During her 12-plus years working with chronic pain patients, Brett Snodgrass has stepped into multiple leadership roles: working with the Tennessee state legislature in developing chronic pain guidelines for healthcare providers, acting as an advocate for nurse practitioners by representing Tennessee in the American Association of Nurse Practitioners, and serving as director of clinical operations for LifeLinc Pain Centers.
She is a pioneer – believed to be the nation’s first nurse practitioner to become a fellow of the Academy of Integrative Pain Management as an advanced credentialed pain practitioner.
“Nurse practitioners really have to stay in the forefront,” Snodgrass said. “If you’re not at the table, you may not be represented appropriately.”
Snodgrass describes the treatment of chronic pain as a relatively new specialty that has evolved within the last five to seven years. “Chronic pain has recently become a very hot topic with the United States’ opioid abuse issue. While pain specialists have been around, appropriate treatment has not been readily available because there were so few of them.”
She served as an RN with local hospitals for several years, but her fascination with the field of chronic pain management developed during her 10 years within a practice that blended family care with pain management and palliative care. Recognizing that such treatment was largely unavailable during those early days, she became a chronic pain expert through hands-on learning.
Their former collegial relationship and shared vision of how chronic pain management should look suited her for the leadership role that LifeLinc owner Eric Callan offered. The importance of appropriate diagnosis and evaluation of pain as well as multidisciplinary approaches are priorities that LifeLinc Centers recognizes while ensuring individualized treatment options — such as physical therapy, cognitive behavioral therapy, anti-inflammatory and other medications, epidural spinal injections, transforaminal and other injections, radiofrequency ablation, and more.
Combating the popular conception that pain management is about dispensing opioids such as morphine, “We try everything we can to get rid of the opioids or lower them to the lowest effective dose,” Snodgrass explained, “often focusing on interventions because chronic back pain is the No. 1 diagnosis in chronic pain.”
“Our goal is for patients to work and have families and fulfilling lives,” she added, “but the bigger picture is incorporating other things along with opioid therapy so they can lead as normal a life as possible with a chronic disease.”
Monitoring patients for abuse is “a big job” that she helped to address when she gathered with others on Gov. Bill Haslam’s selected group of Tennessee pain-treating practitioners to develop Tennessee Chronic Pain Guidelines for patient treatment.
The guidelines allow a minimal amount of opioids to be prescribed in primary practice; when higher doses are needed, it recommends that patients be referred to a chronic pain specialist, where patients are closely monitored.
She admits that the guidelines aren’t perfect. “But we needed to do it because Tennessee was No. 2 in opioid overdose deaths in the U.S.”
The Tennessee Controlled Substance Monitoring Database was already in place, but the 2015 guidelines mandated that all healthcare providers must not only register with the database but must also check it to prevent duplication if they are considering prescribing an opioid or controlled substance. Each year the state sends a cautionary letter to the 50 highest prescribers of opioids on the list.
“Unfortunately that has scared a lot of providers, who are now taking the stance that ‘I won’t write any pain medicine, period,’” she said.
The guidelines further stipulate that every pain office in Tennessee must have a medical director who is a physician to provide supervisory oversight by signing 20 percent of the pain office’s charts within two weeks of the patient’s visit.
Research shows that this level of oversight does not provide better patient care, Snodgrass said, and, in fact, increases costs by requiring nurse practitioners to pay a physician to oversee the practice — although the physician need not be in the office when patients are seen.
“Twenty-three states currently have full practice authority for nurse practitioners, meaning that physician oversight is not required,” Snodgrass points out, “and we are working toward that in Tennessee.” Patients could benefit, she said, from the removal of economic barriers that would allow nurse practitioners to open much-needed practices.
“So we’re encouraging and preparing more nurse practitioners to get pain training, fellowships and pain certifications.”
Education, she added, is key — and one of her toughest challenges. A popular speaker on the subject of chronic pain, Snodgrass points out that, across the board, healthcare providers average four to six hours of chronic pain education in their entire program of study.
“That’s why many providers have been quick to go to an opioid if somebody complains of pain,” she said. “We really push home that chronic pain doesn’t equal opioids. They’re just one component of chronic pain treatment.”
A lifelong Mid-Southerner following in the footsteps of her mother, who grew up in healthcare, Snodgrass earned her degree in nursing from the University of Memphis and returned there to acquire her master’s in nursing with a specialty of family nurse practitioner in 2007.
She takes pride in her contributions as a chronic pain expert and educator to her field, the state and the nation — and in the benefits her efforts bring to patients in appropriate pain assessment and therapy. She looks forward to collaborating with other healthcare providers and referral sources on their patient care, while guiding LifeLinc to pursue growth plans by seeking a nurse practitioner and a cognitive behavioral therapist to add to their team in the Germantown Pain Center, which she helped launch.
LifeLinc has three locations – the other two are in Springfield, Tennessee, and Hopkinsville, Kentucky. Snodgrass serves as director of clinical operations for all three facilities.
Snodgrass regards her family as her greatest accomplishment — daughters age 15 and 17 who are already planning careers in nursing and biomedical engineering, and a husband who supports her in her advocacy efforts.