GoodmanBrown

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So, I didn't see any posts regarding this and I'm curious, what's the best route to get into pain medicine? I'm applying to med schools this round, and I starting to get curious about specialties. I've shadowed anesthesiologists, physiatrists, and neurologists and found each to be interesting in its own way. So, with pain being a cross section of all 3 (plus some psychiatry), I'm definitely interested in it.

So, the questions is, is there a better initial residency to go to get into an accredited pain fellowship? Would one or the other help you more in your day-to-day practice? Thanks!
 

Jcm800

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So, I didn't see any posts regarding this and I'm curious, what's the best route to get into pain medicine? I'm applying to med schools this round, and I starting to get curious about specialties. I've shadowed anesthesiologists, physiatrists, and neurologists and found each to be interesting in its own way. So, with pain being a cross section of all 3 (plus some psychiatry), I'm definitely interested in it.

So, the questions is, is there a better initial residency to go to get into an accredited pain fellowship? Would one or the other help you more in your day-to-day practice? Thanks!

there is no right answer, as long as you dont do PMR, hehe. just kidding.

but the only advice I have do a residnecy in something that you wouldnt mind having a career in, just in case the pain thing doesnt work out, or you change your mind. If you like PMR, do it, because you can always do it again if you either change jobs, dont want to do pain, etc.

but dont do a residency because you think it will be "easier" but you hate doing it, you never know what can happen. Most people dont have the luxury as another potential field to go in. For instance, i may go back to anesthesia if I ahve another day like today...not really...
 

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Best way to get into pain?

Jump off a bridge.



Try the veal....

Everchanging field. Gas>PMR>Neuro>FP sports
 
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GoodmanBrown

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Fair enough. I understand that it's important to do what you enjoy first and foremost and to keep your initial residency as a "back-up" in case pain doesn't work out.

But, what about my second question? Does one of the areas prepare you more thoroughly for pain work? Is it such a mixture of all four that you don't really use more neurology than anesth. day-to-day? It seems like the neurology would be useful for all your general medications, but that the procedures from anesth. would be useful as well. Just curious. Thanks!
 

jettavr6

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Fair enough. I understand that it's important to do what you enjoy first and foremost and to keep your initial residency as a "back-up" in case pain doesn't work out.

But, what about my second question? Does one of the areas prepare you more thoroughly for pain work? Is it such a mixture of all four that you don't really use more neurology than anesth. day-to-day? It seems like the neurology would be useful for all your general medications, but that the procedures from anesth. would be useful as well. Just curious. Thanks!
IMHO, a mixture of everything in medicine... More heavily concentrated in Anesthesia, Neuro, PMR and Psychiatry... But don't discount the value of internal medicine, family practice, ob/gyn, surgery, etc...
 

Doctodd

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have u been keeping up with the current attack on pain medicine?.....id be crazy to go into it again even though i love what i do. Just too much uncertainty.
 
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GoodmanBrown

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I haven't really, but I'm keeping salary expectations low anyhow. If I make 120K-180K in today's dollars I'll be happy overall, I think. I (like a fair number of other pre-meds these days) am interested in having a decent non-work lifestyle as well. Not 12 weeks of paid vacay or anything, but something akin to a reasonable work week (45-50ish hrs. maybe?). So, if compensation isn't what it is now, I'm won't be too depressed.
 

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Lot's of advances are being in made in "functional neurosurgery" using minimally invasive/stereotactic techniques. I predict that within 20 years you'll see deep brain stimulators for migraines, fibromyalgia, intractable facial pain, irritable bowel syndrome, movement disorders/dystonia, spasticity, etc.
 

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Simplistic viewpoint:

If you prefer surgery and treating pain mostly with needles, anesthesia is for you.

If you prefer taking a muscluoskeletal approach and prefer staying away from surgeons, PM&R is for you.

If you prefer taking a neurologic approach and doing long, detailed exanms, neuro is for you.

In reality, all overlap, but the above posters are correct, whatever your primary field is (unless they invent the pain residency by the time you get to it) will be your base and your parachute should pain bottom out. Make sure it is something you can live with doing the rest of your life should pain not work out.

All 3 fields can be very life-style condusive. Anesthesiologists often work (relatively) set hours in the OR + call. PM&R can work any hours you want, often with no call. Neuro usually set their own hours as well, variable call.

I feel PM&R prepared me well for pain for diagnosis and basic treatments, but not for advanced pain interventions. Anesthesia by itself, does not prepare you for pain management, other than the skills of where to stick a needle. neuro probably does as well, but was pain syndrome are considered sub-tentorial, and neuro is heavily a supra-tentorial field traditionally.
 

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Lot's of advances are being in made in "functional neurosurgery" using minimally invasive/stereotactic techniques. I predict that within 20 years you'll see deep brain stimulators for migraines, fibromyalgia, intractable facial pain, irritable bowel syndrome, movement disorders/dystonia, spasticity, etc.
I predict that in 20 years, fibro and IBS will have new names and be treated without neurosurgery.
 
