Management of Chronic Pain in Family Medicine Roles of Nursing, Anesthesia, Medical Coding, Radiology, and Intensive Care
DOI:
https://doi.org/10.22399/ijcesen.3975Keywords:
Chronic Pain Management, Family Medicine, Interprofessional Collaboration, Multidisciplinary Team, Biopsychosocial Model, Nursing RoleAbstract
Chronic pain management is a multifaceted challenge that requires a comprehensive approach in family medicine. Nursing plays a pivotal role by providing patient education, emotional support, and coordination of care among various healthcare providers. Nurses assess patients' pain levels, administer prescribed medications, and monitor for side effects, all while fostering an environment that encourages open communication about pain experiences. Furthermore, nurses are instrumental in integrating non-pharmacological therapies, such as physical therapy and mental health support, into pain management plans. Their direct interaction with patients allows them to identify barriers to effective pain management, making them advocates for patient-centered care. Anesthesia professionals contribute significantly to chronic pain management through interventional techniques, such as nerve blocks and epidural injections, which can provide relief for patients when conventional treatments fail. Medical coding specialists ensure that accurate documentation and billing occur for these complex procedures, ensuring healthcare providers receive proper reimbursement and facilitating access to necessary treatments for patients. Radiology plays a crucial diagnostic role by providing imaging studies that identify the underlying causes of pain, guiding treatment decisions and interventions. In more severe cases, where chronic pain overlaps with critical conditions, intensive care units may be involved to manage acute exacerbations of pain and underlying health problems. Together, these disciplines create an integrated network of care that emphasizes a holistic approach to managing chronic pain, ultimately improving patients' quality of life.
References
[1] Shahid A., et al. Study protocol: development and pilot testing of the critical care pain observation tool for families (CPOT-Fam) Pilot Feasibility Stud. 2022;8(1):147. doi: 10.1186/s40814-022-01102-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
[2] Puntillo K., Naidu R.K. Measurement of chronic pain and opioid use evaluation in community-based persons with serious illnesses. J. Palliat. Med. 2018;21(S2) doi: 10.1089/jpm.2017.0457. S-43. [DOI] [PMC free article] [PubMed] [Google Scholar]
[3] Smith H.A.B., et al. Society of critical care medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility,”. Pediatr. Crit. Care Med. 2022;23(2):e74–e110. doi: 10.1097/PCC.0000000000002873. 2022. [DOI] [PubMed] [Google Scholar]
[4] Haslam B.S., Butler D.S., Kim A.S., Carey L.M. Chronic pain following stroke: current treatment and perceived effect. Disabil Health J. 2021;14(1) doi: 10.1016/j.dhjo.2020.100971. [DOI] [PubMed] [Google Scholar]
[5] Anderson S.R., Gianola M., Perry J.M., Losin E.A.R. Clinician–patient racial/ethnic concordance influences racial/ethnic minority pain: evidence from simulated clinical interactions. Pain Med. 2020;21(11):3109–3125. doi: 10.1093/pm/pnaa258. [DOI] [PMC free article] [PubMed] [Google Scholar]
[6] Pun B.T., et al. Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults. Crit. Care Med. 2019;47(1):3. doi: 10.1097/CCM.0000000000003482. [DOI] [PMC free article] [PubMed] [Google Scholar]
[7] Oliviera C.B., et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur. Spine J. 2018;27:2791–2803. doi: 10.1007/s00586-018-5673-2. [DOI] [PubMed] [Google Scholar]
[8] Erden S., Demir N., Ugras G.A., Arslan U., Arslan S. Vital signs: valid indicators to assess pain in intensive care unit patients? An observational, descriptive study. Nurs. Health Sci. 2018;20(4):502–508. doi: 10.1111/nhs.12543. [DOI] [PubMed] [Google Scholar]
