Monday, March 11, 2013

Barbara St. Marie’s study subject had a history of heroin abuse and broke his neck in a motor vehicle accident. During his lengthy rehabilitation, his medical team treated his acute pain perfectly. He was discharged from the hospital with a handful of oxycodone to help manage his pain.

It didn’t take long before he was out of the prescription pills and screaming in pain. He called his buddy, because he knew his buddy could get him what he needed.

“In so many ways, we have failed people with the disease of addiction when they have acute or chronic pain,” says St. Marie, a postdoctoral research fellow at the University of Iowa’s College of Nursing.

Dr. St. Marie, with three decades of experience as a nurse practitioner, is researching the phenomenon of addiction and pain in order to develop and test interventions for people with acute and chronic pain who are addicted to illegal narcotics or prescription pain medication.  She believes the medical and nursing community must redesign how they provide pain management for patients who are at risk for prescription drug abuse.

A big step, St. Marie says, is making sure that patients have good communication with their primary care provider.

“It is necessary to promote the therapeutic relationship the patient has with their primary care doctor, nurse practitioner or physician’s assistant,” says St. Marie.  “The prescriber must use protocols when prescribing opioids for pain and create a taper schedule to get the patient off the opioids eventually. The patient also must work with physical therapy, occupational therapy, cognitive behavioral therapy, and psychology professionals.”

St. Marie encourages health care providers to work as a team in meeting the challenging needs of those with the disease of addiction and pain.

Opioids certainly aren’t the only answer for pain relief, and these pills can be more of a problem than a help. Health care providers who prescribe opioids need to be aware of their patients’ potential for relapse and create a safe plan for patients who have opioids for pain stored in their homes.

“If you give me a handful of narcotics, I’m going to take them. I’m an addict after all,” another study participant told St. Marie.

Patient privacy is of the utmost importance, but it also makes a health care provider’s job difficult and this is how:Patients may not share their history of drug addiction with their provider, because they don’t consider it important or want to avoid stigmatization.  When important information is withheld from the prescriber, the patient’s safety may be jeopardized and they may not get the proper care for their pain. Prescription monitoring programs exist in some states, and these can be helpful in tracking where patients are getting their prescription opioids. But these programs also may fail to tell the entire story.

“I feel like we can easily exchange the suffering of pain for the suffering of addiction in some of our patients with pain,” St. Marie says.

The University of Iowa experience

St. Marie is mentored by Professor Keela Herr, a well-respected member of the pain treatment community.

“I was aware of Dr. Herr’s nationwide projects involving non-verbal communication of pain and pain management in people with dementia and Alzheimer’s as well as her work in educating the health care team about pain management,” St. Marie says.  “I knew I wanted to study with her.  She was really a draw for me to come to the University of Iowa.”

While she lives and has a part-time clinical practice in the Minneapolis area, St. Marie spends three days on the UI campus every other week and completes other aspects of her postdoctoral study in her home community.  Her current research project involves recruiting people who have chronic pain and received opioids from a primary care center and tracing their experiences.

Herr, co-director of the John A. Hartford Center for Geriatric Nursing Excellence, meets regularly with Dr. St. Marie to discuss her research project and training experiences.

“Barb is an independent postdoc who came here with a pretty good skill set in the area of writing,” Herr says. “She sought training in developing her research skills. We’ve worked together on grant development to get funding for the research she wants to do. Her coursework and training is focused on developing those skills.” 

St. Marie, who received her Ph.D. from the University of Wisconsin-Milwaukee in 2012, is looking forward to continuing her work with Herr on the project.

“My research is a qualitative design for the purpose of laying a foundation of experiences from the patient’s perspective,” says St. Marie, who will complete her two-year postdoctoral appointment in July 2014. “During my postdoc time period, I will develop skills in quantitative methods to support a mixed method approach to my research.  Dr. Herr is expert at that and has helped me think about what is next.

“When I came here, I wanted to develop an area of research on pain and addiction, and the fellowship is helping me know how to do that.”