Most common procedures

[Lostin_space]

Curious to know for those of you who do purely pain, what are the most common types of procedures you do on a regular basis?

I also need advice. Doing lots of soul searching, having rotated in a number of pain/outpatient rotations, these are the things i like to do:

-MBBs
-ESIs
-facet injections
-Botox/TPI with different chemical stuff
-Botox migraine
-different types of nerve blocks
-US procedures
-sacroiliac joint injections - some of my favorite things to do, I could do them all day! (sorry if this sounds lame)
-knee injections
-PRP/prolotherapy stuff

What I don't like
-spinal cord stimulator stuff
-cervical procedures - although I have not done any of these, I've heard many horror stories and don't know too many people who do these, although I'm not sure if my experience is biased here
-cervical/caudal racz

What would you all suggest I do in terms of fellowship? Advice would be appreciated!

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[willabeast]

sounds like a PMR pain or PMR spine fellowship. regarding cervical procedures - they are not more difficult than lumbar. some thoracic procedures can be difficult.
for example - it is a lot easier to do an interlaminar cervical ESI on a 350 pounder than a lumbar interlaminar ESI. but a thoracic T6 interlaminar is going to be more difficult on anyone. eventually, after about 7 years or so, you will be bored doing routine lumbar procedures unless the spines are unusual, for instance a severe rotatory scoliosis lumbar RF etc. but a real challenge would be a borderline personality disordered patient referred for chronic back pain with the referral stating "needs lumbar MBB to see if qualifies for RF" who sued one of your colleagues in the past. ask me how i know...

 

[SSdoc33]

you dont have to do the "higher-level stuff" if you dont want to -- regardless of the type of fellowship. you may not be able to control all aspects of where/how/what you do. apply to the best fellowships you can, and let the chips fall as they may. also, as this has been mentioned before, its not so much how to do a particular procedure -- any technician can do that -- its when to do them and more importantly, when not to do them that counts. find a well rounded fellowship with decent mentors. there are a lot out there who will stick a needle in anything with a pulse.

 

[cbest]

I would choose a fellowship that provides as solid a knowledge base and skill set as possible. I went into my pain fellowship with a similar mindset to you but by the end felt confident in performing cervical spine procedures and found I enjoyed SCS trials (not so much permanent implants). I wouldn't have known this unless I was exposed to a broad pathology and procedural experience. But still don't like pumps at all - no thanks!


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[Lostin_space]

I would choose a fellowship that provides as solid a knowledge base and skill set as possible. I went into my pain fellowship with a similar mindset to you but by the end felt confident in performing cervical spine procedures and found I enjoyed SCS trials (not so much permanent implants). I wouldn't have known this unless I was exposed to a broad pathology and procedural experience. But still don't like pumps at all - no thanks!


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It seems I don't really have a Pain letter though. after all my hard work and excellent evaluation at the end of the rotation. So I'm in a pickle.

 

[melancholy]

Curious to know for those of you who do purely pain, what are the most common types of procedures you do on a regular basis?

I also need advice. Doing lots of soul searching, having rotated in a number of pain/outpatient rotations, these are the things i like to do:

-MBBs
-ESIs
-facet injections
-Botox/TPI with different chemical stuff
-Botox migraine
-different types of nerve blocks
-US procedures
-sacroiliac joint injections - some of my favorite things to do, I could do them all day! (sorry if this sounds lame)
-knee injections
-PRP/prolotherapy stuff

What I don't like
-spinal cord stimulator stuff
-cervical procedures - although I have not done any of these, I've heard many horror stories and don't know too many people who do these, although I'm not sure if my experience is biased here
-cervical/caudal racz

What would you all suggest I do in terms of fellowship? Advice would be appreciated!

While I do think that doing a standard pain fellowship for a good basis in pain management as well as bread and butter fluoro and hopefully US guided procedures is always a safe bet, you could try and find a well respected non-accredited MSK/sports/spine fellowship where you can learn to manage a wide variety of different pain conditions using different modalities.

 

[SeniorWrangler]

That seems pretty "bread and butter" to me. I don't think anybody should do pumps and stims unless they really want to, they are good at it, and they have a good support system for the complicated pain patients that get these treatments.