Pain Management Rotation
The Department of Anesthesiology Pain Management Center (PMC) has been an integral component of the residency training program for over 25 years. An ACGME approved clinical fellowship program which accepts competitive candidates from our residency program and others is filled annually and enriches the resident experience. Patients with all varieties of acute, chronic and cancer pain problems are referred by their physicians. The Center incorporates the expertise of staff in nursing, psychology, social work and medicine/anesthesiology in the evaluation and treatment planning of patients. As part of the Musculoskeletal Center, collaborations with colleagues in Physical Medicine and Rehabilitation, Orthopedics, Rheumatology, Musculoskeletal Radiology and Physical Therapy occur frequently. Therapeutic prescription follows the comprehensive assessment which includes the consideration of data from consultants within and external to the PMC. Modalities employed include pharmacological treatment, TENS and other complementary therapies, an array of analgesic nerve blocks, exercise physiology, and a full gamut of psychology techniques. Interventional diagnostic and analgesic procedures are aided by onsite fluoroscopy. Implantable therapies are also part of the management.
The Acute Pain Service (APS) has been operational since 1987. The APS guided the introduction of PCA therapy into the University Hospital practice and was subsequently able to discharge oversight for this modality in the majority of cases. The management of patients with acute/postoperative pain via epidural, subarachnoid or peripheral nerve local anesthetics with or without opioids is routine, and the average daily census is approximately 10 patients. Medical consults to the APS are received at any time and expand the breadth of problems encountered. There are a growing number of cancer pain-related consults and pediatric cases. The APS team is led by a resident or fellow on assignment to the pain services. All residents serve for 6-8 weeks on a scheduled basis. There is 24-hour attending coverage. Rounds are held daily at which all patients are discussed.
The faculty are active in national and international scientific and research meetings and specialty societies, so the practice is contemporary and progressive. Dr. John C. Rowlingson has been the Director of the Pain Services since 1980. He is a board certified anesthesiologist and has earned the ABA Certificate of Added Qualification in Pain Management. He has been active for years in regional and national societies and is President of the American Society of Regional Anesthesia. Dr. Robin Hamill-Ruth is the Director of the Pain Management Center. She is a board certified Anesthesiologist in Critical Care Medicine and has a certification in Pain Management from the American Board of Pain Medicine. Additional Pain Services faculty include Dr. Robert Goldstein and Dr. Sheryl Johnson . Dr. Dania Chastain is the Director of Pain Psychology. Other areas of clinical and basic science research interest amongst the group include the establishment of a comprehensive database for patients with chronic pain, therapeutic outcome studies, drug trials, low back pain and its effect on faig and innovative approaches to the management of tinnitus and hyperacusis.
Overall, the group has a mix of clinical, research and professional interests that are reflected in the energized discussions at the weekly pain center conferences, the pain psychology seminars, and journal club meetings. The ABA and IASP curricula serve as the templates from which the total conference program is created. An up-to-date bibliography for topics directly and indirectly related to pain management can be accessed through a computerized reference manager program.