Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Interventional Pain

Transcription

1 Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Rotation: Interventional Pain Goals GOALS AND OBJECTIVES The ACGME recognizes that interventional pain medicine is an evolving discipline. Programs shall not be required to offer all techniques to their trainees. However, the program director of an ACGME-accredited Pain Medicine Training Program must demonstrate that fellows are exposed to a didactic curriculum that includes topics in Interventional Pain Treatment (see Medical Knowledge), and that fellows receive direct, hands-on experience with a range of interventional pain treatment techniques. At the conclusion of the training period, the program director must prepare a final report for each fellow that clearly documents the specific interventional techniques with which fellows demonstrate competence. To establish this experience, the fellow must document involvement with a minimum of 60 patients who undergo interventional procedures in the following categories: at least 25 image-guided spinal intervention at least 10 trigger point injection at least 10 neuroablative procedures at least five joint and bursa injections at least five neuromodulation at least five nerve blocks, including a variety of blocks such as intercostal, ilioinguinal blocks, genitofemoral blocks, and lateral femoral cutaneous blocks. Objectives by Core Competency Patient Care Exposure to a wide variety of clinical pain problems amenable to interventional pain techniques. Become familiar with theory, benefits, indications, and practical applications of the following procedures and techniques: 1. A broad range of spinal and peripheral nerve block procedures 2. Joint and bursal sac injections 3. Cryoneurolysis 4. Epidural, subarachnoid, or peripheral neurolysis 5. Electrical stimulation techniques (Spinal and Peripheral) 6. Vertebral Augmentation procedure 1

2 7. Implanted epidural and intrathecal catheters, ports, and infusion pumps 8. Discography and pressure controlled disc stimulation 9. Botox Chemodenervation of muscles and nerves in the periphery 10. Trigeminal ganglion blockade 11. Peripheral neurolysis, via chemical and radiofrequency thermal destruction 12. Sympathectomy techniques (celiac, lumbar, hypogastric, impar) 13. How to avoid, manage and diagnose procedural and device related complications 14. Prevention, recognition and management and resuscitation 15. Recognition and management of therapies, side effects and complications of pharmacologic agents used in pain management with special attention to intrathecal agents. Medical Knowledge Gain a solid understanding of the following topics, lectures and readings pertaining to interventional pain medicine 1. Anatomy and physiology of the pain projection and modulation systems where interventions can be focused 2. Pharmacology of injectates: contrast, local anesthetics, depo-steroids 3. Pharmacology of intrathecal agents: opioids, baclofen, clonidine, bupivacaine, ziconotide and investigational drugs 4. Mechanisms of neural destruction and modulation and clinical application 5. Measurement and assessment of pain and function as could be impacted by interventional pain management 6. Familiarity with equipment for interventional pain 7. Principles of diagnostic neural blockade including false positives and limitations of these techniques. 8. Understanding of treatment algorithms for complex pain syndromes such as postlaminectomy pain and complex regional pain syndromes. 9. Knowing the differential diagnosis of chronic low back pain including sacroiliac, facet, and disc so as to be able to apply interventional techniques 10. Principles and techniques of acute pain management 11. Principles and techniques of cancer pain management so as to appropriately select patients for neurolytic techniques, and implantable therapies 12. Application of interventional pain to chronic neck pain and headache syndromes 13. An in depth understanding of theory and application of cryoanalgesia and radiofrequency techniques in chronic pain medicine 14. Latest developments and applications of spinal cord stimulation technology 15. Basic surgical skills and implantable techniques 16. Lectures on fluoroscopy and MRI interpretation 17. Ultrasound 2

3 Practice-based Learning and Improvement Participate regularly in morbidity and mortality conferences, journal reviews, and research seminars. Interpersonal and Communication Skills Explain pain conditions, formulate a diagnosis and list therapeutic options to other physicians and healthcare providers. Communicate effectively with physicians, nurses, and other healthcare professionals, as well as health related agencies. Work effectively as a member or leader of a health care team or other professional group. Act in a consultative role to other physicians and health professionals. Maintain comprehensive, timely, and legible medical records. Professionalism Demonstrate a commitment to carrying out professional responsibilities and adherence to ethical principles. Show compassion, integrity, and respect for others. Demonstrate responsiveness to patient needs that supersedes self-interest. Maintain respect for patient autonomy and privacy. Demonstrate accountability to patients, society and the pain profession. Show sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Systems-based Practice Demonstrate awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal health care. Able to identify patients for appropriate interventions as well as refer for other diagnostic tests prior to these interventions. Ensure appropriate less invasive therapies have been tried or are not indicated prior to pursuing advanced pain modalities. Prepare prior authorization letters to third party payers which detail the need for a particular therapy. This involvement with insurance providers necessitates fellows to 3

4 have a detailed understanding of a given patient s medical condition as well as the indication for the requested procedure 4

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