Chronic Pain Management

CA0s rotate through the pain medicine clinic for three weeks. It is a regular clinic day where you will see 4-6 chronic pain patients including initial evaluations and follow-up visits. Like most clinic experiences, you will see patients on your own, gather relevant information, and formulate a plan prior to presenting your findings as well as your diagnosis and treatment plan to the attending. After a short discussion over salient points, the two of you will then see the patient together to finalize an action plan and provide any prescriptions necessary for the patient.

There are opportunities to get involved with bedside procedures such as trigger point injections or orbital nerve blocks. This time serves as an initial glimpse into the world of chronic pain prior to the more advanced rotation as a CA2. The application cycle happens quickly during the CA2 year and this early exposure can aid in the decision making process for those who have had little experience with the field prior to residency.

The CA2 rotation is 4 weeks long and CA3s may do additional elective weeks. The clinic experience is the same as described for the CA0s, though it is expected that you have a further developed diagnostic approach and understanding of treatment modalities. You will have 2-3 days per week in the procedure suite. On these days you will perform all bedside procedures including trigger point injections, landmark/ultrasound guided peripheral nerve blocks, and joint/bursa injections among others. You can also perform various fluoroscopic guided procedures such as medial branch blocks/ablations, epidural steroid injections, and sacroiliac joint injections.

Finally, there are 1-2 days with the inpatient chronic pain service. You will round with the chronic pain team on consults and primary admissions which are usually patients receiving ketamine infusions. If there are any scheduled OR procedures, such as spinal cord stimulation or intrathecal pump placement, you will be present for these as well during your inpatient days. An upper level resident interested in chronic pain can expect to perform the same volume of procedures as the pain medicine fellows during this rotation.

• Dania C. Chastain, Ph.D.
• Robert B. Goldstein, M.D., Medical Director, Pain Management Center
• Lynn R. Kohan, M.D., Director, Pain Medicine Fellowship
• Lori A. Urban, Psy.D., Division Head, Pain Psychology
• Xiaoying (Amy) Zhu, M.D., Ph.D.

The Department of Anesthesiology’s Pain Management Center (PMC) has been an integral component of the residency training program for over 25 years. Patients with all varieties of acute, chronic and cancer pain problems are referred by their physicians. The Center takes an interdisciplinary approach, with staff expertise in nursing, psychology, social work, and medicine/anesthesiology contributing to the evaluation of patients and planning for their treatment. The PMC is part of the Musculoskeletal Center, and collaborations with colleagues in Physical Medicine and Rehabilitation, Orthopaedics, 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 PMC is also home to the ACGME approved Pain Management Fellowship which enriches the resident experience.

The Acute Pain Service (APS) has been operational since 1987. The APS guided the introduction of patient controlled analgesia (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, with an average daily census of 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 pain management faculty have various areas of clinical and basic science research interests. These include the establishment of a comprehensive database for patients with chronic pain, therapeutic outcome studies, medication compliance studies, and studies evaluating the safety and efficacy of innovative treatment approaches for patients with chronic spinal pain.

Overall, the group has a mix of clinical, research and professional interests which 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.