Pain Management Fellowship Program
Thank you for your interest in our Department’s Pain Fellowship. The fellows have clinical, administrative and academic responsibilities. Clinically, the fellows spend 4 weeks in the Pain Center in the clinic and interventions. One week in 5, the fellow covers the inpatient consultation services, one day of which is committed to the operating room for pain-surgery and related procedures. Approximately 7,000 patients are seen annually in the Pain Center and 4,000 patients on the acute (postoperative) pain and consult service. Administratively, they assist with scheduling. Academic expectations include presentation of Wednesday morning conferences (6 pain, 1 anesthesia department), journal clubs, and submission of a chapter, review article or case report. Research is also encouraged, with the hope of abstract presentation at a spring pain meeting. Given the new paradigm for pain fellowships, two week rotations to physiatry, psychiatry, neurology and anesthesiology are mandatory, depending upon the fellows’ specialty of origin.
The Pain Management Center emphasizes multidisciplinary evaluation and treatment of patients with acute or complex chronic and cancer-related pain problems. The Center’s program provides an academic background for pain studies and emphasizes the pain consultant’s role in this field. Patients referred to the Pain Management Center undergo record review, history-taking and physical examination, following which their cases are presented to the attending of the day. Consultations as deemed appropriate are sought, using resources within (psychology, nursing, counseling, psychiatry, addictions medicine, physical and occupational therapy) and outside of the Center. A therapeutic plan is developed and the fellows are expected to discuss this in informational detail with the patient and his/her family. The fellows will get experience performing routine regional analgesia and contemporary interventional procedures; however, these are viewed as but one modality, within an otherwise comprehensive program, of treatment. All consults called to the service are discussed with the dedicated consult attending following the fellow’s evaluation of the patient.
The fellowship includes time in the clinic, interventional pain techniques, surgical implants, and inpatient consultation. In general, the clinic is “fellow driven” to maximize the continuity of care and educational experience. Our goal is to provide training in the assessment, development and implementation of a multimodal management plan that incorporates a broad range of therapeutic options. The treatment programs consider all aspects of the individual including psychosocial issues as these often impact compliance and outcome. Interventions are viewed as adjuncts to improve patient coping and function, and rarely as the sole mode of treatment. Procedures are done in the clinic daily. Most of these are done with fluoroscopic control. Intrathecal pumps and spinal cord stimulator trials and placements are performed in the operating room. The patients with chronic, benign pain undergo rigorous screening including psychological testing prior to consideration of major interventional therapy.
The inpatient consultation service covers University Hospital, Kluge Children’s Rehabilitation Hospital and HealthSouth. Approximately 3 new consults are seen each day. These patients are followed longer term to monitor the response to recommendations and fine tune the treatment plan. When indicated, outpatient follow-up with the managing fellow is also arranged. The epidural catheter service is managed primarily by the anesthesia resident and attending, however, the fellow may be asked to assist the resident with the most complicated patients.
In addition to the Anesthesiology Department Grand Rounds conferences, the didactic educational program for the fellows includes 2 hours per week of pain-related topics based upon the IASP curriculum. Attention is also paid to the continuing quality improvement; the business of pain, including reimbursement issues, characteristics and policies of the various major carriers, and awareness of the cost of various medications, therapies; and studies to encourage responsible and appropriate use of health care dollars. Fellows are expected to participate actively in the education program, by giving formal presentations and through day to day clinical teaching of patients, medical students, residents, referring physicians and nurses in the course of routine clinical care.
Research and academic productivity are also highly valued. Fellows are encouraged to develop their own research protocol or participate in an existing project. The goal is to submit an abstract to a major pain meeting in the spring. Other publications such as case reports, review articles, or coauthoring a chapter are promoted. The fellow is expected to produce at least one publishable project during the course of the year. For fellows interested in academics, a second year in basic pain research can be arranged. The faculty is composed of anesthesiologists, a psychiatrist, an addictionologist, and a PhD psychologist who enjoy a close collaborative relationship with multiple other specialties. Several faculty in the department have active, NIH-funded labs doing basic pain-related research. For more details on the Pain Management Center Fellowship experience, click here.
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