CA2 chronic pain rotation-where to start?

[JDMcNugent]

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About to start my CA2 chronic pain rotation in a week. What’s a good resource(s) to peruse as a primer so I don’t look like a total idiot when I start the rotation?

 

[Propofool123]

Tbh most pain faculty know that anesthesia residents don’t care to be in pain clinic so they’ll be impressed if you just show enthusiasm and willingness to learn.

reading a quick primer on low back pain disorders is a good place to start just so that you can run through a differential in your mind of the cause of someone’s pain in clinic.

 

[deleted875186]

Benson essentials of pain medicine

furman atlas of image guideprocedures

both should be on your medical center library. Just read the chapter on back pain and lumbar radiculopathy. Look at the furman atlas to get familiar with fluoroscopy guided lumbar epidural and lumbar medial branch blocks.

 

[fathead88]

As a CA2 if you’re doing procedures it will mostly be lumbar epidural steroid injections, lumbar facet (medial branch) blocks, and SI joint injections. Familiarize yourself with the fluoro and indications for each and you will be well prepared.
One word of advice for the interlaminar lumbar epidurals: we know you’ve probably done 100 or more lumbar epidurals on the L&D floor, landmark based, with women squirming from labor pain. So you think to yourself.. a prone patient, not in labor, AND we get to use fluoro? Must be easy mode! Right? Just be careful young grasshopper, remember you are intentionally placing a needle near stenosis, advance slowly, frequently check the fluoro (and then look over at your attending to see their facial expression), and inject slowly once you get loss. Always review MRI if you have one before the procedure, especially if neither you nor your attending ordered the procedure.

Typically the Pain rotation is super chill compared to the cardiac, Neuro, peds and other subspecialty rotations you do as a CA2, so enjoy the month!

 

[Dr. Ice]

Benson essentials of pain medicine

furman atlas of image guideprocedures

both should be on your medical center library. Just read the chapter on back pain and lumbar radiculopathy. Look at the furman atlas to get familiar with fluoroscopy guided lumbar epidural and lumbar medial branch blocks.

Why look at Furman’s book? He’s a pmr guy sponsoring a NASS fellowship. Everything in that book must be voodoo...🤔

 

[deleted875186]

As a CA2 if you’re doing procedures it will mostly be lumbar epidural steroid injections, lumbar facet (medial branch) blocks, and SI joint injections. Familiarize yourself with the fluoro and indications for each and you will be well prepared.
One word of advice for the interlaminar lumbar epidurals: we know you’ve probably done 100 or more lumbar epidurals on the L&D floor, landmark based, with women squirming from labor pain. So you think to yourself.. a prone patient, not in labor, AND we get to use fluoro? Must be easy mode! Right? Just be careful young grasshopper, remember you are intentionally placing a needle near stenosis, advance slowly, frequently check the fluoro (and then look over at your attending to see their facial expression), and inject slowly once you get loss. Always review MRI if you have one before the procedure, especially if neither you nor your attending ordered the procedure.

Typically the Pain rotation is super chill compared to the cardiac, Neuro, peds and other subspecialty rotations you do as a CA2, so enjoy the month!

Yes, please don’t slam in 3 cc of air or saline all at once when you get LOR, patient will jump and be very unhappy