Regional vs Pain?

[dp101]

so..... this might be a stupid question, but can someone explain the difference between these 2 specialties?

Regional anesthesia is done to provide analgesia for patients in pain. Pain specialists do the same. Why are there 2 separate fellowships for both regional and pain anesthesia ?

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[facted]

so..... this might be a stupid question, but can someone explain the difference between these 2 specialties?

Regional anesthesia is done to provide analgesia for patients in pain. Pain specialists do the same. Why are there 2 separate fellowships for both regional and pain anesthesia ?

These two fields couldn't be more different. Pain does blocks, but those are for chronic pain patients that they see on an ongoing basis in the office. Regional does blocks (different ones) for surgery, whether it be as main anesthetic or for post pain. regional has no office hours or chronic pain patients.

 

[Depakote]

so..... this might be a stupid question, but can someone explain the difference between these 2 specialties?

Regional anesthesia is done to provide analgesia for patients in pain. Pain specialists do the same. Why are there 2 separate fellowships for both regional and pain anesthesia ?

Regional anesthesia tends to be geared towards providing anesthesia and analgesia for acute pain conditions (such as surgical interventions). Their management is frequently limited to the peri-operative period when the patient is admitted under the surgical service. As an aside, most residencies will provide a solid foundation for regional anesthesia, unless your exposure was particularly weak or you plan to do the more esoteric blocks, a fellowship probably wouldn't be worth the year of deferred income.

Pain specialists tend to focus more on the management of chronic pain using both pharmacologic and interventional approaches. This tends to be more of a clinic-based practice with the anesthesiologist acting more like a surgeon. They see the patient in clinic, prescribe medications and perform the appropriate intervention.

 

[facted]

As an aside, most residencies will provide a solid foundation for regional anesthesia, unless your exposure was particularly weak or you plan to do the more esoteric blocks, a fellowship probably wouldn't be worth the year of deferred income.

I'm a bit biased as I did a regional fellowship, but I don't think this is true. For starters, at the current time, regional fellowship is not ACGME accredited and salary can be hybrid between fellow/attending and you can do pretty well for the year. In terms of the skillset, you definitely learn new things and no matter how many blocks you do in residency (and I did a ton), you come out of fellowship far better than out of residency. Regional is also highly marketable these days. I think part of it also depends on geographical area. If your particular labor market is tight, having done a regional fellowship can be very helpful when competing with someone straight out of residency for the same spot. I have really put my skills to use in PP and my group finds it to be so valuable that we are specifically hiring 2 more regional trained people (not just people who can do regional out of residency).

 

[Hoya11]

so..... this might be a stupid question, but can someone explain the difference between these 2 specialties?

Regional anesthesia is done to provide analgesia for patients in pain. Pain specialists do the same. Why are there 2 separate fellowships for both regional and pain anesthesia ?

I am in the camp that would rather work and earn full salary than do a regional fellowship.

Regional fellowship can enhance your block skills, but doesnt really add anything new or different to your practice than residency does. Your still doing blocks for surgery, doing anesthetics in the OR. You apply for the same job types as generalists (arguably with an advantage).

Doing pain lets you leave the OR completely. Financial arrangements are different. Your day to day is completely different with clinic and opiates and patient interaction and MSK diagnostics. It is very different than the usual generalist skillset.

Pain, peds, cardiac, ICU - they let you be an expert in those things and do those unique cases/clinics/units others cant. Your job search is different most likely.

regional is a feather in the cap of a generalist. What cases can you do/surgeons needs can you meet that a generalist who is good at blocks can not?

 

[facted]

Kinda already beat this to death in the fellowship thread: https://forums.studentdoctor.net/threads/percent-doing-fellowships.1230811/

Suffice to say, we'll agree to disagree. I have learned a lot of blocks that are not standard blocks and I use them routinely in my practice. If you consider yourself to be a block expert and can easily and quickly do QL, serratus anterior, and all the more standard blocks on difficult anatomy patients, then maybe fellowship isn't for you. I trained at a strong regional program and I'm in PP with a lot of the same guys. And what I just wrote applies to one of the 5 or 6 people I trained with. Fellowship is repetition and I think that counts for a lot as well, esp. with difficult anatomy patients.

