Irish Pain Nurses Midwives Society
Website: www.IPNMS.ie
7th April 2014
Opening Statement to the Joint Committee on Health and Children for the Meeting to be
held on the 10th April 2014 in Committee Room 2.
The Irish Health Service is reforming with a focus on preventative medicine, a drive for
improvements in primary care and initiatives to prevent disability caused by long term conditions as
outlined in the Clinical Strategy and Programmes by the HSE in which chronic pain is noted by its
absence. The objectives of these programmes are to improve the quality of care, access and cost
effectiveness.
The Irish Pain Nurses and Midwives Society (IPNMS) is a specialised professional organisation of
practicing Nurses, Midwives, Clinical Scientists and others. The IPNMS is committed to promoting
the understanding, diagnosis, treatment and prevention of pain by supporting activities such as
professional practice, education, research, advocacy and networking. It seeks to provide a collective
voice in order to increase knowledge of pain and transform public policy and professional clinical
practice to reduce chronic pain and suffering.
Our membership includes Nurses and Midwives who have acquired Masters Degree and Doctorate
level of education in pain management and many Registered Nurse/Midwife Prescribers.
Approximately twenty of our membership are employed in the HSE as Clinical Nurse Specialist
(CNS) and one as an Advanced Nurse Practitioner (ANP) and interestingly none are employed in
primary care as ANP’s in Pain Management. Presently in primary care there are 2 ANP’s employed
in GP setting and one as a Public Health Nurse (PHN). Appendix 1 outlines the pain management
services in Ireland.
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Irish Pain Nurses Midwives Society
Website: www.IPNMS.ie
The CNS and Clinical Midwife Specialist (CMS) /and the ANP/ Advanced Midwife Practitioner
(AMP) in pain are at the forefront of their profession having attained a level of expertise as well as
formal education to enable them to deliver a service to patients that is cost effective, evidence
based and improves patient outcomes (SCAPE report National Council Nursing Midwifery 2010).
The HSE’S national chronic disease prevention and management programme emphasises the
importance of clear roles and opportunities for CNS’s and ANP’S (HSE 2006b). The DOH Strategic
Framework for Role Expansion for Nurses and Midwives (2011) is committed to developing a health
service based on need. We know that chronic pain affects 13% of Irish residents (Brevik et al.
2006). Ireland is embracing the importance of providing timely chronic disease management,
promoting wellness and reorienting the acute care system to a more community based focus. This
Strategic Framework for Role Expansion document promotes the enhancement of nursing and
midwifery roles within a structured strategic framework to support the healthcare agenda. Our health
system is striving to provide patients with fully integrated healthcare that is easy to access and
externally benchmarked.
Australia National Pain Strategy (2011) made pain a national health priority to improve the
community understanding of the nature of chronic pain and its management. Chronic pain in
Australia costs $34 billion per annum and affects 1 in 5 people. Pain needs to be treated in the
same framework as other chronic diseases allowing its integration into disease classification
systems. Pain services require funding to ease the burden and disability caused by chronic pain
which is estimated to cost €5 billion in Ireland (Raftery et al 2012).
Patients/service users need greater accessibility to pain services, support and knowledge as many
wait up to a year or more to access a pain service. This is particularly problematic if outside the
catchment area of a pain service. Many areas of the country do not have a pain service or care
pathway to a service. There are minimal supports available while waiting for assessment and
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Irish Pain Nurses Midwives Society
Website: www.IPNMS.ie
treatment, so disability spirals out of control. We need an integrated approach to improve care for
patients with all types of pain with access to a multidisciplinary team.
The role of the ANP/AMP promotes wellness, offers interventions and advocate healthy lifestyle for
patients/clients, families and carers in various settings in collaboration with other healthcare
professionals according to agreed scope of practice guidelines. (SCAPE 2010). The ANP/AMP is
autonomous, experienced practitioners, competent, accountable and responsible for their own
practice, registered as prescribers and educated to Master’s degree level (or higher) and are
required to initiate and coordinate nursing/midwifery audit, research and training. The ANP/AMP role
will contribute to quality patient care, health policy development, implementation and evaluation. The
SCAPE study (2010) points towards positive outcomes for service users in relation to ANP/AMP,
delivering direct care through physical and psychosocial interventions, with early diagnosis, holistic
assessment, appropriate referral to other clinicians and responsible for increased collaboration and
improved communication within the multidisciplinary team.Developing more ANP/AMP roles will be
essential when developing a national pain strategy.
The role of the CNS is underpinned by a number of core competencies which demonstrates the
contribution the CNS can make to the development, rollout and expansion of pain services under a
National Strategy for Pain. The CNS maintains clinical expertise through ongoing clinical practice.
The management of the patient’s acute postoperative and chronic pain is a key clinical practice
issue. Effective pain assessment and pain management interventions in the postoperative period
improves pain control and facilitates earlier discharge home which has financial and economic
implications for the patient and the service provider. The CNS considers the appropriateness of
medication regime as well as direct patient care involving the patient and their families and also the
planning and delivery of care that may be complex. The CNS/CMS has a major role as an advocate
by understands issues faced by patients and their families with skills in effective communication
and counselling to empower the patient in pain and advocates for the patient in pain whose voice
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Irish Pain Nurses Midwives Society
Website: www.IPNMS.ie
may often not be heard. The CNS/CMS educate patients, families and healthcare professionals.
There is a need to make education regarding pain management compulsory for undergraduate
programmes for all healthcare professionals. The CNS can and does contribute to the area of
research and can improve service provision through the development of a National Strategy for pain.
The CNS can spearhead research into chronic pain to inform evidence based practice and
contribute to the development of clinical standards and guidelines and policymaking which further
helps towards more efficient interventions e.g. improvements happening in acute pain, patients
discharged home quicker. The CNS provides a consultant role to primary teams, allied healthcare
professionals, registered nurses /midwives, students and support staff. Best practice for pain
management suggests a coordinated interdisciplinary approach involving physical, psychological
and environmental risk factors for each patient (Australia 2011).
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Irish Pain Nurses Midwives Society
Website: www.IPNMS.ie
The IPNMS have the following key suggestions for you as a member of the Joint Health
Committee in relation to a national pain strategy

