marathon chick

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A Program Director at my school told me that Anesthesia owns Interventional Pain Management and will continue to own it. He said many physicians don't even think to refer their patients to PM&R doctors for pain management-for rehabilitation yes but not pain. He even went as far as to say "PM&R only get the scrapes and left overs that Anesthesia doesn't want" What are your thought about this and do you have any facts to prove his statement wrong.



Interventional Pain Management
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Well, yes anesthesia "owns" pain management. I do not think you could argue with that.

However, if you market yourself as a "pain management" specialist, that is how your refering docs will think of you. I do not think they will really care whether you got there via Anesth. or PM&R, unless they are smart and know the advantages a PM&R pain doc can give.

PM&R is such a small field compared to Anesth as far as residencies and practicing docs!

Seriously though, Anesthesiologists put people to sleep for a living, while PM&R docs see neuro-muskculoskeletal patients all day, many/most with pain complaints. How does putting people to sleep really help you to understand how to treat their pain and keep them *functional* when they are awake, especially if you get very little neurology or orthopedic exposure as a Anesth resident?

I suppose if you want a "block doc" anesthesia is the way to go. But if you want a doc with the training to treat pain and improve function, then PM&R is the best way to go.

I respect Anesth. very much and hope I have not upset anybody with these comments.

Sorry for the rambling post. thanks!
Nov 21, 1998
Over the rainbow
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Was the program director you spoke with in Anesthesia? You have to take these turf war things with a grain of salt. One of the anesthesia-trained pain specialists I worked with as a student told me that if he knew that he would be doing pain medicine after burning out of OR-anesthesia he would have gone into PM&R. He cited the training in physical medicine, physical diagnosis, and electrodiagnostics as huge advantages. You can teach a monkey *where* to stick a needle, but teaching the monkey *when* to stick the needle and *why* to stick the needle---that's a different matter altogether.
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Stinky T

As a medical student, I had several Anesthesia Pain Docs tell me that they wished they had done a PM&R residency instead. If you want to do Interventional Pain Management, I think PM&R is a better route. The interest in Interventional Pain Management by PM&R residents is a recent phenomenon. Previously, most graduates did inpatient rehab and did fellowships in SCI, TBI, Cardiac, Pulmonary, etc. Most residents now want to do outpatient physical medicine. The rules regarding board certification in Pain Management recently changed. In 2003, you will need to do a fellowship accredited by the ACGME. This is the reason that many of the PM&R fellowship weren't accredited because they didn't need to be. With these new requirements, many more PM&R fellowships will apply for accreditation. The PM&R program at Harvard, for example, applied and received ACGME accreditation this year for their Interventional Pain Managment Fellowship. Also, everyone in my program that has wanted to do an Anesthesia Pain Fellowship got a position. At MGH (Harvard), the Anesthesia Pain Program has taken a PM&R graduate every year for the last three years. The Pain Group at Yale last year specifically sought and found a Physiatrist to join their group. In addition to sharing the interventional pain procedures, he will be doing EMGs and medical orthopedics. Many groups and fellowships are starting to realize that Physiatrists bring an extra dimension to the practice of Pain Management.

In my opinion, if you want to do Pain Management, you should do an Anesthesia residency only if you want to do OR Anesthesia on a part-time basis as well. Otherwise, the origin of most of the pain you will see will have a neuromuscloskeletal origin and the training in Anesthesia doesn't cover this.

Here's a couple of thread that you might want to read:



Amercian Board of Physical Medicine and Rehabilitation:

Subspecialty in Pain Management:

PASSOR PM&R Fellowship Database:


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Actually there are already three accredited PM&R Interventional Pain Fellowships:

1. Spaulding
2. Virginia
3. Oklahoma City (through Baylor)

I'm sure that there are many other programs that will receive appropriate ACGME-certification within the next 5 years. Given the small number of PM&R residencies, I would speculate that 15 fellowships would be adequate to supply the demand for them.

And, there are several anesthesia pain fellowships that are more than willing to take good PM&R graduates.


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I have had similar questions regarding pain, and until discovering this forum, I have had to do my own research. My understanding is that a recent ruling allowed Pain programs to be open to Anesth, PM&R and Neurology residents. While a lot of Anesth programs take Anesth. residents, many of them take PM&R residents also (and perfer to in order to increase diversity).

I am in my intern year for internal medicine, and I just did a pain elective with the neurology department (I'll start PM&R next year). The neuro-pain doc admitted that a lot of his patients might have been better served going to a PM&R doc (lots of back pain for example). It's a shame that PM&R lacks the widespread exposure. He is not into prodecures, so he mostly handles patients with meds and will refer to Anesth. for big time blocks, etc. He specializes in chronic headaches.

I agree with Ligament and the other posters. In the real-world, once you establish yourself as a pain specialist, nobody really cares what you did before. Its just a matter of establishing your pain "niche". Hospitals and practices have their own connections with certain pain docs. There is so much demand for pain docs, that competition is not as fierce as it might appear.
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