Why is Anesthesia best suited for pain?

[Chocolateagar04]

I know I may have made an inflammatory comment especially those PMR and Neurology based but this is an honest question.

Most pain programs are run by Anesthesia so I was just wondering why that is. I know in my neurology clinic I see tons and tons of chronic pain patients and sometimes I feel helpless. I feel like if I had extra training in interventional pain I could at least offer them something. So how did Anesthesia come to dominate the field? I dont really care for the politics behind it I just want to know scientifically, clinically, what makes anesthesia the best suited for a pain fellowship? I feel like they dont have exposure to chronic pain patients as PMR or Neuro may but obviously Anesthesia is king in Pain fellowship so I was just wondering why.


Thanks for the information, I hope this thread doesn't become argumentative....

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[lobelsteve]

I know I may have made an inflammatory comment especially those PMR and Neurology based but this is an honest question.

Most pain programs are run by Anesthesia so I was just wondering why that is. I know in my neurology clinic I see tons and tons of chronic pain patients and sometimes I feel helpless. I feel like if I had extra training in interventional pain I could at least offer them something. So how did Anesthesia come to dominate the field? I dont really care for the politics behind it I just want to know scientifically, clinically, what makes anesthesia the best suited for a pain fellowship? I feel like they dont have exposure to chronic pain patients as PMR or Neuro may but obviously Anesthesia is king in Pain fellowship so I was just wondering why.


Thanks for the information, I hope this thread doesn't become argumentative....

Politics and money more than anything else. Anesthesia gets much better residency training in interventions, but no adequate training in reading films or performing exams. PMR gets edge there but most programs have traditionally neglected to teach anything other than joint injections and EMG.

 

[pmrmd]

Anesthesia was doing ESIs and nerve blocks for years and thereby came to become the "pain doctors".

 

[101N]

John Bonica.

 

[lonelobo]

Probably because by nature they are the Hardest working

 

[hyperalgesia]

I know I may have made an inflammatory comment especially those PMR and Neurology based but this is an honest question.

Most pain programs are run by Anesthesia so I was just wondering why that is. I know in my neurology clinic I see tons and tons of chronic pain patients and sometimes I feel helpless. I feel like if I had extra training in interventional pain I could at least offer them something. So how did Anesthesia come to dominate the field? I dont really care for the politics behind it I just want to know scientifically, clinically, what makes anesthesia the best suited for a pain fellowship? I feel like they dont have exposure to chronic pain patients as PMR or Neuro may but obviously Anesthesia is king in Pain fellowship so I was just wondering why.

Thanks for the information, I hope this thread doesn't become argumentative....

Nothing to do with "best suited". Anesthesia embraced the field first.

 

[Ducttape]

not to be argumentative either...

2 points:
1. Every doctor is taught how to do a physical exam. PMR is clearly better than anes, and one can argue that neurology is better in some respects than PMR.

every anesthesiologist knows how to do - and do well - a nerve block or an epidural. im not sure you can say that about the other fields in this respect.



2. Anesthesiology as a discipline is about pain management. From wikipedia:

Anesthesiologists (anaesthetists in the UK) are physicians who provide medical care to patients in a wide variety of (usually acute) situations. These can include delivering anesthesia during surgical procedures, caring for critically ill patients in an Intensive Care Unit (ICU), managing medical emergencies such as cardiac arrests and traumas either in-hospital or in the public domain (termed 'pre-hospital medicine'), the inter-hospital transfer of unwell patients, and the management of acute and chronic pain conditions.

an·es·the·si·ol·o·gy (ns-thz-l-j)
n.
The medical specialty concerned with the pharmacological, physiological, and clinical basis of anesthesia, including resuscitation, intensive respiratory care, and pain management.

versus

Physical medicine and rehabilitation (PM&R), physiatry /fɨˈzaɪ.ətri/ or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a physiatrist or rehabilitation medicine specialist. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).

 

[Jcm800]

Probably because by nature they are the Hardest working

out of the list of these three, yes

 

[lobelsteve]

out of the list of these three, yes

At supervising CRNA's and "Airway, Bagels, Coffee".

Hardest working for sure, but last as far as smartest working.

 

[emd123]

I know I may have made an inflammatory comment especially those PMR and Neurology based but this is an honest question.

Most pain programs are run by Anesthesia so I was just wondering why that is. I know in my neurology clinic I see tons and tons of chronic pain patients and sometimes I feel helpless. I feel like if I had extra training in interventional pain I could at least offer them something. So how did Anesthesia come to dominate the field? I dont really care for the politics behind it I just want to know scientifically, clinically, what makes anesthesia the best suited for a pain fellowship? I feel like they dont have exposure to chronic pain patients as PMR or Neuro may but obviously Anesthesia is king in Pain fellowship so I was just wondering why.


Thanks for the information, I hope this thread doesn't become argumentative....

Anesthesia took the most interest in Pain early on historically. Many specialties are very well suited for Pain yet few take interest, like Anesthesia and PMR.

For example, 70% of patients Emergency Physicians see have acute and or chronic pain as a chief complaint, yet only a handful have ever shown enough interest to seek ACGME fellowship training. Why? There's just not much interest. That doesn't imply there's a lack of being suited for the field.

Anesthesia staked their claim on the "turf" many years ago and now it's there's to defend. That doesn't mean that anesthesia is necessarily "best suited" for Pain. Many specialties see a tremendous amount of patients with chronic (or acute) pain. Neurosurg, ortho, ER, primary care, neurology, psych (fibro).....

It mostly comes down to who's interested enough to pursue the field, and which specialties have been most interested in the past.

Any specialty can go into Pain, do an ACGME fellowship and be ABMS boarded.

 

[Jcm800]

i agree completely. anyone can do pain, except for ER.

Anesthesia took the most interest in Pain early on historically. Many specialties are very well suited for Pain yet few take interest, like Anesthesia and PMR.

For example, 70% of patients Emergency Physicians see have acute and or chronic pain as a chief complaint, yet only a handful have ever shown enough interest to seek ACGME fellowship training. Why? There's just not much interest. That doesn't imply there's a lack of being suited for the field.

Anesthesia staked their claim on the "turf" many years ago and now it's there's to defend. That doesn't mean that anesthesia is necessarily "best suited" for Pain. Many specialties see a tremendous amount of patients with chronic (or acute) pain. Neurosurg, ortho, ER, primary care, neurology, psych (fibro).....

It mostly comes down to who's interested enough to pursue the field, and which specialties have been most interested in the past.

Any specialty can go into Pain, do an ACGME fellowship and be ABMS boarded.

 

[101N]

Absolutely, let ER in and there goes the neighborhood!

 

[joshmir]

In academic centers, the pain dept is usually a hybrid chronic and acute service, and usually runs the acute postop pain service, which requires residents/fellows to perform blind epidurals in older, sick folks to place catheters for epidural analgesia, and the occasional blind blood patch in the ER

They sometimes also perform high volume local anesthetic nerve blocks (usually with ultrasound guidance); ideally you want the folks doing these on a regular basis to be able to intubate quickly

Here PMR and neurology and ER are at a disadvantage because they do not do blind ESIs and manage airways nearly as much as an anesthesia resident who covers labor and delivery doing tons of blind epidurals

Since academic centers have the most fellowships, and they tend to be hybrid acute/chronic pain, thats how the cookie crumbles