MR-VAMC Pain Management Rotation
Expectations
- Clinical management of acute, chronic and cancer pain
- Basics of the clinical application of spinal anesthesia (caudal, epidural, or subarachnoid)
- Knowledge of the appropriate use of diagnostic and therapeutic nerve blocks in Pain Management. Management of Pain with oral opioid and non-opioid analgesic’s, as well as adjuvant co-analgesic drugs.
- Recognition and appreciation of the importance of proper medical records in quality pain management and their direct relationship to reimbursement.
- Learn the basics of routine perioperative surgical care for commonly performed surgical procedures, and their implications for quality pain management.
- Relevant clinical research issues in pain management
- Understand the basic anatomy and physiology of the pain projection system
- Understand the pharmacology centrally acting drugs used in pain management, such as anticonvulsant, antidepressants, and major tranquilizers.
- Knowledge of behavioral, cognitive, and supportive psychotherapeutic
The rotation at the MR-VAMC Pain Clinic will enable the fellow to become
proficient with the following:
- 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
A. Patient Care Skills
1. Complete patient assessment skills
a. Learn to perform a thorough, directed history and physical examination with emphasis on diagnoses of different pain states
b. Differentiate among the different chronic pain states such as neuropathic pain, sympathetically maintained pain, myofascial pain syndromes
c. Know when it is appropriate to refer patients to different specialists for definitive or adjunctive therapy
d. Know the laboratory tests, radiological studies, and psychological tests used for different chronic pain syndromes
e. Design management plans
2. Comprehensive Management plans
a. Know the multidisciplinary approach to pain management
b. Know the types of drugs that relieve pain and their efficacy, indications, side effects, contraindications, drug interactions and dose adjustments
c. Know particular pain procedures and techniques commonly used for particular chronic pain syndromes
d. Know indications and complications of pain procedures
e. Appropriate pre-procedural evaluation
f. Appropriate post-procedural follow-up and continuing care
- Medical Knowledge
1. Thorough knowledge of neuroanatomy and physiology
2. Knowledge of dermatomal mappings
3. Adequate basic knowledge of anatomy and physiology in general as they impact the performance of procedures
4. Knows the different modalities of physical therapy that may relieve chronic pain and learn how to obtain them
5. Adequate knowledge of medical conditions giving rise to pain syndromes
6. Understands pathophysiology of pain syndromes and is able to discuss treatment options including pharmacotherapy, physical and occupational therapy, psychotherapy, diagnostic and therapeutic interventional procedures and alternative pain modalities
7. Know the indication for stimulation techniques such as transcutaneous electrical never stimulation (TENS), dorsal column stimulation, and deep brain stimulation
8. Know the acute, chronic, and cancer pain guidelines in conjunction with the medicare federal government as follows:
a. Treatments
1. Drugs: analgesics, opiates, sedatives, and stimulants
2. Nerve blocks
3. Neurolysis, surgical and chemical
b. Routes of administration and risk and benefits of each epidural
1. Intramuscular
2. Intrapleural
3. Intravenous
4. Oral
5. Patient controlled
6. Subarachnoid
7. Subcutaneous
c. Diagnose and treat the following pain syndromes
1. Diabetic neuropathy
2. Inflammatory states such as bursitis, carpal tunnel syndrome, skeletal pain and tendonitis
3. Phantom limb pain
4. Post-herpetic neuralgia
5. Reflex sympathetic dystrophy
6. Trigeminal neuralgia
7. Low back pain
- Professionalism
1. Motivation, initiative and promptness
2. Reliability and responsibility
3. Integrity
4. Attitude
- Interpersonal and communication skills
1. Relationships and communication with other clinics and consult services
2. Relationships and communication with clinic staff
3. Relationships and communication with patients and their families
4. Relationships and communication with faculty
- Practice-based learning
1. Responds appropriately to faculty direction and criticism and demonstrates learning from faculty/resident interactions
2. Appropriately utilizes general medical literature and anesthesiology literature to develop a treatment plan for their patients.
3. Is committed to self-education by attending Departmental educational activities including conferences, journal clubs and simulator sessions
- Systems-based practice skills
1. Practices cost-effective healthcare that does not compromise patient care
2. Appropriately utilizes consultants and diagnostic testing information to prepare the patient for interventional pain management
3. Recognizes and plans for appropriate post-procedural follow-up care
4. Record keeping skills-includes documentation of medical care as well as appropriate documentation of effort for reimbursement; demonstrates knowledge of and behavior consistent with strict medical compliance
5. Participates actively as an effective healthcare team member facilitating optimal and efficient patient care
