Pain Management Clinical Experience

Acute Pain Service: 

The Acute Pain Service provides daily management of patients with postoperative, post-traumatic, and other types of acute pain requiring specialized interventions such as epidural analgesia, other regional anesthetic techniques, or complex pharmacological management. Patient volume is approximately 1,800 total patient days annually. The service does not provide routine management for patients on IV-PCA postoperatively, but does so when consulted by the primary service. Support is also provided to the operating rooms for placement of epidural catheters and regional blocks for surgery preoperatively. A dedicated anesthesiology attending is assigned daily, along with one resident and/or fellow.

Chronic Pain:

Anesthesiology Pain Management Center: The Center is our hospital-based outpatient clinic for the management of chronic and cancer pain. We provide anesthetic interventions as one component of a comprehensive, interdisciplinary, yet individualized approach to patient care, which draws upon the expertise of our faculty as well as consultants from dentistry, psychiatry, neurology, surgery, physical medicine, and other specialists. A three pronged approach to patient evaluation and management emphasizes pain control, psychological optimization, and rehabilitation. Our dedicated clinic facility includes specialized procedure rooms with state of the art monitoring, interview rooms, C-arm fluoroscopy, quantitative sensory testing (current perception threshold), and psychologists office on-site. A comprehensive pain text and video library is housed within the clinic. Non-physician staff includes a transcriptionist, two receptionists, and four full-time nurses. In 1998-1999, there were a total of 4,500 patient encounters, with 2400 procedures performed, including: trigger point injections, cervical and lumbar epidural blocks/steroids, sympathetic blocks, plexus blocks, peripheral blocks, intravenous infusions, facet blocks, radiofrequency denervation, nerve root blocks, spinal cord stimulator trials, intrathecal catheter trials, and epidural catheter implants.

Consultation Service: The chronic pain staff provides consultations for complex inpatient pain management problems, and daily rounds are performed.

The University of North Carolina Spine Center: The Spine Center is an interdisciplinary clinic practice which meets daily immediately adjoining the Pain Management Center. Participants include physician specialists from our program and from neurosurgery, orthopedic surgery, rheumatology and physical medicine and rehabilitation, as well as specialty nurses, physical therapists, and vocational rehabilitation specialists.

The core of the educational program in pain management involves clinical assignment in the Pain Management Center and Spine Center where we evaluate and manage patients with chronic and cancer pain.

Fellows are assigned to our inpatient Acute Pain Service for the first two weeks. This will serve as a general orientation to our department, the hospital, and our standard practices regarding acute pain management.

Call

You will be responsible for carrying the call pager for the Acute Pain Service from 5:00 p.m. to 7:00 a.m. nightly Monday through Thursday for one week every 2 months. You will also be the first call for acute and chronic pain problems from 5:00 p.m. Friday through 7:00 a.m. Monday on alternate weekends.  There is no overnight, in-house call.

Goals and Objectives

The primary objective is to provide trainees the opportunity to develop skills in clinical care, clinical judgment, teaching, administration, and research. Emphasis is placed on comprehensive, interdisciplinary management of a wide variety of clinical pain problems.

Specific goals and expectations are set for the trainee on a quarterly basis:

First quarter:  

• Establish essential skills in the assessment and management of inpatients with acute pain
• Develop general orientation and familiarity with the assessment of patients with chronic pain, the variety of chronic pain syndromes, therapeutic approaches and techniques
• Preliminary plans established for research program

Second quarter:

• Capability for independent assessment and management of acute pain
• Maturation of skills for comprehensive assessment and treatment of patients with chronic and cancer pain, with evidence for the ability to independently develop plans of care
• Familiarity with and ability to develop an organized approach to patients with a variety of chronic pain syndromes
• Initiation of data collection for research program

 
Third quarter:

• Demonstration of the ability to independently evaluate and develop a plan of care for patients with a wide variety of chronic pain syndromes, including very complex cases
• Ability to work in a time and cost efficient manner, and to integrate services effectively with an interdisciplinary care team
• Proficiency with simple and complex procedures or techniques
• Identification of a clinical/administrative topic as a focus for developing an area of special expertise

Fourth quarter:

• Ability to function independently in all clinical areas, as a consultant for pain management
• Demonstration of special expertise in a clinical or administrative area, by development of clinical guidelines/pathways, invited presentation, practice innovation, publication, or the equivalent
• Active data analysis and plan for completion of research program