Considering pain

[greymatters]

Been looking at old posts, there is some info but a bit confusing so thought I'd ask for clarification.

1. How difficult is it getting into a pain fellowship from Neurology, are a few publications and good LORs enough? (I understand it's more difficult than gas and also PMR)

2. Would a Neurologist have a different scope of practice than someone from a more traditional background, or are they able to offer everything that an anesthetist could?

3. Could a pain physician have their own practise or does one have to be a partner?

Thank you for reading, would appreciate any replies

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[rjgennarelli]

Ever get an answer to this?

 

[michaelrack]

3. Could a pain physician have their own practise or does one have to be a partner?

It can be done either way

 

[nerdology123]

I'm a pgy-4 neurology resident starting a pain fellowship next year. For us, it is VERY competitive. But then, it depends on your USMLE scores, publications/posters within pain medicine, and more importantly who you know. It is certainly doable. Some programs won't even look at your application of you are from Neuro, BUT there are other programs that pride themselves in diversity and are welcoming to Neuro.

Once you do a pain fellowship, in terms of scope of practice no one cares if your background is anesthesia or pm&r or Neuro or psych. As long as you feel comfortable doing those procedures and went to a program that gave you exposure to those procedures during fellowship.

I would argue Neuro is more relevant to clinical pain management than anesthesiology. Headaches, peripheral neuropathy, etc are important and we come in with a strong clinical skill set that many others don't get. We can diagnose the underlying causes, interpret NCS/EMGs, and treat medically even before starting fellowship. Maybe we overall have a steeper learning curve with procedures but hey, each of the 4 specialties bring something to the table.

 

[dunecat]

.

 

[Newyawk]

reviving this bc I didn't know this was possible. any new insight anyone has to offer?

 

[liquidshadow22]

Some of these pain procedures seem relatively invasive, e.g. minimally invasive lumbar discectomy, pain pump/stimulator implantation. I wonder how anesthesia, neuro, and psych are able to perform these procedures well? I understand PMR does a lot of injections during their residency, but I wonder how easy it is for these other physicians to learn the anatomy well enough and become proficient in the more technically advanced procedures within a year?

 

[Thama]

Some of these pain procedures seem relatively invasive, e.g. minimally invasive lumbar discectomy, pain pump/stimulator implantation. I wonder how anesthesia, neuro, and psych are able to perform these procedures well? I understand PMR does a lot of injections during their residency, but I wonder how easy it is for these other physicians to learn the anatomy well enough and become proficient in the more technically advanced procedures within a year?

Discectomy, even minimally invasive, and intrathecal pump placement are neurosurgical procedures. These may be done in collaboration with pain specialists but you aren't going to become a neurosurgeon after a year of fellowship after a clinical residency. Learning injections, on the other hand, is not a big deal for a neuro resident who is experienced with LPs and EMGs, though it might be for a psychiatry resident who hasn't picked up a stethoscope in several years.

 

[liquidshadow22]

pain trained physicians can perform these procedures kyphoplasty, X-STOP, MILD procedure, and implants. You don't need to be a neurosurgeon to perform them.

 

[SeniorWrangler]

If you're interested in pain fellowship, try to spend time in training with headache providers, get experience with nerve blocks and EMG which are highly relevant, see if you can do a pain rotation, and do some pain-relevant research. You want to demonstrate by word and deed that you're really interested in the field and have some relevant skills. It tends to be a competitive fellowship.
Also consider attending some pain conferences if you can, like American Pain Society, it is cheap when you're in training and you will learn a lot about the actual field of pain.