May 22, 2024


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Pain Management Education for APRNs Is Still Lacking


Many early career advanced practice register nurses (APRNs) report low confidence and competence in managing chronic and acute pain, according to research presented at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).

“These initial findings call for a transformation within APRN education and training with regard to pain management,” lead study author Theresa Mallick-Searle, NP, and colleagues noted.

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The need for increased pain management education for physicians has been well documented in the medical literature, and organizations such as the Institute of Medicine and the National Pain Strategy have made calls for better pain management training for all health care clinicians.

However, data on the needs of APRNs regarding pain management education is lacking. Data from the 2020 AANP Member Educational Needs assessment survey show that 1 in 5 of the more than 6000 respondents felt that pain management was an area in which they would like additional continuing education. Pain management also ranked eighth on a list of areas in which NPs requested additional resources.

To assess the current state of pain education for APRNs, the researchers conducted a nationwide survey of APRNs. The 10-question survey was available online and utilized numerous databases to generate as diverse a respondent pool as possible.

In total, 276 APRNs responded to the pilot survey, and were representative of 45 US states and Washington, DC, Canada, and the Netherlands; a “fair representation” of the US was achieved from 4 US regions, the study authors noted. A majority of respondents — 71{13aab5633489a05526ae1065595c074aeca3e93df6390063fabaebff206207ec} — had been in practice for 5 years or more.

Most APRNs Receive Less Than 5 Hours of Pain Education

Overall, 69{13aab5633489a05526ae1065595c074aeca3e93df6390063fabaebff206207ec} of APRNs reported receiving less than 5 hours of pain management education during primary training; 24{13aab5633489a05526ae1065595c074aeca3e93df6390063fabaebff206207ec} reported receiving 5 to 10 hours of pain education, 5{13aab5633489a05526ae1065595c074aeca3e93df6390063fabaebff206207ec} received more than 10 hours, and 2{13aab5633489a05526ae1065595c074aeca3e93df6390063fabaebff206207ec} did not recall or did not respond to this question. Most reported that on the job training served as their primary mode of pain management education followed by self-directed continuing education activities.

Fifty-two percent of respondents (n=144) reported spending at least 50{13aab5633489a05526ae1065595c074aeca3e93df6390063fabaebff206207ec} of their time managing pain in daily practice. Of those respondents, 78 worked in either pain management or palliative care specialty, while the remaining worked in family or internal medicine, among other specialties.

Respondents who reported primary care, internal medicine, or surgery as their specialty collectively reported spending less time on pain management practices compared with APRNs in other specialties.

When asked about their level of preparation for caring for patients with basic chronic or acute pain management needs, 67{13aab5633489a05526ae1065595c074aeca3e93df6390063fabaebff206207ec} of participants felt neutral to unprepared to do so during their first year of clinical practice (Figure).

These results are indicative of “low confidence and perceived competence in providing pain management across acute and chronic pain settings,” the researchers noted. Most clinicians reported receiving either less than 5 hours of pain education or could not recall any focused pain education during their advanced practice training.

“This is a first attempt to look at the educational need for pain management at a national level, from the perspective of perceived readiness to practice… [in] both the novice and more experienced clinician,” the researchers wrote. “For those who focus their careers in pain management as a specialty, a system for certification would help to facilitate a metric of quality control and further delineation of competency in practice.”

Visit Clinical Advisor’s meetings section for complete coverage of AANP 2021. All conference sessions are available to registered attendees through August 31, 2021.


Mallick-Searle T, Jackson H, O’Brien S. Educating advance practice providers in pain management: a needs assessment. Poster presented at: 2021 American Association of Nurse Practitioners National Conference; June 15-20, 2021. Poster 53.