Karen Little, NPKaren Little, NP, is a chronic pain nurse practitioner at the Pain Management Center at Massachusetts General Hospital. Part of the Mass General Department of Anesthesia, Critical Care and Pain Medicine, the Pain Management Center is a comprehensive, multidisciplinary care center for patients with acute, chronic and cancer-related pain.

Prior to coming to Mass General, Karen built her 18-year career as a nurse, and later as a nurse practitioner, on the chronic pain teams at two separate institutions—one of which was Spaulding Rehabilitation, a member of the Mass General Brigham integrated health care system.

“I couldn’t pass up the chance to work at the Mass General Pain Management Center,” she says. “I knew that this would be an exciting opportunity for me to join a talented team of clinicians and introduce the advanced practice role into the clinic’s approach.”

Below, Karen describes her experience as the first dedicated nurse practitioner at the Mass General Pain Management Center and what she wants patients, caregivers, and providers to know about pain management.

Q. Why did you choose to specialize in pain management?

Before I became a nurse practitioner, I was an editor at a medical publishing company and worked on several pain management articles. I was struck by how much there still was to learn about the causes of chronic pain, the psychological, social-emotional, and physical aspects of it, and the treatments for it.

In nursing school, I felt strongly that pain management was the field for me despite being cautioned about specializing too soon. At Spaulding in particular, I learned so much about interdisciplinary pain care and how nursing can be an integral part of a pain care team.

Q. What is one thing that you wish people knew about chronic pain management?

While I wish we had the tools to eliminate pain completely, we don’t right now. One of the main goals in pain management is to make living with some degree of chronic pain more manageable—that means reducing pain and improving function. It’s important that patients and caregivers understand this goal right from beginning. The best results come when patients take an active role in their care by committing to improving their physical functioning and psychological wellbeing in addition to pain reduction.

I always aim to meet my patients where they are at and create a care plan from there. Pain care takes time—I ask for patience from patients and their caregivers from the beginning.

Q. What are the unique challenges that patients with chronic pain experience?

Chronic pain touches many aspects of a person’s life—physical, social, and emotional wellbeing, ability to function normally, ability to work, etc. Some patients also have a history of trauma which can influence their experience with pain. In my practice, I approach chronic pain care from a holistic perspective, partnering with patients and their primary care team to provide educational resources and collaborate with a multidisciplinary team of clinicians.

Q. What has been your experience as the first dedicated nurse practitioner at the Mass General Pain Management Center?

It’s been both exciting and challenging! At first, we weren’t quite sure how to integrate the nurse practitioner role into the pain clinic; however, the center’s clinical and administrative leadership was open right off the bat to my ideas and suggestions. Darlene Sawicki, MS, NP-BC, director of Advanced Practice Providers at Mass General, was also immensely helpful in supporting and guiding me.

It’s also been enormously helpful to have pain management experience under my belt, as I came into this role with an understanding of how best to support this patient population.

Q. What does your day-to-day look like in this role?

Along with the physicians, I help to co-manage the patients that come to the Pain Management Center. When I see a new patient, some of my responsibilities are to help them manage their medication(s), order diagnostic studies, refer them to physical therapy and refer them to the physician team for spinal injections. I also help to care for urgent-care patients who are referred from the Emergency Department. Some physicians will refer patients to me that solely require medical management or injections that I perform. Examples of the type of interventional care that I administer include trigger point injections for myofascial pain and Botox injections for migraines, and the refills and management of intrathecal pumps to help minimize pain.

Q. What has helped you to achieve success in this role?

I had an amazing pain physician mentor prior to joining Mass General who allowed me to see firsthand how a mutually respectful NP-MD team approach can benefit both patients and providers. I’m not afraid to ask questions, admit when I don’t know something, and use the expansive resources and network available at Mass General. I’ve learned a lot from my colleagues about who to refer patients to and how to navigate a large health care system.

Q. What advice would you give to someone who aspires to pursue a similar career?

Learn to set boundaries and practice self-care. Pain practitioners work with patients during some of the most distressing times in their lives. To remain an effective, thoughtful, empathetic clinician, you need to take care of yourself. When I first began working in pain medicine, I had trouble leaving work at the end of the day, which resulted in not having the energy to give my best self in clinic. I find this work incredibly rewarding, but in order to remain effective, I need to make sure I am healthy first and foremost.

Also, partner with your patients and provide them with the tools, skills and resources they need to be active participants in their own care.