from colleagues across our region who have been approached about starting pain services, but they don’t know where to start,” Hunter said.

In their guidebook, the duo lays out the path to setting up pain clinics based on partnerships, because collaborative care is the most effective defense against opioid addiction, they said.

“Other CRNAs and providers, as they’re setting up their pain clinics, they’re not just thinking about, ‘OK, we can do this injection, we can prescribe this medication,’ but also, ‘We can send this person to dietary, we can send this person to physical therapy, we can send them to alternative therapies,’ to really focus on how to treat pain overall,” Stokes said.

Overdoses killed more than 70,000 Americans in 2017, a record, according to the New York Times, as synthetic opioids like fentanyl have been on the rise. The opioid crisis has been hardest hit in rural areas.

Stokes said he believes the epidemic began due to a lack of interprofessional crossover, and prescribing medication to mask the pain became the “easy” route.

“We knew that there was a need for this, but as we started to speak to other nurse anesthetists, we really began to realize it really is a significant need,” he added. “Hopefully it will benefit a lot of people.”

Pain management clinics are also fighting the obesity epidemic. Hunter says making major physical and mental lifestyle changes is an important way to combat chronic pain.

After completing the fellowship, the pair continued their graduate studies at USF and will graduate with a Doctor of Nursing Practice in Nurse Anesthesia later this month. USF’s advanced pain management fellowship is one of five accredited fellowship programs for nurse anesthetists in the United States.

The fellows have seen success with their pain management practice as well as the guidebook.

Hunter and Stokes have presented their guide at national conferences and promoted its use to the American Association of Nurse Anesthetists (AANA) and at academic institutions. It is currently on sale through online retailers.

Ultimately, the accomplishment is being most felt at the pair’s professional home in Moose Lake, where the population is estimated at 2,832.

“I think we’ve increased our pain procedures by 30 percent in just 12 months,” Hunter said. “Revenue-wise, our hospital administration is extremely happy because pain services are very profitable. My last meeting with our CEO, he basically said our department was one of our highlights of the year in a year that was fiscally tough.”

Story by Alex Hooper, USF College of Nursing