Patient interaction in interventional pain management vs. chronic pain management?

[bananasewq]

Hey everyone!

Just got step 1 scores back, and I'm looking more into anesthesia and pain management fellowship. I was wondering if someone knew how the patient interaction changes between interventional pain management vs. chronic pain management. Also, how much note writing is there for each? Can someone who is involved in either talk about the lifestyle/day to day?

I can see myself doing lots of procedures in the future, and interventional pain management seems right up my alley. Doing procedures back to back every day, I can see myself being very fulfilled! Short and simple for the patient, quick and hopefully very beneficial outcomes for them as well. Short and sweet patient interactions for me, as I'm not so keen on patient interaction anyways.

Thanks! Remember to enjoy the summer everyone!

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[nimbus]

Interventional pain management is part of chronic pain management. The patients can be some of the most complicated and frustrating in all of medicine. The interactions are not simple.

You’d enjoy operating room anesthesia more. Lots of procedures and short n sweet patient interactions.

 

[narcotics999]

Short and sweet interactions with these pain in the axx pts?

Sweetheart, you need CCW!

 

[Psai]

Make a rep for yourself as an awesome interventionalist and then hire an army of PAs to do all the pesky patient interaction for you. Win-win!

 

[244913]

Don't go into chronic pain if you don't want to have interactions with chronic pain patients. The needle jock days are going away, good riddance. Don't be a scumbag. Your patients deserve better.

The solutions for chronic pain sufferers rarely drip out the end of a 22 g needle

 

[neutro]

I switched back to a 90% anesthesia and 10% pain practice currently, after 3 years of 70% pain and 25% pain practice.

I could not be happier.

Putting it simply, chronic pain management has an extremely high rate of burnout and there is no end point therapeutically. To be honest, a lot of anesthesia residents go into pain because they dont want to work weekends or take call. However, the daily rut of 8-4 or 8-5 seeing 20-35 chronic pain patients a day is far worse than a few calls a month.
Pain management is a dumping ground, and no matter how excellent of an interventional pain doctor you are, the evidence behind most pain procedures is mild-moderate benefit. Certainly you are not curing patients routinely with your ESIs.

Also, I would not make any decisions about my specialty, let alone a pain fellowship based on USMLE Step 1 score. I recommend focusing on core 3 rd year rotations, and exposure to other important subspecialties (ICU, trauma, nephrology come to mind) and being a well rounded physician, before deciding what you really want. And no, anesthesia (or any program director) does not expect you to know about anesthesia on your residency interview - they however, expect you to be trainable with good work ethic, non lazy, reasonable, and well rounded. I cannot stress this enough. I had a 4th year student today on anesthesia rotation and all he wanted to do was intubate despite me telling him a million times the importance of seeing patients pre-op to evaluate the airway and focusing on ventilation. He would be sitting around doing nothing and then just show up in OR ready to intubate.
Anyways...a two week anesthesia rotation during MS-3 and MS-4 year is not indicative of your interest, future passion or desire to be a clinic anesthesia resident.

 

[Biohazard685]

You need to figure out if pain is right for you.

Anesthesia isn't the only route. You can do neurology or pmr.

There is no chronic pain vs interventional pain, you end up dealing with it all. Can't have procedures to do without a productive clinic.

If it's lambos and mansions you want, then stick with anesthesia. If you want headaches, heartache, and a slash in scruples do a pain fellowship.

 

[Hoya11]

Hey everyone!

Just got step 1 scores back, and I'm looking more into anesthesia and pain management fellowship. I was wondering if someone knew how the patient interaction changes between interventional pain management vs. chronic pain management. Also, how much note writing is there for each? Can someone who is involved in either talk about the lifestyle/day to day?

I can see myself doing lots of procedures in the future, and interventional pain management seems right up my alley. Doing procedures back to back every day, I can see myself being very fulfilled! Short and simple for the patient, quick and hopefully very beneficial outcomes for them as well. Short and sweet patient interactions for me, as I'm not so keen on patient interaction anyways.

Thanks! Remember to enjoy the summer everyone!

pain looks great on paper, when your in it its the worst

 

[Aether2000]

I agree with Hoya and neutro. I spent 20 years full time pain medicine then the past two years doing half anesthesia and half pain medicine, and now full time anesthesia. I couldn't be happier. The practice of pain medicine is largely one of futility- not enough tools to adequately manage pain, a passive and non-motivated population that refuses to take any meaningful action to reduce their pain, recycling patients over and over again through limited effectiveness procedures, battling the constant group of patients either spinning out of control with controlled substances or begging for more meds, threats of self-harm by patients, threats to the staff, slowly collapsing reimbursement and limitations of scope of practice through lack of insurance coverage, etc. With pain medicine, there is a higher risk of litigation from dissatisfied patients and a much higher risk to your license and being imprisoned if you prescribe opioids. There is the daily grind of seeing frustrated dissatisfied patients because you can never relieve enough of their pain. You deal with patients who begin to question whether the 3 weeks of pain relief they receive 5-6 times per year with injections is worth it. A high percentage of the pain patient population is obese (even higher than the US population), continue to smoke, refuse exercise of any kind, and are on disability with no plans to ever try to get off disability. For those that enjoy the concept of being a prison guard, pain medicine would suit them well. Yes, there are a few home runs in pain medicine, but those are uncommon compared to stepping up to the plate and knocking one out of the park with each swing as with anesthesia. Anesthesia indeed is a different mind-set.

 

[BobLoblaw78]

It is pretty satisfying (and surprising) when you can talk to someone and they actually start exercising, lose weight, stop smoking or wean off of opioids. And crazy enough, they do feel much better!

 

[neutro]

It is pretty satisfying (and surprising) when you can talk to someone and they actually start exercising, lose weight, stop smoking or wean off of opioids. And crazy enough, they do feel much better!

yeah but realistically, thats like 0.5% of the pain population.