Advanced Practice Providers Play A Pivotal Role in Pain Therapy

As part of Women’s Health Week, we spoke with three advanced practice providers to better understand the role of APPs: Ashley Comer, MSN, APRN, FNP-C; Zohra Hussaini, MSN, FNP-BC, MBA; and Brittney Misercola, MSN, APRN, FNP-C, CFRN.

The field of pain medicine is one in which nurse practitioners – coming to be more commonly known as advanced practice providers (APPs) – have come to play a more vital role in the last few years. As health care shifts and pain therapy treatment options continue to evolve, the role and required skill set of an APP have changed and become more integral to the overall pain treatment process.

“Advanced practice providers interface with patients throughout the pain therapy continuum,” said Brittney Misercola, MSN, APRN, FNP-C, CFRN, of Pain Specialists of Austin. “APPs work collaboratively alongside physicians to progress treatment plans, and they play a vital role in assessing patients, obtaining comprehensive medical histories and pertinent physical exams to identify appropriate candidates for various pain treatments.”

Misercola also noted that because of their interactions with patients throughout the pain continuum, APPs are uniquely positioned to educate patients and caregivers on interventional pain strategies which can significantly improve their quality of life.

University of Kansas Health System’s Zohra Hussaini, MSN, FNP-BC, MBA, added that an APP’s role is centered around improving patient outcomes and access to care, while collaborating with a practice’s interventional pain physicians. “It’s a collaborative effort to manage these chronic pain patients with a shared goal of improving function while reducing pain,” she said. “We play a strong role in assessing and managing these patients and identifying a targeted treatment plan. In doing so, we help our collaborative physicians focus on optimizing the procedures and surgical treatments necessary to help the patients reach their goals.”

Hussaini takes it one step further to explain that she then engages her patient in the plan saying, “Here are some of the things I can do to help you, and here is what I will need you to do for yourself.”

Additionally, the actual day-to-day responsibilities of an APP can vary. According to Ashley Comer, MSN, APRN, FNP-C, of the Spine and Nerve Center of the Virginias, an APP could be responsible for the clinical side of a practice, as well as be utilized within both the office and surgical setting.

“APPs are members of the healthcare team that often times manage the clinical side of the practice with patient evaluation, selection, education, management, procedures follow ups, post-op visits, lab or imaging review, and more,” she said. “APPs managing the clinical side of patient care allows the physician to have more availability to perform procedures, thus creating the opportunity to improve the lives of more patients. When utilized in both the office and surgical setting, this allows the APPs to follow the patient and maintain continuity.”

Comer also said that an APP’s diverse scope of duties has led to a recent increase in the recognition of the role of APPs as well as a keener awareness for the need of APPs to be highly educated in the new pain therapies and technologies alongside physicians.

“As advancements in the field of pain management continue, it is important to recognize that it is often the APP, rather than the physician, who first sees a patient in the office,” Comer said. “APPs can become even more effective in their practice when they are made aware of new therapies and technologies that are available. If the APP is unaware of the availability and success of a treatment, then many patients may miss out.”

“Pain is a symptom that will always drive an individual to seek medical attention; however, pain management is a very specialized area of healthcare that is often not well taught or understood during our general schooling,” Hussaini explained. “The lack of knowledge and training has led to a crisis and critical behaviors, for example, around opioid use. It is important that we get the proper training, so we can formulate an effective treatment plan and educate our patients appropriately to help them understand the treatment plan. APPs play a crucial role as we generally have more time to spend doing exactly that [educating].”

But training goes beyond just learning about the new modalities of interventional treatment or pharmacologic treatment says Hussaini. “Yes, APPs need to be competent and informed of all the latest advancement of the technologies and pain modalities that are available, but it’s also important to understand the full spectrum of pain and how it affects patients not just physically but also mentally. We need to focus on the person as a whole, rather than just the physical ailment.”

Fortunately, as the need for APPs to be more diversely educated within pain medicine increases, Misercola said many national organizations have begun including APPs on various committees and focusing education efforts specifically on APPs. For example, Comer shared that the American Society of Pain and Neuroscience (ASPN) is developing a mentoring program for APPs and physicians that will not only aid in furthering networking and learning efforts but also help to “improve diversity and empower women and underrepresented groups.”

And Comer brings up an important point.

Over the last few years, the role of both APPs and women in pain medicine in general, have become more recognized for their contributions to helping patients who suffer from chronic pain. Comer, Hussaini and Misercola all agreed that for female APPs, the future is extremely bright. Various efforts are being made for female APPs – and APPs in general.

“[We] are gaining and recognizing more female physicians and APPs in pain medicine,” Comer said. “This allows more access to discuss best practices, guidelines, and personal experiences so that the field can continue to improve.”

Hussaini said there have been more diversity inclusion efforts, noting as an example that at national conferences, diversity committees are being formed to help bring the women and people of diverse backgrounds to the forefront. “More female speakers, presenters, and leaders in our field are being recognized and invited,” she said.

The field of pain medicine is rapidly evolving, and APPs are a key part of the changes currently happening, and to come, for long-term improvements in treating pain patients.