The role of nurses and allied health providers in chronic pain management

Nurses and allied health providers (eg occupational therapists, pharmacists, psychologists, physiotherapists) play a key role in managing patients with chronic pain. They are an important component of any multidisciplinary pain management team. Nurses and allied health providers, in any setting, can provide patient education, and assist with developing and monitoring individual management plans and management goals.

Some nurses and allied health providers are specialised in chronic pain management. These practitioners can be identified through professional networks (eg the National Pain Services Directory) or local pain services.

Nurses (ward-based and practice-based) play an important role in chronic pain management. Nurses can monitor pain using measurement tools (eg the PEG scale, Brief Pain Inventory), provide patient (and carer) education, initiate some nonpharmacological techniques, review analgesic efficacy and provide support to patients changing medications. They can identify psychosocial factors that may be aggravating the pain, provide basic psychological techniques (eg reassurance, active listening) and refer to other allied health professionals if necessary.

Psychologists help patients to understand how psychosocial factors (eg thoughts, feelings, behaviours, social environment) may impact pain, and support them to respond in constructive ways; see here for specific psychological management techniques.

Physiotherapists assess, diagnose and manage physical contributors to chronic pain. They provide individualised physical activity plans, manual therapies (eg passive mobilisation) and assist patients with physical activity goal setting. Consider referral to a specialist pain physiotherapist (credentialed though the Australian College of Physiotherapists) if significant improvements are not achieved with physiotherapy after 3 months.

Occupational therapists assess functional capacity and teach patients management strategies to maintain activity and function. This can involve teaching the patient skills, task simplification for everyday activities (eg chores, driving, shopping, showering, work tasks) and advice about suitable aids.

Pharmacists provide medication reviews to optimise drug regimens, cost-effective use of analgesics and reduce analgesic-related harm. Pharmacists provide accessible medication counselling to help patients better understand their pain management plan, and how to avoid or manage adverse effects and drug interactions. They play a key role in deprescribing analgesics, identifying medication nonadherence and aberrant behaviours, and can offer staged-supply and dose administration aid services.

Pharmacies accommodate safe return and disposal of unwanted medicines—this is an essential element of any deprescribing plan, and ensures the safety of household members.