I need closure

[DocFeelGooD]

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Hi all, im a 3rd yr med student interested in pm&r. However, i enjoy giving nerve blocks and botox injections and was wondering on which programs emphasize these trigger point injections.

 

[axm397]

Hi all, im a 3rd yr med student interested in pm&r. However, i enjoy giving nerve blocks and botox injections and was wondering on which programs emphasize these trigger point injections.

If learning how to do injections is the only thing you are looking for in residency, then I would actually suggest applying to Anesthesia. I can tell you now that you will be quite unhappy in PM&R since the ACGME requires that you get a certain number of inpatient months and although almost all the programs in PM&R will give you exposure to botox and nerve blocks, that will not be the priority of most programs. In anesthesia, you will learn how to do those injections plus other procedures like intubating, starting lines, etc.

I would definitely look into the field of PM&R a little more and decide whether you will truly be happy pursuing a career in PM&R.

 

[lobelsteve]

Teaching trigger point injections takes 10 minutes maximum. That includes a powerpoint presentation and practical. This is not what is learned in residency. PMR should not be doing a lot of trigger points- they should be done by the FP and if that doesn't work- they send them to PMR for evaluation.

If a patient has a nurse or MA in their family- I'll teach them how to do trigger points so they can avoid a copay and a trip to the office.

 

[paindefender]

Teaching trigger point injections takes 10 minutes maximum. That includes a powerpoint presentation and practical. This is not what is learned in residency. PMR should not be doing a lot of trigger points- they should be done by the FP and if that doesn't work- they send them to PMR for evaluation.

If a patient has a nurse or MA in their family- I'll teach them how to do trigger points so they can avoid a copay and a trip to the office.

Yeah. Send them to the new generation PMR guys for a stim or pump eval.They don't waste their time doing triggers.

 

[axm397]

Teaching trigger point injections takes 10 minutes maximum. That includes a powerpoint presentation and practical. This is not what is learned in residency. PMR should not be doing a lot of trigger points- they should be done by the FP and if that doesn't work- they send them to PMR for evaluation.

If a patient has a nurse or MA in their family- I'll teach them how to do trigger points so they can avoid a copay and a trip to the office.

agree- learned how to do trigger points as med student - took literally 5sec - "see one" then "do one" 😀

I was talking more in general about looking for only injection training in residency. I've seen too many people become disillusioned and unhappy during their inpatient PM&R months and some even switch fields - so I wanted the IP to understand what he/she was getting him/herself into before committing to 4 years of PM&R residency. Most physiatrists - even interventional ones - have some kind of philosophical reason for choosing to do PM&R (i.e. learn how to do a good MSK eval, focus on function, etc).

 

[paz5559]

Yeah. Send them to the new generation PMR guys for a stim or pump eval.They don't waste their time doing triggers.

Why don't you quote me some literature that shows your trigger point injections work before adopting a holier-than-thou attitude toward those of us who practice evidence based medicine with procedures that actually have literature to document the efficacy of what we do.

 

[paindefender]

Why don't you quote me some literature that shows your trigger point injections work before adopting a holier-than-thou attitude toward those of us who practice evidence based medicine with procedures that actually have literature to document the efficacy of what we do.

Evidence based medicine? Show me your literature on your tripoles and sacral stimulators.

 

[paz5559]

Evidence based medicine? Show me your literature on your tripoles and sacral stimulators.

What is this, third grade?

I'll only show you mine if you show me yours first? Tripoles and retrogrades are novel, off-label uses that thought leaders have suggested, but have only been utilized recently. Anterograde SCS for radicular pain have a Johns Hopkins generated RCT produced by Richard North.

TPIs, on the other hand, have overt literature that documents they are no better than placebo with regard to any long or mid-term benefit

Your undercurrent of hostility and aggresive tone, however, seem worrisome - perhaps you might wish to discuss that with your therapist at your next visit.

 

[paindefender]

What is this, third grade?

I'll only show you mine if you show me yours first? Tripoles and retrogrades are novel, off-label uses that thought leaders have suggested, but have only been utilized recently. Anterograde SCS for radicular pain have a Johns Hopkins generated RCT produced by Richard North.

