Pain Management via Neurology, really?

[bigfrank]

Hi,

I am really interested in pain management but have been apalled at how anesthesiologists go about it. Procedures, procedures and some more procedures. In-and-out, you get the idea.

But...99% of the pain fellowships are anes-based.

That said, I know that Neurology is another theoretical path by which one can become a pain management specialist.

So my question is this: Can you REALLY do pain management via Neurology? If so, HOW? Don't the anes-based ones only accept MDAs?

Thanks, anyone's advice is v. appreciated.

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[Stinky T]

Neurologists that do Pain Management usually do not do Interventional Pain Fellowships. Next to Anesthesiologists, Physiatrists are the ones who fill up the fellowships and practice interventional pain management. The Anesthesia Pain Fellowships do not only take Anesthesiologists. One of our graduating seniors was offered Anesthesia's Pain Fellowship at Mass General and there was also a Physiatry fellow at MGH the year before. Everyone in my program that has wanted an Interventional Pain Fellowship through Anesthesia has gotten one.

 

[bigfrank]

Bump...

 

[drusso]

Anesthesia and PM&R are the two most recognized pathways to pain management. But, neuro is an option. Depends what area(s) of pain you're interested in doing. The anesthesia pain fellowships are heavy into procedural aspects and cancer pain. PM&R based fellowships also get a fair amount of procedural training, but the emphasis is more on musculoskeletal conditions and modalities. Psych is also another avenue if you wish to deal with the psychosocial aspects of pain.

 

[Neurogirl]

Yes, neuro IS a viable option to INTERVENTIONAL pain mgmt (an option I'm still considering). The path is via an interventional pain fellowship (usu an anesthesia program, but there are a couple of interventional neuro programs). A few months ago I spent some time with an interventional pain guy (an anesthesiologist) and he said that if that's what I want to do I won't have ANY problem getting an interventional fellowship (anesth). He said that MOST of the serious pain research is done by anesth and neuro (his words...not mine), and that I'd be welcomed by most programs.

 

[Stinky T]

Well.....I guess I must have heard something different. Most of the people I've met doing Interventional Pain (including Anesthesiologists) have stated that PM&R is a much better route. Many of the patients that you see in the Pain Clinic have musculoskeletal origins for their pain or at least need to have that excluded. PM&R docs spend a lot of time during residency learning the anatomy, diagnosis, and treatment of these conditions. Anyone that wants to be boarded in Pain now has to do a fellowship accredited by the ACGME. In response to this, we know have our own Pain fellowship run by PM&R and accredited by the ACGME. Many of the Pain fellowships run by PM&R will probably also apply for accreditation. Personally, I think if you are interested in Interventional Pain, you should try to go to a progam that has its own fellowships and/or offers ample elective for you to get to know the people there or elsewhere. Also, in my opinion, PM&R is a better fit for those interested in Interventional Pain. However, I think that the best programs are the ones that have more than one specialty involved in the training of their fellows.