Pain Medicine FAQ's

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10.What are the new ACGME Pain Medicine multidisciplinary fellowship program requirements I keep hearing about?

A. Definition and Scope of the Subspecialty

Pain medicine is a discipline within the practice of medicine that specializes in the management of patients suffering from acute or chronic pain, or pain in patients who require palliative care. The management of acute and chronic pain syndromes is a complex matter involving many areas of interest and different medical disciplines. Clinical and investigative efforts are vital to the progress of the specialty. Physicians training in pain medicine may originate from different disciplines and approach the field with varying backgrounds and experience. All pain specialists, regardless of their primary specialty, should be competent in pain assessment, formulation, and coordination of a multiple modality treatment plan, integration of pain treatment with primary disease management and palliative care, and interaction with other members of a multidisciplinary team. Therefore, the didactic and clinical curriculum of the multidisciplinary pain program must address attainment of these competencies.

11. I'm from a non-anesthesiology background, what basic anesthesiology skills should I try to obtain before starting fellowship in order to "hit the ground running?"

Fellows will enter the fellowship in pain medicine with a range of different experiences. The pain medicine program must demonstrate separate, identifiable clinical experiences that provide the elements from medical disciplines essential to the practice of pain medicine. The clinical experience within the four disciplines outlined below may take the form of discrete clinical rotations, or may occur concurrently with the core clinical curriculum. This fellowship will vary from institutio n to institution based on the interests and expertise of the faculty who work directly in the pain clinic. The training experience must be provided by the pain medicine program and acquired by the fellow over the course of the program. The program must provide each fellow distinct clinical experience in each of the disciplines listed, with the exception of the fellow’s primary discipline. The principal multidisciplinary elements of pain medicine education from the disciplines relevant to pain medicine are as follows:

(1) Anesthesiology

The fellow will demonstrate competency in:
(a) obtaining intravenous access in a minimum of 15 patients;
(b) basic airway management, including a minimum of mask ventilation in 15 patients and endotracheal intubation in 15 patients;
(c) certification provider course in basic life support and advanced cardiac life support;
(d) management of sedation, including direct administration of sedation to a minimum of 15 patients;
(e) administration of neuraxial analgesia, including placement of a minimum of 15 thoracic or lumbar epidural injections using an interlaminar technique.

Anesthesiology faculty must be from an anesthesiology residency program accredited by the ACGME, and/or must be members of the Pain Medicine Fellowship Program.

12.I'm from an Anesthesia background and have some elective time in my CA-3 year, what should I focus on?

(2) Neurology

The fellow shall be able to elicit a directed neurological history, perform a detailed neurological examination to include at least mental status, cranial nerves, motor, sensory, reflex, cerebellum examinations, and gait in fifteen patients. Faculty shall verify this experience in a minimum of 5 observed patient examinations. The fellow shall also become familiar with basic neuro- imaging, and identify significant findings, to include at least MR and CT of the spine and brain on a minimum of 15 CT and/or MRI studies drawn from the examples within the following areas: brain, cervical, thoracic, and lumbar spine. The fellow shall have an understanding of the indicators and interpretation of electro-diagnostic studies.

Neurology faculty must be from a neurology training program accredited by the ACGME, and/or be members of the Pain Medicine Fellowship Program Faculty.

Image/study identification training shall be verified by a faculty member of a residency program accredited by the ACGME in neurology, neurosurgery, or radiology, or by a faculty member with qualifications judged to be acceptable
by the RRC.

(3) Physical Medicine & Rehabilitation

The curriculum should be designed to emphasize the performance of a comprehensive musculoskeletal and appropriate neuromuscular history and examination with emphasis on both structure and function as it applies to diagnosing acute and chronic pain problems and developing rehabilitation programs for them. This should include assessments of static and dynamic flexibility, strength, coordination and agility for peripheral joint, spinal, and soft tissue pain conditions. Fellows should gain an understanding of the natural history of various musculoskeletal pain disorders and be able to appropriately integrate therapeutic modalities and surgical intervention in the treatment algorithm. The fellow shall have an understanding of the indicators and interpretation of electro-diagnostic studies. Fellows must gain significant hands-on experience in the musculoskeletal and
neuromuscular assessment of 15 patients
, and demonstrate proficiency in the clinical evaluation and rehabilitation plan development of a minimum of 5 patients.


Physiatry faculty must be from an ACGME-accredited physical medicine & rehabilitation residency program, and/or must be members of the Pain Medicine Fellowship Program Faculty, or a faculty member with qualifications
judged to be acceptable by the RRC.

(4) Psychiatry

The fellow must carry out a complete psychiatric history with special attention to psychiatric and pain comorbidities, must conduct a complete mental status examination on a minimum of 15 patients, and must demonstrate this ability in five patients to a faculty observer. The program should provide educational experience in frequent psychiatric and pain co-morbidities, which include substance-related, mood, anxiety, somatoform, factitious, and personality disorders. The program should also provide educational experience in the effects of pain medications on mental status. The fellow must understand the principles and techniques of the psychosocial therapies, with special attention to supportive and cognitive behavioral therapies, sufficient to explain to a patient and make a referral when indicated. Faculty must be psychiatrists or clinical psychologists who have documented experience in the evaluation and treatment of patients with chronic pain.

Psychiatry faculty must be from a psychiatry residency program accredited by the ACGME, and/or must be members of the Pain Medicine Fellowship Program Faculty, or a faculty member qualifications judged to be acceptable by the RRC.
 
Does anyone know if a Half-Time (2yrs instead of 1yr) ACGME accredited Pain Medicine Fellowship would preclude me from board certification eligibility?
 
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10.What are the new ACGME Pain Medicine multidisciplinary fellowship program requirements I keep hearing about?