[9] Maxwell L.G., V Fraga M., Malavolta C.P. Assessment of pain in the newborn: an update. Clin. Perinatol. 2019;46(4):693–707. doi: 10.1016/j.clp.2019.08.005. [DOI] [PubMed] [Google Scholar]
[10] Haslam B.S., Butler D.S., Kim A.S., Carey L.M. Chronic pain following stroke: current treatment and perceived effect. Disabil Health J. 2021;14(1) doi: 10.1016/j.dhjo.2020.100971. [DOI] [PubMed] [Google Scholar]
[11] Cadoy R.M., Park J. 2018. Nurses Experiences in Postoperative Pain Management on Major Surgery. [Google Scholar]
[12] Bengtsson U., Kjellgren K., Hallberg I., Lundin M., Mäkitalo Å. Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system. Scand. J. Prim. Health Care. 2018;36(1):70–79. doi: 10.1080/02813432.2018.1426144. [DOI] [PMC free article] [PubMed] [Google Scholar]
[13] Blackwood D.H., Walker D., Mythen M.G., Taylor R.M., Vindrola‐Padros C. Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: a systematic review. J. Clin. Nurs. 2019;28(23–24):4276–4297. doi: 10.1111/jocn.15049. [DOI] [PubMed] [Google Scholar]
[14] Vuille M., Foerster M., Foucault E., Hugli O. Pain assessment by emergency nurses at triage in the emergency department: a qualitative study. J. Clin. Nurs. 2018;27(3–4):669–676. doi: 10.1111/jocn.13992. [DOI] [PubMed] [Google Scholar]
[15] Adeboye A., et al. Assessment of functional pain score by comparing to traditional pain scores. Cureus. 2021;13(8) doi: 10.7759/cureus.16847. [DOI] [PMC free article] [PubMed] [Google Scholar]
[16] Anderson S.R., Gianola M., Perry J.M., Losin E.A.R. Clinician–patient racial/ethnic concordance influences racial/ethnic minority pain: evidence from simulated clinical interactions. Pain Med. 2020;21(11):3109–3125. doi: 10.1093/pm/pnaa258. [DOI] [PMC free article] [PubMed] [Google Scholar]
[17] Shahid A., et al. Study protocol: development and pilot testing of the critical care pain observation tool for families (CPOT-Fam) Pilot Feasibility Stud. 2022;8(1):147. doi: 10.1186/s40814-022-01102-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
[18] Haslam B.S., Butler D.S., Kim A.S., Carey L.M. Chronic pain following stroke: current treatment and perceived effect. Disabil Health J. 2021;14(1) doi: 10.1016/j.dhjo.2020.100971. [DOI] [PubMed] [Google Scholar]
[19] O. I. A. R. D. O. F. PAIN . 2020. International Association for the Study of Pain. USA Washington DC [cit. 2022-02-04]. Dostupné z: [Google Scholar]
[20] Lewis J.S., et al. Global series: complex regional pain syndrome: abstracts from the International Association for the Study of Pain complex regional pain syndrome SIG virtual symposia 2021. Pain Rep. 2023;8(1):e1056. doi: 10.1097/PR9.0000000000001056. [DOI] [PMC free article] [PubMed] [Google Scholar]
[21] 2.Devlin J.W., et al. Executive summary: clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit. Care Med. 2018;46(9):1532–1548. doi: 10.1097/CCM.0000000000003259. [DOI] [PubMed] [Google Scholar]
[22] 3.I. A. R. D. O. F. PAIN . 2020. International Association for the Study of Pain.https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx USA Washington DC [cit. 2022-02-04]. Dostupné z: [Google Scholar]
[23] 4.Anderson S.R., Gianola M., Perry J.M., Losin E.A.R. Clinician–patient racial/ethnic concordance influences racial/ethnic minority pain: evidence from simulated clinical interactions. Pain Med. 2020;21(11):3109–3125. doi: 10.1093/pm/pnaa258. [DOI] [PMC free article] [PubMed] [Google Scholar]
[24] Custom Consumption Graphs for Opioid Medicines [Internet] Place unknown: University of Wisconsion; [date unknown; cited 2018 Oct 13]. Available from: https://ppsgchart.medicine.wisc.edu/ [Google Scholar]
[25] Viana MC, Lim CW, Garcia Pereira F, Aguilar-Gaxiola S, Alonso J, Bruffaerts R, et al. Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain: Findings from 19 Countries. J Pain. 2018;19:99–110. doi: 10.1016/j.jpain.2017.08.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
