Educational Objectives for Pain Fellows
Quality pain management. This requires of the
trainee a certain fund of knowledge, pool of technical skills, and
bedside manner
To recognize the need for a multidisciplinary
approach for pain management
To gain knowledge of the role of a Pain
Management physician
To distinguish clinical characteristics of acute,
chronic and cancer pain
To recognize and appreciate the role as a Pain
Consultant
Understand the principles of neural stimulation
(TENS, PNS AND DCS)
Understand the principle and rationale for
intrathecal catheters and infusions
Understand and become familiar with alternative
pain therapies
Evaluation and treatment of all genders, adults
and children and to become familiar with the diagnostic methods and
treatment modalities of male and female pain patients. To include the
differences in pain presentations and techniques based on gender
Evaluation and treatment of pain patients
utilizing the various interventional and invasive management techniques,
indications, contraindications and follow-up. To include intradiscal
electrothermal therapy {IDETT}, spinal cord stimulators, intrathecal
pumps, vertebroplasty and kyphoplasty
Principles, evaluation and treatment of workman’s
compensation, disability claims and impairment ratings
Learning the appropriate billing and coding for
evaluation and medical treatment and interventional therapies
Exposure to and/or knowledge of:
Clinic visits for prescription refills
Clinic visits for continuity of care
Morphine pump refills
Removal of trial stimulating catheters
Follow-up visits for post surgical or IPM
procedures
Removal of sutures or staples
Interrogation of Spinal Cord Stimulators and
peripheral nerve stimulators
Examination and re-evaluation of an acute pain
flare
Consultations/Letters/Conferences
Occasional minimally invasive procedures
Telephone call backs
Cervical, Thoracic, Lumbar and Caudal Epidural
Catheter Placements
Trial and Permanent Spinal Cord Stimulators
Permanent Morphine Pump Placement
Peripheral Nerve Stimulator Placement
Replacement of Malfunctioning SCS and Morphine
Pumps
Repositioning of SCS electrode leads
Sacral Stimulating Catheter Placement
Subcutaneous Cervical Stimulator
Neucleoplasty
Dekompressor
Racz Catheter Techniques
Cervical, Thorasic and Lumbar Discography
Rotating VAMC (R) Four Month Rotation:
The assigned Fellow will spend time rotating through
different services within the institution and/or at Shands on different days
of the week. This will cover the multi-disciplinary requirements.
Brief Description of Each Rotation and Related
Learning Expectations
Acute Pain Rotation
Fellows will rotate through the acute pain service at
Shands hospital one day a week for a total of 2 months. The Fellow will act
as an advisor and teacher to residents rotating through the regional and
acute pain service.
Learning expectations
Participation in the assessment of surgical
patients regarding postoperative pain control
Consultation for inpatients with acute pain,
including medical management, PCA and interventional techniques
Evaluation and performance of the appropriate
regional technique for the surgical procedure
Psychology Rotation:
The Fellow will actively participate in the
evaluation and treatment of patients requiring psychological pain
interventions.
The Fellow will rotate through the clinic once a week for a total of
four months.
To become familiar with and utilize psychological evaluation of chronic
pain patients, pain coping modalities/skills, cognitive and operant
behavioral therapy and neuro-psychological testing.
Radiology Rotation
Learning expectations:
Identification of appropriate radiologic imaging
studies for diagnosis of pain syndromes
Interpretation of radiologic images
Correlation of radiologic images with clinical
findings
Oncology/Palliative Care Rotation
The Fellow will rotate with the oncology and
palliative care medicine faculty once a week for four months. This would be
under the guidance of the medicine service.
Learning Expectations:
Attendance and participation in clinical
conferences.
Facilitation and promotion of interventional pain
management in cancer patients for diagnostic and therapeutic purposes.
Involvement in pain management of hospice
patients.
Inpatient involvement in cancer/chronic pain
management.
In addition, the fellow will participate in the
VA Pain clinic evaluating cancer patients referred to the clinic by the
oncology service. This will be for one half day for a 4 month rotation.
Physical Medicine and Rehab (PM&R)/Physical Therapy Rotation
The Fellow will rotate through the PM&R service one
half day a week for four months.
Learning Expectations:
The Fellow will gain knowledge in the various
diagnostic maneuvers that are done in physical diagnosis by rehab
physicians. This includes the evaluation for appropriate physical therapy
and knowledge of the appropriate physical modalities.
Active participation in physical rehabilitation
of patients.
Knowledge in principles of various therapeutic
regimens for physical rehabilitation.
Indications and technical aspects of EMG and NCS.
Application of these results to clinical practice.
