Virginia nurse revolutionizes pain treatment
NEWPORT NEWS, Va - “She has changed the way we think about pain.”
Hospice practitioners, physicians, compounding pharmacists, nurses and medical students all attest to the influence of Maureen Carling in their approach to pain management.
An English-born nurse and hospice worker, Carling, 73, worked at Riverside Regional Medical Center in Newport News, Va., in the 1990s before “retiring” in Williamsburg, Va. In retirement she developed the “Carling Pain Assessment Algorithm,” developed tapes and CDs and conducted workshops around the country on pain management.
This year, the Virginia Association for Hospices & Palliative Care recognized her work with a Lifetime Achievement Award.
While at Riverside, her supervisors noted that Carling's patients lived longer because she managed their pain better. As a newcomer and a nurse, Carling was reluctant to tell physicians how to do their jobs, but she soon became in demand for her skill in assessing pain and her ability to ease it through the use of targeted drugs administered topically.
“This is not nuclear physics. It's applied pharmacology and good nursing,” Carling says, in a phone interview from Houston, where she is staying with her daughter Debbie. In October 2011, the midwife/home health visitor/registered nurse received a devastating diagnosis of advanced pancreatic cancer. Her ensuing treatment has put on hold her collaborative work in a pending clinical trial through the Pain Management Education and Research Foundation.
“On a scale of one to 10 (unbearable), how do you rate your pain?” That's the question every medical practitioner traditionally asks. Carling explodes over the phone, “It doesn't assess pain. Do you find it helpful? No. All you are asking is 'how bad is it?'”
She learned early in her career from an English doctor that most patients suffer from more than one type of pain and almost one-third from as many as four.
In order to zone in on her patients' suffering, Carling broke pain into eight types: bone, muscle, pleuritic, soft tissue, neuropathic, etc. To that she added questions about duration — was it continuous, variable or intermittent.
As an example, visceral pain “just aches all the time,” she says, while pleuritic is worse with breathing and bone pain with movement. She asked her patients to describe their pain. Was it burning, shooting or stabbing. She asked them which drugs relieved their pain, to what extent and for how long.
“She came with a whole new look for pain management. It opened up a new area for us,” says her former supervisor Sharron Nichols, nurse manager for Riverside Hospice. “She brought a different way to look at pain. She introduced more of a spiritual, personal element.” She credits Carling with improving terminal patients' quality of life, which in turn led them to live longer.
Impressed by the skill of Carling's pain assessment, Brenda Clarkson, a fellow UK native and executive director of the Virginia Hospice Association, hired her to teach nurses at the hospice she ran in the Richmond area. “She's one of life's rare people, she's really made a difference,” says Clarkson.
An avid talker, Carling found that other professionals were starting to listen to her. A professor at the University of Virginia in Charlottesville and Virginia Commonwealth University in Richmond asked her to publish her findings. She started getting letters from doctors all over the country.
“There's no one more astonished than me,” she says.
Abbot Laboratories in Illinois asked her to write more extensively. She joined a national speakers' bureau. She instructed the military at Fort Eustis and then at Fort Carson in Colorado, where she was awarded the Commander's Coin for Excellence.
She developed audiotapes, CDs and a workbook to pass on her findings and her assessment methods. She committed her algorithm, the Carling Pain Assessment Algorithm, to a single laminated card that nurses could carry bedside. She developed a body map for patients to pinpoint their pain along with its description and appropriate treatment.
“Opiates and narcotics don't relieve all pain,” she says. “They relieve it in soft tissue, but bone pain isn't responsive. Pain is what the patient says it is.”
Some may dismiss a patient's pain as psychosomatic, others as a drug-seeking ploy. “When you're in pain, you can do without that,” says Carling with indignation. She emphasizes how documenting every detail helped her to gain buy-in from other medics.
By targeting the specific pain, Carling found that lower-dose drugs often worked better than more powerful medications and with fewer side effects. “Medical professionals are trained to treat the diagnosis, but chronic pain is completely different. The brain continues to send out pain signals even after wounds are healed. It creates changes in the nervous system,” says Carling. She revels in “seeing the light go on” when doctors and nurses get an answer to something they didn't understand.