[26] Doehring A, Oertel BG, Sittl R, Lötsch J. Chronic opioid use is associated with increased DNA methylation correlating with increased clinical pain. Pain. 2013;154:15–23. doi: 10.1016/j.pain.2012.06.011. [DOI] [PubMed] [Google Scholar]
[27] Tumber PS. Optimizing perioperative analgesia for the complex pain patient: medical and interventional strategies. Can J Anaest. 2014;61:131–140. doi: 10.1007/s12630-013-0073-x. [DOI] [PubMed] [Google Scholar]
[28] Rosenthal BD, Suleiman LI, Kannan A, Edelstein AI, Hsu WK, Patel AA. Risk Factors for Prolonged Postoperative Opioid Use after Spine Surgery: A Review of Dispensation Trends From a State-run Prescription Monitoring Program. J Am Acad Orthop Surg. 2019;27:32–38. doi: 10.5435/JAAOS-D-17-00304. [DOI] [PubMed] [Google Scholar]
[29] Miclescu A, Butler S, Karlsten R. The Changing face of acute pain services. Scand J Pain. 2017;16:204–210. doi: 10.1016/j.sjpain.2017.04.072. [DOI] [PubMed] [Google Scholar]
[30] Rozen D, Grass GW. Perioperative and intraoperative pain and anesthetic care of the chronic pain and cancer pain patient receiving chronic opioid therapy. Pain Pract. 2005;5:18–32. doi: 10.1111/j.1533-2500.2005.05104.x. [DOI] [PubMed] [Google Scholar]
[31] King T, Ossipov MH, Vanderah TW, Porreca F, Lai J. Is paradoxical pain induced by sustained opioid exposure an underlying mechanism of opioid antinociceptive tolerance? Neurosignals. 2005;14:194–205. doi: 10.1159/000087658. [DOI] [PubMed] [Google Scholar]
[32] Nguyen LL, Sing DC, Bozic KJ. Preoperative reduction of opioid use before total joint arthroplasty. J Arthroplasty. 2016;31(9 Suppl):S282–S287. doi: 10.1016/j.arth.2016.01.068. [DOI] [PubMed] [Google Scholar]
[33] Tompkins DA, Campbell CM. Opioid-induced hyperalgesia: clinically relevant or extraneous research phenomenon? Curr Pain Headache Rep. 2011;15:129–136. doi: 10.1007/s11916-010-0171-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
[34] Dob?ehring A, Oertel BG, Sittl R, Lötsch J. Chronic opioid use is associated with increased DNA methylation correlating with increased clinical pain. Pain. 2013;154:15–23. doi: 10.1016/j.pain.2012.06.011. [DOI] [PubMed] [Google Scholar]
[35] Hina N, Fletcher D, Poindessous-Jazat F, Martinez V. Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery: An observational case-control study. Eur J Anaesthesiol. 2015;32:255–261. doi: 10.1097/EJA.0000000000000197. [DOI] [PubMed] [Google Scholar]
[36] Aasvang EK, Lunn TH, Hansen TB, Kristensen PW, Solgaard S, Kehlet H. Chronic pre-operative opioid use and acute pain after fast-track total knee arthroplasty. Acta Anaesthesiol Scand. 2016;60:529–536. doi: 10.1111/aas.12667. [DOI] [PubMed] [Google Scholar]
[37] Custom Consumption Graphs for Opioid Medicines [Internet] Place unknown: University of Wisconsion; [date unknown; cited 2018 Oct 13]. Available from: https://ppsgchart.medicine.wisc.edu/ [Google Scholar]
[38] Miclescu A. The switch from buprenorphine to tapentadol: is it worth? Rom J Anaesth Intensive Care. 2016;23:133–139. doi: 10.21454/rjaic.7518/232.bup. [DOI] [PMC free article] [PubMed] [Google Scholar]
[39] P. J., etc. Opioid prescription levels and postoperative outcomes in orthopedic surgery. Pain. 2017;158:2422–2430. doi: 10.1097/j.pain.0000000000001047. [DOI] [PubMed] [Google Scholar]
[40] Doehring A, et al. Chronic opioid use is associated with increased DNA methylation correlating with increased clinical pain. Pain. 2013;154:15–23. doi: 10.1016/j.pain.2012.06.011. [DOI] [PubMed] [Google Scholar]
[41] Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152:85–92. doi: 10.7326/0003-4819-152-2-201001190-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
