Pain Fellowships

[Paindoc1]

OK so I will admit that I don't really visit the neuro forum but it seems like no one here is really interested in Pain Management. Is this true? More people seem to be into neuro-rads. Just wondering why there are only 4 neuro-based acgme acc. fellowships.
Any thoughts?

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[neurologist]

OK so I will admit that I don't really visit the neuro forum but it seems like no one here is really interested in Pain Management. Is this true? More people seem to be into neuro-rads. Just wondering why there are only 4 neuro-based acgme acc. fellowships.
Any thoughts?

I think there are 3 reasons for this:

1. Not a lot of people go into neuro expecting that pain mgmgt will be a big part of their practice. I know I didn't. This is a huge "flaw in the system" stemming from the structure of most neuro training programs, which in med school and residency focus on hospital-based neurology, i.e., stroke and other acute events. If more time was spent in an outpatient setting during training, I think people would recognize that at least 50% of general neuro is some type of pain issue (headache, back pain, peripheral neuropathy, etc).

2. Many (most?) docs simply don't like deaing with chronic pain patients.

3. Interventional pain mgmt (which is where the real $$$ is in pain) has long been the realm of anesthesia and/or rads. They're not going to be happy to give it up, and again, you just don't get exposed to it in med school/neuro residency.

 

[Green Xenon]

I think there are 3 reasons for this:

1. Not a lot of people go into neuro expecting that pain mgmgt will be a big part of their practice. I know I didn't. This is a huge "flaw in the system" stemming from the structure of most neuro training programs, which in med school and residency focus on hospital-based neurology, i.e., stroke and other acute events. If more time was spent in an outpatient setting during training, I think people would recognize that at least 50% of general neuro is some type of pain issue (headache, back pain, peripheral neuropathy, etc).

2. Many (most?) docs simply don't like deaing with chronic pain patients.

3. Interventional pain mgmt (which is where the real $$$ is in pain) has long been the realm of anesthesia and/or rads. They're not going to be happy to give it up, and again, you just don't get exposed to it in med school/neuro residency.

Pain can kill you if intense enough, whether you feel it or not.

Thats what nociassociation is.

 

[neurologist]

Pain can kill you if intense enough, whether you feel it or not.

Thats what nociassociation is.

Then why is Bill Clinton still alive?
After all, didn't he "feel our pain"?

 

[PainDr]

I think there are 3 reasons for this:

1. Not a lot of people go into neuro expecting that pain mgmgt will be a big part of their practice. I know I didn't. This is a huge "flaw in the system" stemming from the structure of most neuro training programs, which in med school and residency focus on hospital-based neurology, i.e., stroke and other acute events. If more time was spent in an outpatient setting during training, I think people would recognize that at least 50% of general neuro is some type of pain issue (headache, back pain, peripheral neuropathy, etc).

2. Many (most?) docs simply don't like deaing with chronic pain patients.

3. Interventional pain mgmt (which is where the real $$$ is in pain) has long been the realm of anesthesia and/or rads. They're not going to be happy to give it up, and again, you just don't get exposed to it in med school/neuro residency.

Agree with all the above. I'm a neurologist and interventional pain physician. I was interested in pain mgmt first then decided on my residency. I really loved neuro and to me, it seemed like a logical pathway to the subspecialty. I was able to land a top anesth pain fellowship, but it wasn't easy. During fellowship interviews, I realized that many people just didn't get it and I faced an uphill battle. Fortunately, I was able to document a longstanding interest in the field (pain rotations starting in med school and continuing throughout residency, research, mentors, etc.) and some of the more progressive programs were actually really interested in having multidisciplinary fellows so it all worked out. If you have any specific questions, feel free to ask.

 

[Yoyomama88]

I was looking at some of the pain procedures online - intrathecal pump, neuromodulation etc...some of these procedures look like neurosurgical procedures of the spine. Is that a fair assessment and how are these physicians qualified to perform these types of procedures with only a 1 yr fellowship?

 

[bustbones26]

OK so I will admit that I don't really visit the neuro forum but it seems like no one here is really interested in Pain Management. Is this true? More people seem to be into neuro-rads. Just wondering why there are only 4 neuro-based acgme acc. fellowships.
Any thoughts?

I think what happens is a number of individuals become neurologists then sort of develop an interest in pain during residency. By that time, its probably too late to convert to anesthesia or PM&R.

Back whenever I first went into neuro residency, there was hopes that interventional vascular neurolgy would be a big wave of a future. Likely, this is why there is still a big interest in neurorads today.

Myself, I took an interest in pain, well sort of. I became a headache specialist, so I would to think that I am pretty good at nerve block for craniofacial pain. On occasion, I have considered going out and doing a full out interventional pain fellowship but don't really have the endurance and am getting old. For guys like yourself, if its what you want to do, go for it.