Pain-Management Challenges in Rural Communities Impacted By Multi-Drug Overdoses

Purpose: The purpose of this study is to identify themes that describe pain management challenges experienced by nurses in a rural Appalachian area of the United States (US) that has been negatively impacted by opioid overdoses. Internationally pain management interventions by nurses includes pain assessment, teaching about pharmacological and non-pharmacological modalities, and the evaluation of treatment effectiveness (Doorenbos, Jansen, Oakes & Wilson, 2013). However, pre-licensure nursing and continuing education curricula do not contain content on how to effectively manage pain in people who concurrently are living with substance abuse or addiction to alcohol or drugs (Hamilton & Watson, 2014). Rural communities in the Appalachian area of the United States have been experiencing an epidemic of accidental overdoses of opioids (Campbell, Boyer, Rovnyak & Campbell, 2012, Fetzer, 2015). Health care providers across settings of care such as the emergency department, medical-surgical acute care unit, or in labor and delivery encounter people who not only have a current or past history of substance abuse, but may also be experiencing pain. Yet we have few studies that describe the challenges that nurses practicing in communities impacted by the health care crisis of accidental overdoses are facing in pain management their practice, and therefore the literature lacks the evidence base to guide nursing practice during this epidemic.

Methods: A secondary data analysis of findings from a study of pain management learning needs Campbell, Boyer, Rovnyak, & Campbell, 2012) was conducted to identify themes that describe pain management challenges experienced by nurses in rural Appalachia. In the original study 2,136 surveys were mailed to registered nurses in seven counties in rural Appalachia and 295 surveys were returned, for a 13.8% return rate. Respondents were 98% Caucasian, 47%.1 had a BSN or higher degree, 52.9% ADN/Diploma. We received sixty-one different narrative responses to two open-ended questions on the survey completed by the participants in the primary study. They were asked to identify additional learning needs and to tell a narrative about challenges related to pain management from their clinical practice.

Thematic analysis was used to analyze the narrative responses in data.

Results:  In the original study 2,136 surveys were mailed to registered nurses in seven counties in rural Appalachia and 295 surveys were returned, for a 13.8% return rate. Respondents were 98% Caucasian, 47%.1 had a BSN or higher degree, 52.9% ADN/Diploma. We received sixty-one different narrative responses to two open-ended questions on the survey completed by the participants in the primary study.

Data analysis revealed three themes related to additional learning needs: pain management of people with addictions (including babies born with neonatal alcohol syndrome), pain management in people with chronic pain (back pain, neuropathy, and arthritis), and alternative and complementary therapies for pain management. Four major themes from the narratives about pain management challenges were identified: managing pain in people with current or past history of abuse to opioids and alcohol; managing pain in people with history of anxiety, depression and schizophrenia, poor nurse-physician collaboration, and pain management at end of life.

Conclusion:

Implications for nursing education for pre-licensure students and continuing education for licensed nurses will include collaborating with expert nursing colleagues in psychiatric-mental health nursing to develop educational sessions education with topics such as pain management in people who have history of substance abuse and other mental health issues. Palliative care providers can consult with clinical partners on effective treatments to manage chronic pain. Future research should also include studies to explore how interprofessional collaboration in may improve pain management outcomes.