Pain is a disease in its own right, focus must shift to prevention particularly preventing the
development of chronic pain and disability as a consequence.

Establishment of a task force involving all the stakeholder groups to identify partnership
frameworks and resources required to achieve the desired outcome of a National Pain
Strategy.

Develop care pathways and standardise documentation.This electronically integrated to allow
information sharing among Health Care Professionals.

Develop a pain management network (e.g. Hub and Spoke Model) to improve the quality of
care, access and cost effectiveness. With strong links from acute and primary care with an
emphasis on identifying patients at risk of progressing from acute to chronic pain. We do not
need to reinvent the wheel but draw on the excellent resources and expertise that is available
nationally and internationally for example Professor Peter O Sullivan, a Professor at the
school of physiotherapy in Perth is speaking and demonstrating his area of expertise in
assessing and managing patients with low back pain at a conference in the University of
Limerick on Wednesday April 9th 2014.

The need to drive education through primary care and preventative medicine. There is a need
to make education regarding pain management compulsory for undergraduate programmes.
Our Vision is for well informed, educated public, patient and health professionals and change
attitude to pain and pain medications through engaging with the public. Dr Foster report (UK)
has developed links to primary care which offers advice on a range of pain services and
development of educational sessions for practice nurses and GP’s from members of chronic
pain teams. Satellite clinics established in GP practices as well as pain nurses holding
consultation sessions in GP practices and health centres to deal with GP referrals would be
helpful..
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Irish Pain Nurses Midwives Society
Website: www.IPNMS.ie

CNS/ANP can offer savings as highly educated, resourceful, less costly than NCHD and can
manage a caseload of patients. (SCAPE NCNM 2010).

Develop an integrated approach to improve care for all types of pain and address the issues
facing patients with chronic pain which include:
1. Condition not recognised as a disease in its own right
2. Unacceptable waiting times to access specialist services
3. The need for prevention, awareness and early intervention when appropriate
4. The need to improve management of acute pain in order to prevent the development
chronic pain
5. The development of disability, dysfunction, physical deconditioning, depression and
anxiety as well as loss of employment and social isolation.
We look forward to the opportunity to sit at the table and play a significant role in the devising of a
strategy that will help the patients we treat and care for in the most evidence based, resourceful
manner available and hope you will support this issue for the benefits of not only pain patients, their
families but the wider public in general.
Thank you.
Yours sincerely,
Cathy Sexton
President.
Irish Pain Nurse Midwife Society (IPNMS)
Tel no 086-1986721
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