pain procedures

[wood]

Does anyone know what types of procedures are done at pain clinics, and if these are the sole domain of anesthesia or are they in danger of turf wars with neuro, etc??

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[wood]

thanks for the feedback. The procedural end of anesthesia is fascinating. Turf wars are just a concern because of what is going on in interventional radiology and int. cardiology, etc. I can't help but think the neurologists may want in here.

 

[Fermata]

thanks for the feedback. The procedural end of anesthesia is fascinating. Turf wars are just a concern because of what is going on in interventional radiology and int. cardiology, etc. I can't help but think the neurologists may want in here.

I think neuro would stand a better chance of treading on rads territory than gas territory.

 

[Tenesma]

neuro is very interested in pain - primarily because reimbursement is higher than general neuro.... However, in my experience, I find that the neurons are usually very excited about procedures, then quickly most of them realize that they don't have the dexterity, and end up practicing pain from a non-interventional point of view....

the turf war over time will be between PM&R and Anesthesia... but since as of now most (>90%) of interventional pain programs are anesthesia based, that isn't an immediate concern.

 

[Finally M3]

Yes, the turf battle will be with us!

However, it's about keeping the procedures 'in house', and since there are many PM&R patients who get referred out for LESI or facet blocks. Personally, I would consider a pain fellowship to be able to perform the above procedure on my patients...but wouldn't go out of my way recruiting chronic pain patients.

I've had enough of chronic pain patients in my intern clinic....God forbid I would be accepting refferals for them in a pain clinic!

 

[Fermata]

Yes, the turf battle will be with us!

However, it's about keeping the procedures 'in house', and since there are many PM&R patients who get referred out for LESI or facet blocks. Personally, I would consider a pain fellowship to be able to perform the above procedure on my patients...but wouldn't go out of my way recruiting chronic pain patients.

I've had enough of chronic pain patients in my intern clinic....God forbid I would be accepting refferals for them in a pain clinic!

It would also help since the patients would follow the new % rule about having certain types of ailments.

PM&R is a cool and ever-evolving specialty.

 

[Idiopathic]

Ive been told that PM&R is not the best track for chronic pain control, simply because they dont get the intrathecal experience.

 

[Stinky Tofu]

Ive been told that PM&R is not the best track for chronic pain control, simply because they dont get the intrathecal experience.

I wouldn't agree with this statement because you would be assuming that lots of chronic pain patients get intrathecal pumps and that just isn't the case. Also, your experience with placing intrathecal pumps is more about your fellowship experience rather than whether you did Anesthesia or PM&R. I would actually argue that by virtue of my PM&R training, I probably have more experience with pumps than most Anesthesia residents do prior to fellowship training. We see lots of patients with spasticity in PM&R (both in adults and kids) and some of these patients will go on to get intrathecal baclofen pumps. The trials and implantations for these patients can be more technically challenging than implanting a pump for pain control. Since we do see patients with baclofen pumps in clinic, we also have more experience with pump refills.

 

[Idiopathic]

Fair enough. In actuality, it was expressed to me that anesthesiologists get more experience placing needles in people's spines than do PM&R docs do.

 

[Stinky Tofu]

Fair enough. In actuality, it was expressed to me that anesthesiologists get more experience placing needles in people's spines than do PM&R docs do.

Yes, Anesthesiologists do have more experience with doing "blind" epidurals and with using the LOR (loss of resistance) technique. However, I felt that my residency gave me more experience with doing procedures under fluoroscopy and with doing the procedures via the transforaminal approach.

Personally, I think that having a clinic staffed by both Physiatry and Anesthesiology is ideal. I've rotated through several Anesthesia departments and felt that I had lots to offer the Anesthesia residents just as they had lots to offer me. I also felt like the best Pain departments were the ones who could appreciate and utilize what the other specialities had to offer.

 

[Tenesma]

my original posting was never intended as a PM&R vs Anesth. thread.... all i was pointing out is the low likelihood of infringement of PM&R over the next 10-20 years considering the preponderanece of anesthesia-based programs....I think Physiatrists are good pain doctors... in fact the director of interventional pain at Stanford is a physiatrist (who got his training at an anesthesia based program)

 

[neuropathic]

I think Physiatrists are good pain doctors... in fact the director of interventional pain at Stanford is a physiatrist (who got his training at an anesthesia based program)

I am not sure about this staement. Many physiatrists are not interested in dealing with chronic pain patients. In some cases, they may do all sorts of procedures, and when patients are still complaining, they "kindly" refer them to the anesthesia pain clinic. It is one of the reasons that many PM&R programs don't click with the gas folks.

BTW, you are referring to the PM&R spine center (not interventional pain) at Stanford. Anesthesia trained physiatrists running ACGME pain programs that I know of are UC Davis, MD Anderson.

 

[Tenesma]

stanford's spine center is interventional pain....