Navigating Chronic Pain: A PAs Approach to Personalized Care

Navigating Chronic Pain: A PAs Approach to Personalized Care   

Christa Nelson, MPAS, PA-C 

Chronic pain varies significantly from person to person, making it essential to understand each patient’s unique experience.  

As a PA specializing in chronic pain management, I take the time to sit down with patients and listen to their stories. 

Because pain isn’t something we can see during an exam, I rely on the patient’s description to understand how pain affects their life, what motivates them to seek change and what their goals are.  

For example, some patients want to return to work, while others may want to resume hobbies like gardening or golfing. Others might be focused on staying active with their children or grandchildren. Understanding these personal factors helps me develop a personalized treatment plan, as each patient’s goals and motivations can differ.  

While modern medicine offers advanced imaging and tests to identify the source of pain, these are just tools that must align with the patient’s reported pain. Treatment options for chronic pain range from conservative measures like physical therapy and massage to medication management and more invasive procedures like spinal cord stimulators or intrathecal pain pumps. I work closely with my patients to discuss all available options and together we decide on the best course based on their goals, preferences and comfort level with different treatments. 

Managing Stress and Maintaining a Positive Outlook   

Managing stress and maintaining a positive outlook are crucial. I start by having an open and honest conversation with patients about their goals and setting realistic expectations.  

My goal is to reduce their pain levels, but the expectation isn’t always to become completely pain-free. Once pain becomes chronic, there often isn’t a “fix,” but rather a focus on managing the pain.  

I encourage patients to find a good support system through family, friends, support groups or mental health providers. I also help patients focus on what they can do functionally. Sometimes, even if their pain level hasn’t decreased on a 1-10 scale, they may be able to walk further distances or do their own grocery shopping, which are significant wins.  

Effective Non-Invasive Therapies   

In managing chronic pain, I often recommend non-invasive therapies such as physical therapy, chiropractic care and massage therapy.  

I strongly encourage patients to participate in physical therapy and establish a home exercise and stretching routine. Although it can be challenging for those with chronic pain to stay active, it’s important to do what is within their limits to prevent muscle weakness and further decline.  

Chronic pain can take a toll on a patient’s mental health, so I advise them to see a mental health provider, especially one who specializes in chronic pain. Many patients with chronic pain also struggle with depression or anxiety and addressing these mental health issues can significantly improve their quality of life.  

Some clinics may offer a range of interventional options, including injections, nerve blocks, radiofrequency ablations, peripheral nerve stimulation, spinal cord stimulation and intrathecal pain pumps.  

My role as a PA includes performing some in-clinic injections and identifying patients who may benefit from more advanced procedures with our anesthesiologists. One of the most common procedures we perform is lumbar medial branch blocks and radiofrequency ablation, which treat chronic low back pain related to degenerative changes and arthritis in the lumbar facet joints. This is a great option for patients who aren’t candidates for or don’t want lumbar spinal surgery, with relief lasting from 6 months to a year. 

Advancements in Chronic Pain Management   

One of the most exciting advancements in chronic pain management is the development of peripheral nerve stimulation and spinal cord stimulation. Several companies are working on these technologies, finding new indications and achieving success. While permanent spinal cord stimulation has been around for a while and is effective for conditions like failed back surgery syndrome and complex regional pain syndrome (CRPS), peripheral nerve stimulation is relatively new.  

A temporary peripheral nerve stimulator worn for 60 days has also been shown to have lasting results for 6 months to a year. This is an excellent option for patients who are at high risk for permanent spinal cord stimulation due to anticoagulation status or other comorbidities. 

Balancing Pain Management with Opioid Prescribing   

The opioid crisis has raised concerns about pain medication use, making it essential to balance effective pain management with responsible opioid prescribing practices. Current research generally doesn’t support long-term opioid use for chronic pain, as patients can develop tolerance and dependence.  

High doses of opioids may also increase the risk of side effects and may even worsen pain due to opioid-induced hyperalgesia.  

Many pain clinics have a policy of not prescribing opioids for chronic pain unless we are helping a patient taper off them. However, there are exceptions where long-term opioid use may be appropriate for a given patient. If considering this, it’s important to carefully weigh all risks and benefits and have an open discussion with the patient. It may be helpful to develop a pain management agreement that outlines how opioids should be used, who will prescribe them, which pharmacy will fill the prescriptions and any conditions that may lead to termination of the opioid prescription. This agreement should foster a more open conversation and trust between the patient and provider. Additionally, all patients with opioid prescriptions should receive a prescription for naloxone and both patients and their families need to be instructed on how and when to use it. 

Ultimately, I communicate with my patients and discuss all options that may be available for their specific concerns. Together, we can make a decision based on their goals, preferences and comfortability with different treatments.