Management of Chronic Musculoskeletal Pain in an Urban Nurse-managed Clinic: A Quantitative Study

Abstract

The diagnosis of chronic musculoskeletal pain that is not malignant in origin presents many well documented challenges for the health care practitioner. This study examined this topic using a retrospective chart review to determine the management of chronic pain by nurse practitioners in a nurse managed academic health center in the Midwest. The practice setting was unique in that all patients were designated as underserved at 150% of poverty or less. This population similarly challenged the nurse practitioner providers and prompted this study to assess their current management of this common problem. <p>Five hypotheses were developed from the general research question: minorities would be prescribed fewer narcotics than Caucasians; patients on anti-depressants would receive more narcotic prescriptions than those who are not prescribed anti-depressants; there would be an increase in narcotic prescribing with concomitant substance use. (alcohol, tobacco or illicit drugs); women would be prescribed more narcotics than men; and patients over the age of forty years would receive more prescriptions for non-narcotics than patients less than forty years of age. <p>Data from a convenience sample of 50 charts of patients seen from July 1, 2007 to July 31, 2008, who had a diagnosis of chronic musculoskeletal pain for greater than 3 months, was collected. 367 visits were entered into the study using an adapted data collection tool that was used with permission. The data was entered into SPSS and the results analyzed. <p>This paper presents the complete findings of the study. It revealed that equal treatment was given to all races in terms of narcotic prescribing habits of the nurse practitioners. This was interesting in that it contrasted with the current literature review that reflected disparities in this aspect of treatment of chronic pain based upon race. A second significant finding revealed an increase in number of narcotic prescriptions given to treat chronic pain in the group of patients who also smoked cigarettes. All other hypotheses were not significant. The full results of the study along with discussion of the results are presented in the study. <p>Implications for nursing practice include: a need for providers to have a better understanding of all of the variables involved in treatment of this challenging condition. One possible explanation of the study finding of equal narcotic prescribing to chronic pain patients regardless of race may have been the result of this clinic’s mandated cultural diversity training. Other primary care practices may want to consider cultural diversity training as a possible method of improving treatment of chronic musculoskeletal pain. However, further research is indicated in this area. <p>The relationship found in this study of tobacco use and increased narcotic prescriptions could be used by the nursing community as further impetus to educate, support and encourage the cessation of tobacco use, both to assist in healthier life styles and to potentially improve the management of chronic musculoskeletal pain.