Pain and anesthesia

[optimus_prime]

I was wondering if someone could tell me how realistic it is to practice both pain and OR anesthesia. Is it common to find situations in which one could do a few days a week of each?

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[toxic-megacolon]

I was wondering if someone could tell me how realistic it is to practice both pain and OR anesthesia. Is it common to find situations in which one could do a few days a week of each?

I did a pain management rotation, had 3 attendings, all of whom worked both in the OR, as well as in the pain clinic/procedure lab. Keep in mind this is academics though, don't know anything about the private world.

 

[Aether2000]

Much depends on the clinic set up, the support staff available, the type of procedures performed, and the on call fungibility coverage. For starters, no one can serve two masters, and if the OR is taking priority over the pain clinic leaving patients waiting for hours for appointments or procedures while the anesthesiologist is chained to a machine, this is clearly a disservice to patients and represents a physician who has lost control of their practice of medicine (not to mention having their priorities screwed up). If a physician is the only one in the group implanting pumps or stims and does not have designated 24 hour coverage in case of emergencies, that is tantamount to malpractice. If the pain clinic is open 1 day a week and the physician frequently calls in prescriptions for narcotics during the remainder of the week, the doc is walking a tightrope with the DEA and state regulators for not performing appropriate evaluations prior to prescribing narcotics, esp if he has never seen the patient before.
There are times when a pain center can function well with OR anesthesia but the physician must be rigid in his obligation to the pain patients and give them the time necessary for examination and therapy

 

[Kenzie1]

Yes, i also agree with algosdoc. It totally depends on clinic. So, you have to select clinic very carefully and prefer which have all facilities along with efficient staff.

 

[nctxil]

Yes. It can be done, but I think most practice one or the other. I practice 1/2 time doing each. I had previously practiced 100% pain. I prefer my current setup especially given that future reimbursement is uncertain in either with health care reform. I want the flexibility to do either if needed.

For those of you doing both anesthesia and pain, what do you think about the future of both with health care reform? I think the primarily elective nature of interventional pain is going to make getting procedures done a challenge.

 

[marrydavidson10]

Pain is spent to a CNS on two basic conduction paths: the Specific path - back horns of a spinal cord specific kernels of a thalamus a cortex of a back central gyrus. This path is little neuronic, fast, spends threshold, emotionally uncolored, precisely localised pain (epicritic a pain). Nonspecific (paleospinothalamic) a path - back horns of a spinal cord nonspecific kernels of a thalamus a cortex frontal and a parietal lobe diffusively. Spends the subthreshold, emotionally imbued, badly localised pain (a protopathic pain). Is slow, multineural since forms numerous collaterals to myelencephalon, a reticular formation, limbic system, a hippocampus. Subthreshold painful impulses are exposed to a summation in a thalamus. Impulses spent on a nonspecific painful path provoke the emotional centres of limbic system, the vegetative centres of a hypothalamus, myelencephalon. Therefore the pain is accompanied by pavor, burdensome experiences, increase of breath, sphygmus, BP lifting, a mydriasis, dyspeptic disorders. Action of painful nociceptive system is counteracted antinoceptive by the system which basic neurones are localised in aqueduct grey matter (a Sylvian aqueduct bridges III and IV ventricles). Their axons form descending pathes to prolate and to a spinal cord and ascending pathes to a reticular formation, a thalamus, a hypothalamus, limbic system, basal ganglions and a cortex. Mediators of these neurones are pentapeptideses: Met-enkephalin and Leu-enkephalin, having as trailer amino acids accordingly methionine and Leucinum.

 

[PMR 4 MSK]

Pain is spent to a CNS on two basic conduction paths: the Specific path - back horns of a spinal cord specific kernels of a thalamus a cortex of a back central gyrus. This path is little neuronic, fast, spends threshold, emotionally uncolored, precisely localised pain (epicritic a pain). Nonspecific (paleospinothalamic) a path - back horns of a spinal cord nonspecific kernels of a thalamus a cortex frontal and a parietal lobe diffusively. Spends the subthreshold, emotionally imbued, badly localised pain (a protopathic pain). Is slow, multineural since forms numerous collaterals to myelencephalon, a reticular formation, limbic system, a hippocampus. Subthreshold painful impulses are exposed to a summation in a thalamus. Impulses spent on a nonspecific painful path provoke the emotional centres of limbic system, the vegetative centres of a hypothalamus, myelencephalon. Therefore the pain is accompanied by pavor, burdensome experiences, increase of breath, sphygmus, BP lifting, a mydriasis, dyspeptic disorders. Action of painful nociceptive system is counteracted antinoceptive by the system which basic neurones are localised in aqueduct grey matter (a Sylvian aqueduct bridges III and IV ventricles). Their axons form descending pathes to prolate and to a spinal cord and ascending pathes to a reticular formation, a thalamus, a hypothalamus, limbic system, basal ganglions and a cortex. Mediators of these neurones are pentapeptideses: Met-enkephalin and Leu-enkephalin, having as trailer amino acids accordingly methionine and Leucinum.

Holy WTF?!?

 

[lambartdennis12]

I was wondering if someone could tell me how realistic it is to practice both pain and OR anesthesia. Is it common to find situations in which one could do a few days a week of each?