TPIs, on the other hand, have overt literature that documents they are no better than placebo with regard to any long or mid-term benefit

Your undercurrent of hostility and aggresive tone, however, seem worrisome - perhaps you might wish to discuss that with your therapist at your next visit.

No hostility here. I never said trigger points were effective or better than placebo. Maybe a therapist will keep you off the internet and help you find a decent job.

 

[lobelsteve]

Neuromodulation August 2006- Sacral Nerve Stim article- transforaminal vs retrograde.....

 

[paz5559]

Yeah. Send them to the new generation PMR guys for a stim or pump eval.They don't waste their time doing triggers.

I never said trigger points were effective

Ah, my bad. When you said those of us who place stimulators as a last resort don't waste our time doing trigger point injections first, I was clearly of the erroneous belief you were of the impression that would be a worthwhile endevour. I obviously was mistaken.

 

[Brooklyndo2.1]

Ok somewhat serious question... so please dont bash the student...
if a patient "swears it works" (whatever it is) and provides enough symptomatic relief to function where other (for the sake of arguement more evidence based) interventions did not succeed, should a physician continue to do only those things that have evidence based proof or should the physician do what the patient is helped with even if it can possibly be relying on the placebo effect?

 

[paz5559]

Ok somewhat serious question... so please dont bash the student...
if a patient "swears it works" (whatever it is) and provides enough symptomatic relief to function where other (for the sake of arguement more evidence based) interventions did not succeed, should a physician continue to do only those things that have evidence based proof or should the physician do what the patient is helped with even if it can possibly be relying on the placebo effect?

The specific "it" matters, since the risk benefit ratio is how I personally would decide whether to go forward or not.

(see, no bashing at all!

 

[Brooklyndo2.1]

well lets go out on a limb here and say tpi for myofacial pain syndrome vs lets say Tricyclics...
Im not talking about surgical procedures here, just two pretty "benign" (as far as that goes) interventions...
(and i appreciate the non bashed state i am currently in, thanks)

aside: i do not know how, if at all, proven tricyclics are to work in this case, but for the sake of argument can we assume them to be the next best thing since sliced bread, (p=.05)

 

[Spine Specialist]

What is this, third grade?

I'll only show you mine if you show me yours first?

ROFL

 

[Disciple]

If learning how to do injections is the only thing you are looking for in residency, then I would actually suggest applying to Anesthesia. I can tell you now that you will be quite unhappy in PM&R since the ACGME requires that you get a certain number of inpatient months and although almost all the programs in PM&R will give you exposure to botox and nerve blocks, that will not be the priority of most programs. In anesthesia, you will learn how to do those injections plus other procedures like intubating, starting lines, etc.

How do you know that same person won't be unhappy stool sitting, taking it from surgeons, SICU, OB epidurals/night call, CCU, etc.

Anesthesia residents do blind epidurals. I don't think they get any more (and possibly even less exposure in some cases) to interventional pain procedures (transforaminals, MBBs, facets, SIJ injections) than Physiatry residents.

 

[axm397]

How do you know that same person won't be unhappy stool sitting, taking it from surgeons, SICU, OB epidurals/night call, CCU, etc.

Anesthesia residents do blind epidurals. I don't think they get any more (and possibly even less exposure in some cases) to interventional pain procedures (transforaminals, MBBs, facets, SIJ injections) than Physiatry residents.

True - but in terms of "procedures" - not just interventional pain but just plain procedures (like epidurals, lines, some regional anesthesia techniques, etc.) - you would get more exposure in anesthesia than in rehab.

I just want people to know what they are getting themselves into when they apply to PM&R solely to do interventional pain without actually knowing what the rest of PM&R training entails. I've seen too many people get disillusioned and unhappy because of lack of exposure to PM&R as a field before applying to the field. AND - if you go into the application process with the mindset that the residency training is just a stepping stone to get to interventional pain, PDs and academic physiatrists who will be interviewing applicants - tend to frown upon that mindset (whether that's right or wrong, I'm not making a judgement).

 

[Disciple]

If you go into the application process with the mindset that the residency training is just a stepping stone to get to interventional pain, PDs and academic physiatrists who will be interviewing applicants - tend to frown upon that mindset (whether that's right or wrong, I'm not making a judgement).

Yeah, it's important to be diplomatic about it, though I have known some people who left Anesthesia due to the reasons I listed above.