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Pain vs. Spine fellowships

Discussion in 'PM&R' started by bigfrank, Jul 29, 2002.

  1. bigfrank

    bigfrank SDN Donor
    7+ Year Member

    Feb 20, 2002
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    Hi drusso, ligament, stinkytofu, etc.:

    I was wondering if you could compare the differences and similarities between "pain" and "spine" fellowships, specifically:

    1. What procedures are tought and to what extent?

    2. What type of outpatient practice does each lend itself to?

    The reason for this is that I recently talked to an interventional physiatrist (via email) who works for a large HMO in Northern California and this doctor told me that he would recommend a "spine" fellowship which teaches lots of interventional procedures and better prepares a PM & R grad for what s/he will likely see during their practcie.

    Thanks for any help.
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  3. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 21, 1998
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    Attending Physician
    Good Question. It's my impression that pain fellowships are broader in scope and depending upon the nature of the training can deal with anything ranging from cancer pain, neuropathic pain, musculoskeletal pain. These kind of anesthesia-based programs also emphasize regional anesthesia and maybe some more esoteric kinds of "blocks", stellate ganglion blocks for example. And, not all pain fellowships are interventional in nature. Some focus more on comprehensive outpatient kind of pain training---oral meds and medically directing pain management programs

    In general, it's a tertiary care, referral based practice. Patients will be referred to you by specialists and primary care doctors who are fed up and/or can't manage these patients anymore. You may be in private practice, group practice with a surgical group, or in a multidisciplinary spine or pain center. I really prefer the latter. Spine centers take a multidisciplinary, coordinated case-based approach to care. Usually there are 3 or 4 docs including a surgeon (either ortho or neuro), a pain specialist (either PM&R or anesthesia) plus or minus a neurologist or psychiatrist. There might also be psychologists, physical/occupational therapists, case-workers/social workers, nursing staff, etc. Ditto for pain centers

    Not bad advice. I've really gone round and round about this question too. I think that a spine fellowship (like the one offered through PM&R at the Hospital for Special Surgery in NY for example) might allow you to stay more current with electrodiagnostic training and the latest spinal therapeutics (including surgical and non-surgical managment). You would then be a bonafide spine specialist. The downside is that spine fellowships in and off themselves aren't accredited by the ACGME (neither are some pain fellowships) and this could be a problem with reimbursement. However, one could always argue that spine rehab is in fact well within the purview and scope of practice of primary board certification in PM&R. It's still an open question...

    Here's an example of a job advertisement for a "spine physiatrist" that might give you a flavor for what they do...


    The Virginia Spine Institute (click here) is expanding it's practice and has an opening for a fellowship trained physiatrist who desires to excel in spinal injection procedures and the non-operative management of spinal disorders. The Physiatrist will be supporting the spinal surgeons and the staff in non-operative spinal care and decision-making, spinal rehabilitation, spinal injection techniques, discography, EMGs, IDETs, and post surgical management. Additionally, the proper management of athletic spinal injuries ranging from amateur through professional athletics is emphasized in the practice.

    The Virginia Spine Institute, located in the Washington, DC suburbs, is an internationally known center of excellence with a primary focus on adult degenerative and spinal deformity spinal care. The Physiatrist will have the opportunity to participate in ongoing medical and surgical research projects and to initiate self-directed quality research at the Anthony G. (3ristina Institute for Biomedical Science, a private, not-for-profit 501(c)(3) research center affiliated with the Virginia Spine Institute. The Physiatrist is expected to continue to develop and run the physiatry Fellowship program. Credentials: We desire a candidate that is currently in a Physiatrist Fellowship or has completed one.

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