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GoodmanBrown

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Simplistic viewpoint:

If you prefer surgery and treating pain mostly with needles, anesthesia is for you.

If you prefer taking a muscluoskeletal approach and prefer staying away from surgeons, PM&R is for you.

If you prefer taking a neurologic approach and doing long, detailed exanms, neuro is for you.

In reality, all overlap, but the above posters are correct, whatever your primary field is (unless they invent the pain residency by the time you get to it) will be your base and your parachute should pain bottom out. Make sure it is something you can live with doing the rest of your life should pain not work out.

All 3 fields can be very life-style condusive. Anesthesiologists often work (relatively) set hours in the OR + call. PM&R can work any hours you want, often with no call. Neuro usually set their own hours as well, variable call.

I feel PM&R prepared me well for pain for diagnosis and basic treatments, but not for advanced pain interventions. Anesthesia by itself, does not prepare you for pain management, other than the skills of where to stick a needle. neuro probably does as well, but was pain syndrome are considered sub-tentorial, and neuro is heavily a supra-tentorial field traditionally.
Very interesting! Thanks! So, what are some advanced pain interventions? Are they mainly fluoro-guided nerve blocks? Implantable medication delivery systems? Surgical procedures? Just curious.
 
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PMR 4 MSK

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Very interesting! Thanks! So, what are some advanced pain interventions? Are they mainly fluoro-guided nerve blocks? Implantable medication delivery systems? Surgical procedures? Just curious.
Implanted intrathecal pumps, spinal cord stimulators, sympathetic blocks, radio-frequency ablation, vertebroplasty, IDET, Perc-D. Basically anything beyond epidurals, facets, SI joints. You should be able to walk out of any good anesthesia and PM&R residency doing the latter three, but to do the others usually requires fellowship.
 

SleepIsGood

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I think with Anesthesia you get a lot of invasive procedural training (ie epidurals, spinals, peripheral blocks, stellate ganglion, lumbar plexus, lumbar sympathetic blocks,etc to name a few).

To me this is a logical extension to then go into pain as you are very procedural.

Yes PMR may be able to do physical exams and EMGs better.
 
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GoodmanBrown

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Implanted intrathecal pumps, spinal cord stimulators, sympathetic blocks, radio-frequency ablation, vertebroplasty, IDET, Perc-D. Basically anything beyond epidurals, facets, SI joints. You should be able to walk out of any good anesthesia and PM&R residency doing the latter three, but to do the others usually requires fellowship.
So, admittedly, I had to look up most of the procedures you mentioned. I noticed that many of them relate to back pain, disc fusion, etc. Is most of pain medicine helping people with back pain? I'm just curious if you get phantom foot pains, old shoulder injuries, etc.?
 

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Spine is probably the majority of pain. But anything can hurt.
 

ampaphb

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Is most of pain medicine helping people with back pain?
Much of what we do addresses pain that arises from elements of spinal anatomy. Back pain implies axial only, and clearly both pain emanating in a somatic referral pattern, as well as radicular components are addressed by pain practitioners.

Neither headaches nor atypical facial pain are "back pain", but these also fall squarely within our domain.
 

lobelsteve

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Much of what we do addresses pain that arises from elements of spinal anatomy. Back pain implies axial only, and clearly both pain emanating in a somatic referral pattern, as well as radicular components are addressed by pain practitioners.

Neither headaches nor atypical facial pain are "back pain", but these also fall squarely within our domain.
We keep trying to give HA back to the Neurologists, but they keep failing to rescue enough patients.
 

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We keep trying to give HA back to the Neurologists, but they keep failing to rescue enough patients.
I gave it back a few years ago. Nothing seems to work for more than months whether I treat them or a neurologist does. Neuro developed all the headache categories, they can have it.
 

Jcm800

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Yes PMR may be able to do physical exams and EMGs better.[/QUOTE]

EMGS better? they CAN DO EMGS, anesthesia cannot. at least i dont know of any anesthesia trained guy that can do a REAL EMG, not that i think they are very useful anyway.

and their (PMR) exam out of residency and fellowship ar FAR superior, but it can be learned, and i have spent a great deal of time on this on my own to get better at it, but im still lacking.

but i bet I can put a central line in much quicker, which let me tell you, is a very usefull skill in my current practice of 100% pain, haha
 

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but i bet I can put a central line in much quicker, which let me tell you, is a very usefull skill in my current practice of 100% pain, haha
For the fibro's requesting IV dilaudid "because I'm hurting so BAD today! And I don't want to have to go to the ER again!" :D
 

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As a gas rez, I wanna know what I need to start doing now prior to applying. I'm kinda peeved with the 60 %ile on the last ITE. AKT6 was better at 80%. What can I do? Hope the next AKT18 or ITE is better?

I feel like I'll never get a pain spot or am I worrying too much. What to do?