I'm just curious, how did you get dual boarded in interventional pain medicine, from an EM background? I was under the impression you weren't able to get interventional pain medicine from EM.
You can. Pain is officially a subspecialty of EM now, as much as it is anesthesia, as of 2014. Even before that, you could do an accredited Pain fellowship right along anesthesia fellows and get dual boarded, and a handful of people did (like myself) but few people knew about it.
Pain is a very competitive subspecialty among anesthesia and PMR residents because they associate Pain with injections and see the interventional side of it. They see epidurals, nerve blocks, spinal cord stimulators, joint injections, nerve ablations, migraine Botox injections, SI joint injections, and kyphoplasties etc.
EM is not a popular subspecialty among EM residents because they see "opiates."
But considering the pendulum is swinging heavily against opiate use, that makes the future of interventional Pain bright, in my opinion. In fact, I haven't started a single non-cancer patient on schedule opiates in the past 4 years. I guarantee my old EM partners have. I've have
continued many people on opiates, though. But only low-moderate dose, only after formal referral, screening, resulted GC/LS drug test, criminal background check, PMP check, proof of pathology on imaging, zero roxicodone, zero methadone, zero soma, stimulants, or benzos (accept 1-2 tab for MRI or procedure) or doses above my practice dose limit of 90 MME per day. That's no higher than 25 mcg fentanl patch or OxyContin 30 mg BID. For example, the Percocet 10/325 1-2 q4-6 hr prescription you wrote in the ED is 180 MME. Much higher than I prescribe. I have lots of elderly patients that simply need 1 or two percocets per day to walk. They're not drug abusers.
Also, no opiates on the first visit, no opiates for fibromyalgia, no opiates for headaches or other non-verifiable pain syndromes. The simple ability to have a scheduling clerk say, "You will receive no opiate prescription on the first visit, no exceptions" causes the majority of drug abusers/diverters to cancel or no show. I presume they go down the road to the nearest pill mill, but they don't usually waste their time with me.
Having an EM background, is by far the best speciality to come from for a pain doctor. No one has a better handle on the danger of opiates and is more motivated not to prescribe them, unless absolutely necessary.
Bottom line: If you focus on doing lots of procedures, minimize opiates as much as possible (preferably none) and are strong, willing, able and ready to say "No" when it's best for the patient, then a Pain fellowship may be worth looking in to. Also, if you hate having a normal life, sleeping 8 hours every night, always feeling rested, and never working nights, weekends, holidays or being on call, then it's clearly not for you.
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