[42] Hina N, Fletcher D, Poindessous-Jazat F, Martinez V. Hyperalgesia induced by low-dose opioid treatment before orthopaedic surgery: An observational case-control study. Eur J Anaesthesiol. 2015;32:255–261. doi: 10.1097/EJA.0000000000000197. [DOI] [PubMed] [Google Scholar]
[43] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287–333. doi: 10.1016/j.ejpain.2005.06.009. [DOI] [PubMed] [Google Scholar]
[44] Miclescu A, Butler S, Karlsten R. The Changing face of acute pain services. Scand J Pain. 2017;16:204–210. doi: 10.1016/j.sjpain.2017.04.072. [DOI] [PubMed] [Google Scholar]
[45] Prodduturi S, Sadrieh N, Wokovich AM, Doub WH, Westenberger BJ, Buhse L. Transdermal delivery of fentanyl from matrix and reservoir systems: effect of heat and compromised skin. J Pharm Sci. 2010;99:2357–2366. doi: 10.1002/jps.22004. [DOI] [PubMed] [Google Scholar]
[46] Peng PW, Tumber PS, Gourlay D. Review article: perioperative pain management of patients on methadone therapy. Can J Anaesth. 2005;52:513–523. doi: 10.1007/BF03016532. [DOI] [PubMed] [Google Scholar]
[47] Dowdy D.W., Eid M.P., Sedrakyan A. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005;31:611–620. doi: 10.1007/s00134-005-2592-6. [DOI] [PubMed] [Google Scholar]
[48] Zimmerman J.E., Kramer A.A., Knaus W.A. Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care. 2013;17:R81. doi: 10.1186/cc12695. [DOI] [PMC free article] [PubMed] [Google Scholar]
[49] Nolan J.P., Ferrando P., Soar J. Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation. Crit Care. 2016;20:219. doi: 10.1186/s13054-016-1390-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
[50] Wunsch H., Angus D.C., Harrison D.A. Variation in critical care services across North America and western Europe. Crit Care Med. 2008;36:2787–2793. doi: 10.1097/CCM.0b013e318186aec8. [DOI] [PubMed] [Google Scholar]
[51] Granja C., Teixeira-Pinto A., Costa-Pereira A. Quality of life after intensive care—evaluation with EQ-5D questionnaire. Intensive Care Med. 2002;28:898–907. doi: 10.1007/s00134-002-1345-z. [DOI] [PubMed] [Google Scholar]
[52] Grifith D.M., Salisbury L.G., Lee R.J., Lone N., Merriweather J.L., Walsh T.S. Determinants of health-related quality of life after ICU. Crit Care Med. 2018;46:1. doi: 10.1097/CCM.0000000000002952. [DOI] [PubMed] [Google Scholar]
[53] Granja C., Teixeira-Pinto A., Costa-Pereira A. (duplicate entry; removed)
[54] Cuthbertson B.H., Roughton S., Jenkinson D., Maclennan G., Vale L. Quality of life in the five years after intensive care: a cohort study. Crit Care. 2010;14:R6. doi: 10.1186/cc8848. [DOI] [PMC free article] [PubMed] [Google Scholar]
[55] Orwelius L., Fredrikson M., Kristenson M., Walther S., Sjöberg F. Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study. Crit Care. 2013;17:R236. doi: 10.1186/cc13059. [DOI] [PMC free article] [PubMed] [Google Scholar]
[56] Soliman I.W., de Lange D.W., Peelen L.M. Single-center large-cohort study into quality of life in Dutch intensive care unit subgroups, 1 year after admission, using EuroQoL EQ-6D-3L. J Crit Care. 2015;30:181–186. doi: 10.1016/j.jcrc.2014.09.009. [DOI] [PubMed] [Google Scholar]
[57] EurKaarlola A., Pettilä V., Kekki P. Quality of life six years after intensive care. Intensive Care Med. 2003;29:1294–1299. doi: 10.1007/s00134-003-1849-1. [DOI] [PubMed] [Google Scholar]
[58] Cunningham U, Ward M, De Brún A, McAuliffe E. Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis. BMC health services research. 2018;18(1):536. doi: 10.1186/s12913-018-3331-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
[59] Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev. 2013;(3):3. [DOI] [PMC free article] [PubMed]
[60] Ballangrud R, Hall-Lord M, Persenius M, Hedelin B. Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study. Intensive Crit Care Nurs. 2014;30:179–187. doi: 10.1016/j.iccn.2014.03.002. [DOI] [PubMed] [Google Scholar]
