Pain Medicine

Pain Medicine Rotation

The educational experience at the Center for Pain Medicine and Regional Anesthesia is very active and diverse. Anesthesia residents rotate for a total of four weeks during the CA2 year, while CA3 residents may choose to spend additional time in the Pain Clinic as their elective rotation. Residents receive an orientation packet that delineates expectations and responsibilities (acute pain call and rounds, chronic pain clinic), and information on the electronic patient record, EPIC (consultation and procedure notes, orders). Additionally, up-to-date electronic educational materials are made available at the beginning of the rotation.

Clinical Experience

Residents on the Pain Medicine rotation gain experience in acute, chronic, and cancer pain management. The EPIC Dashboard allows the resident to follow a patient throughout the entire visit so that care is provided in a timely manner, avoiding unnecessary delays. It includes preliminary information about the patient’s diagnosis and visit purpose (consultation vs. procedure).

Residents on the pain rotation do perform interventional pain procedures. An attempt is made to distribute procedures equitably between trainees.

Chronic Pain Medicine Service

The Center for Pain Medicine and Regional Anesthesia serves patients with a wide array of chronic benign ailments as well as cancer related pain conditions. Our clinic staff includes physicians, nurses, and a clinical pharmacist, and we work closely with psychology and physical therapy. Residents are exposed to conservative treatments, blind and ultrasound-guided procedures (such as trigger point injections, peripheral nerve blocks, and joint injections), as well as to interventional fluoroscopically-guided procedures including spine injections (epidurals, facets, sacroiliac joints), sympathetic blocks and chemical and thermal neurolysis. In addition, intrathecal drug delivery, spinal cord stimulation and cryoablation may be performed in select patients. There is close collaboration with other department specialties such as neurosurgery, orthopedics, psychiatry, neurology, oncology and palliative care.

Acute Pain Medicine Service

The Acute Pain Service actively manages postoperative pain in the in-patient setting. The Service also serves as a resource when clinicians from other disciplines have complex pain questions. Common modalities used for postoperative pain control include: intravenous patient-controlled analgesia (PCA), thoracic and lumbar epidural catheters, and peripheral nerve/plexus catheters.

Education

The educational program is multifaceted and includes in-depth clinical exposure, as well as teaching of medical students. Diverse teaching activities take place, among them: a weekly didactic lecture series (in collaboration with other departments), the Pain Medicine Morbidity and Mortality Conference (tri-monthly), and pain medicine journal club (monthly). Residents rotating on the Pain Medicine Service are encouraged to attend these educational activities, but residents on other rotations are always welcome. Residents on the Pain Rotation take call from home approximately every sixth night. The resident on pain call is expected to come into the hospital when epidural catheter placement and/or additional analgesia is required for postoperative pain management. An attending physician is accessible for questions and available to come into the hospital if needed. On weekends, the call resident and the attending pain staff round together in the mornings.

Research

Residents with an interest in pain research are encouraged to speak with the rotation director or the Vice Chair for Research.

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