 

[epidural man]

so..... this might be a stupid question, but can someone explain the difference between these 2 specialties?

Regional anesthesia is done to provide analgesia for patients in pain. Pain specialists do the same. Why are there 2 separate fellowships for both regional and pain anesthesia ?

Regional anesthesia is done to provide analgesia for patients in Pain = TRUE

Pain Specialist do the same = Absolutely not. Pain specialists give high dose opioids to patients to keep them coming back to do injections that don't provide analgesia at all but do pay well. They also validate the sick roll in the patient which also helps them coming back for more "treatment".

Also, regional anesthesia is a "dying" specialty. It is being swallowed up by a much more needed and encompassing fellowships - acute pain fellowships or perioperative medicine fellowships.

 

[deleted171991]

I wouldn't say regional is dying. It depends on the residency program, e.g. many big academic hospitals expose the resident to a ton of GA for sick patients but not enough regional. There are also programs which graduate residents with almost fellowship-level knowledge of regional.

There are few both well-balanced and good residency programs, so one will always graduate with some weak points (best if in pedi or cardiac). It's not a bad idea to do a fellowship to fill in those gaps. One should aim to becoming a well-rounded anesthesiologist, unless one decides to practice exclusively pain or CCM (which would be a waste, just do some moonlighting).

When one is in residency, or working in an academic place, one can easily forget that one needs to be good at everything. There are "teams" for almost everything that requires a fellowship. Most of the country doesn't work like that, so having good regional skills (for example) is vital. Plus one could need the regional skills while on call in an academic place.

 

[Aether2000]

Clearly the focus of regional anesthesia is on peripheral nerve and plexus injections for short term anesthesia of 6-24 hours, extended to 2-3 days with catheters. The focus of pain medicine is to provide long term relief without anesthesia through injections of joints and the epidural space, the use of neuroablative procedures (RF neurotomy, chemoneurotomy, cryoneurotomy), neuromodification procedures (Pulsed RF), and neuromodulation (spinal cord stimulation, peripheral nerve stimulation, intrathecal pump infusion). Pain physicians also use a variety of oral and topical medications, something not typically employed in regional anesthesia. US use by pain physicians is frequently for diagnostic musculoskeletal evaluation and for guided injections into tendons, joints, and only less frequently nerves. Pain physicians would only very rarely (if at all) perform any brachial plexus, popliteal, adductor, femoral, sciatic, ankle, TAP, pec 1 or pec 2 blocks, whereas these are much more commonly used in regional anesthesia. Pain physicians may employ celiac plexus, stellate ganglion, lumbar sympathetic, splanchnic nerve blocks, vertebroplasty, and intradiscal procedures/disc decompression procedures: all things rarely (if ever) performed by regional anesthesia trained docs. Pain physicians are office based. Regional anesthesia physicians are usually hospital or surgery center based. The clienteles are quite different with pain physicians dealing with chronic pain psychopathologies on a daily basis whereas regional anesthesia docs rarely address these issues. Most regional anesthesia docs are highly proficient at what they do- only some pain docs are highly proficient. Pain docs may come from any background specialty since the ACGME pain fellowships are open to anyone from any residency training program. Many pain docs were "grandfathered" through 1998 in anesthesia, and through 2003-6 in physiatry/neurology never having done a fellowship at all, and were given the same ACGME "additional qualifications in pain medicine" as a fellowship trained doc. Many pain docs have neither ACGME pain boards nor a fellowship. However over the past 5-10 years, most entering pain medicine have an ACGME fellowship. Regional pain fellowship trained physicians are 100% from an anesthesiology background residency, although the fellowship is not ACGME sanctioned, and the ABMS does not recognize the fellowship training.

 

[facted]

Also, regional anesthesia is a "dying" specialty. It is being swallowed up by a much more needed and encompassing fellowships - acute pain fellowships or perioperative medicine fellowships.

Well, except that it in the works of being the next ACGME accredited fellowship in anesthesia.