A Day at PMC
A Day in Chronic Pain Management
Update provided by Isaac Shields, CA-2
The chronic pain management rotation involves a mix of clinic and procedure experiences. Most of the rotation is spent at the Fontaine Research Park, which is approximately a 5-10 minute drive from the main UVA hospital. The rotation does incorporate some inpatient chronic pain consult service time as well. We complete this month long rotation as CA-2 residents, but categorical anesthesiology residents starting in 2016 have the opportunity to rotate through the clinic as interns. This is a great opportunity for interns to get their feet wet early in their UVA career and foster a potential interest in pain management.
A typical day starts around 7:45am with a departmental huddle to review how the day looks. If I’m in procedures for the day, I review the schedule with the pain medicine fellow and divide up procedures for the day. As soon as the patient arrives we perform a brief history/exam and ensure proper consent is obtained for the relevant procedure. Looks like today I have several trigger point injections and occipital nerve blocks, a lumbar epidural steroid injection, and a SI joint injection. Although it is often busy, the procedure attending and fellow always find time to teach about the relevant anatomy or technical considerations behind these procedures. My first patient today had 10/10 pain related to occipital neuralgia. It was so gratifying providing her instant relief with an occipital nerve block and watching her walk out of the office with a smile on her face!
Clinic days also start at about the same time. There is a nice mix of initial visits and established patients due to the large catchment area. As I look up my next patient, I see she has a history of CRPS so I start to review the Budapest diagnostic criteria for CRPS and look at different treatment modalities for this condition. After talking with the patient, I present the patient to my attending and we come up with a treatment plan after discussion with the patient. I work on the summary paperwork/print scripts for the clinic visit, ensure proper follow up is scheduled, and it’s on to the next patient.
Before I know it, the day is coming to a close (usually around 3:30-4:30) and I finalize some clinic notes before heading home. There is still plenty of time for me to go to the gym and do some study questions if I feel ambitious. In addition to informal teaching throughout the day, there are dedicated lectures by either the pain faculty members or fellows on Wednesday which have been very helpful and cover material frequently tested on the annual in-training exam. It has been a great month and I look forward to work tomorrow!