[61] Bank I. Snell L, Bhanji F. Pediatric crisis resource management training improves emergency medicine trainees' perceived ability to manage emergencies and ability to identify teamwork errors. Pediatr Emerg Care. 2014;30:879–883. doi: 10.1097/PEC.0000000000000302. [DOI] [PubMed] [Google Scholar]
[62] Budin WC, Gennaro S, O'Connor C, Contratti F. Sustainability of improvements in perinatal teamwork and safety climate. J Nurs Care Qual. 2014;29:363–370. doi: 10.1097/NCQ.0000000000000067. [DOI] [PubMed] [Google Scholar]
[63] Carbo AR, Tess AV, Roy C, Weingart SN. Developing a high-performance team training framework for internal medicine residents: the ABC'S of teamwork. J Patient Saf. 2011;7:72–76. doi: 10.1097/PTS.0b013e31820dbe02. [DOI] [PubMed] [Google Scholar]
[64] Catchpole KR, Dale TJ, Hirst DG, Smith JP, Giddings TA. A multicenter trial of aviation-style training for surgical teams. J Patient Saf. 2010;6:180–186. doi: 10.1097/PTS.0b013e3181f100ea. [DOI] [PubMed] [Google Scholar]
[65] Clay-Williams R, McIntosh CA, Kerridge R, Braithwaite J. Classroom and simulation team training: a randomized controlled trial. Int J Qual Health Care. 2013;25:314–321. doi: 10.1093/intqhc/mzt027. [DOI] [PubMed] [Google Scholar]
[66] Chowder? (Note: placeholder removed to avoid duplication)
[67] Cheng A, Eppich W, Grant V, Sherbino J, Zendejas B, Cook DA. Debriefing for technology-enhanced simulation: a systematic review and meta-analysis. Med Educ. 2014;48(7):657–666. doi: 10.1111/medu.12432. [DOI] [PubMed] [Google Scholar]
[68] Gordon M, Findley R. Educational interventions to improve handover in health care: a systematic review. Med Educ. 2011;45:1081–1089. doi: 10.1111/j.1365-2923.2011.04049.x. [DOI] [PubMed] [Google Scholar]
[69] McEwan D, Ruissen GR, Eys MA, Zumbo BD, Beauchamp MR. The effectiveness of teamwork training on teamwork behaviors and team performance: a systematic review and meta-analysis of controlled interventions. PloS one. 2017;12(1):e0169604. doi: 10.1371/journal.pone.0169604. [DOI] [PMC free article] [PubMed] [Google Scholar]
[70] Chanques G., et al. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales. Pain. 2010;151(3):711–721. doi: 10.1016/j.pain.2010.08.039. [DOI] [PubMed] [Google Scholar]
[71] Barros M.M.A., Luiz B.V.S., Mathias C.V. Pain as the fifth vital sign: nurse's practices and challenges in a neonatal intensive unit care. BrJP. 2019;2:232–236. [Google Scholar]
[72] Ballangrud R., Hall-Lord M., Persenius M., Hedelin B. Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study. Intensive Crit Care Nurs. 2014;30:179–187. doi: 10.1016/j.iccn.2014.03.002. [DOI] [PubMed] [Google Scholar]
[73] Polit D., Beck C. Lippincott Williams & Wilkins; 2020. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. [Google Scholar]
[74] Rose L., et al. Survey of assessment and management of pain for critically ill adults. Intensive Crit. Care Nurs. 2011;27(3):121–128. doi: 10.1016/j.iccn.2011.02.001. [DOI] [PubMed] [Google Scholar]
[75] Davis K.D., et al. Discovery and validation of biomarkers to aid the development of safe and effective pain therapeutics: challenges and opportunities. Nat. Rev. Neurol. 2020;16(7):381–400. doi: 10.1038/s41582-020-0362-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
[76] Agarwal S.K., et al. Clinical diagnosis of endometriosis: a call to action. Am. J. Obstet. Gynecol. 2019;220(4) doi: 10.1016/j.ajog.2018.12.039. [DOI] [PubMed] [Google Scholar]
[77] Larson C.M., Wilcox G.L., Fairbanks C.A. The study of pain in rats and mice. Comp. Med. 2019;69(6):555–570. doi: 10.30802/AALAS-CM-19-000062. [DOI] [PMC free article] [PubMed] [Google Scholar]
[78] Statistics I.S. IBM Corp,” Google Search; Armonk, NY: 2013. “IBM Corp. Released 2013. IBM SPSS Statistics for Windows. Version 22.0. [Google Scholar]
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 International Journal of Computational and Experimental Science and Engineering

This work is licensed under a Creative Commons Attribution 4.0 International License.