A. Definition and Scope of the Subspecialty

Pain medicine is a discipline within the practice of medicine that specializes in the management of patients suffering from acute or chronic pain, or pain in patients who require palliative care. The management of acute and chronic pain syndromes is a complex matter involving many areas of interest and different medical disciplines. Clinical and investigative efforts are vital to the progress of the specialty. Physicians training in pain medicine may originate from different disciplines and approach the field with varying backgrounds and experience. All pain specialists, regardless of their primary specialty, should be competent in pain assessment, formulation, and coordination of a multiple modality treatment plan, integration of pain treatment with primary disease management and palliative care, and interaction with other members of a multidisciplinary team. Therefore, the didactic and clinical curriculum of the multidisciplinary pain program must address attainment of these competencies.

11. I'm from a non-anesthesiology background, what basic anesthesiology skills should I try to obtain before starting fellowship in order to "hit the ground running?"

Fellows will enter the fellowship in pain medicine with a range of different experiences. The pain medicine program must demonstrate separate, identifiable clinical experiences that provide the elements from medical disciplines essential to the practice of pain medicine. The clinical experience within the four disciplines outlined below may take the form of discrete clinical rotations, or may occur concurrently with the core clinical curriculum. This fellowship will vary from institutio n to institution based on the interests and expertise of the faculty who work directly in the pain clinic. The training experience must be provided by the pain medicine program and acquired by the fellow over the course of the program. The program must provide each fellow distinct clinical experience in each of the disciplines listed, with the exception of the fellow’s primary discipline. The principal multidisciplinary elements of pain medicine education from the disciplines relevant to pain medicine are as follows:

(1) Anesthesiology

The fellow will demonstrate competency in:
(a) obtaining intravenous access in a minimum of 15 patients;
(b) basic airway management, including a minimum of mask ventilation in 15 patients and endotracheal intubation in 15 patients;
(c) certification provider course in basic life support and advanced cardiac life support;
(d) management of sedation, including direct administration of sedation to a minimum of 15 patients;
(e) administration of neuraxial analgesia, including placement of a minimum of 15 thoracic or lumbar epidural injections using an interlaminar technique.

Anesthesiology faculty must be from an anesthesiology residency program accredited by the ACGME, and/or must be members of the Pain Medicine Fellowship Program.

12.I'm from an Anesthesia background and have some elective time in my CA-3 year, what should I focus on?

(2) Neurology

The fellow shall be able to elicit a directed neurological history, perform a detailed neurological examination to include at least mental status, cranial nerves, motor, sensory, reflex, cerebellum examinations, and gait in fifteen patients. Faculty shall verify this experience in a minimum of 5 observed patient examinations. The fellow shall also become familiar with basic neuro- imaging, and identify significant findings, to include at least MR and CT of the spine and brain on a minimum of 15 CT and/or MRI studies drawn from the examples within the following areas: brain, cervical, thoracic, and lumbar spine. The fellow shall have an understanding of the indicators and interpretation of electro-diagnostic studies.

Neurology faculty must be from a neurology training program accredited by the ACGME, and/or be members of the Pain Medicine Fellowship Program Faculty.

Image/study identification training shall be verified by a faculty member of a residency program accredited by the ACGME in neurology, neurosurgery, or radiology, or by a faculty member with qualifications judged to be acceptable
by the RRC.

(3) Physical Medicine & Rehabilitation

The curriculum should be designed to emphasize the performance of a comprehensive musculoskeletal and appropriate neuromuscular history and examination with emphasis on both structure and function as it applies to diagnosing acute and chronic pain problems and developing rehabilitation programs for them. This should include assessments of static and dynamic flexibility, strength, coordination and agility for peripheral joint, spinal, and soft tissue pain conditions. Fellows should gain an understanding of the natural history of various musculoskeletal pain disorders and be able to appropriately integrate therapeutic modalities and surgical intervention in the treatment algorithm. The fellow shall have an understanding of the indicators and interpretation of electro-diagnostic studies. Fellows must gain significant hands-on experience in the musculoskeletal and
neuromuscular assessment of 15 patients
, and demonstrate proficiency in the clinical evaluation and rehabilitation plan development of a minimum of 5 patients.


Physiatry faculty must be from an ACGME-accredited physical medicine & rehabilitation residency program, and/or must be members of the Pain Medicine Fellowship Program Faculty, or a faculty member with qualifications
judged to be acceptable by the RRC.

(4) Psychiatry

The fellow must carry out a complete psychiatric history with special attention to psychiatric and pain comorbidities, must conduct a complete mental status examination on a minimum of 15 patients, and must demonstrate this ability in five patients to a faculty observer. The program should provide educational experience in frequent psychiatric and pain co-morbidities, which include substance-related, mood, anxiety, somatoform, factitious, and personality disorders. The program should also provide educational experience in the effects of pain medications on mental status. The fellow must understand the principles and techniques of the psychosocial therapies, with special attention to supportive and cognitive behavioral therapies, sufficient to explain to a patient and make a referral when indicated. Faculty must be psychiatrists or clinical psychologists who have documented experience in the evaluation and treatment of patients with chronic pain.

Psychiatry faculty must be from a psychiatry residency program accredited by the ACGME, and/or must be members of the Pain Medicine Fellowship Program Faculty, or a faculty member qualifications judged to be acceptable by the RRC.

how difficult is it for someone trained in psychiatry to get a pain fellowship? Are all fellowships only 1 year?
 
So researching fellowships, I hear about some programs doing "cutting edge procedures." Could someone provide a list of the following...

Bread and Butter Procedures:

Innovative Procedures:

Cancer Pain Procedures:
 
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