Rheum and pain

[Spodermin]

MS3 here interested in interventional pain management, but I love autoimmune disease.
I'm thinking about doing medicine -> rheum -> pain. Plausible?
In doing so I would obviously need to train through internal medicine. What are the pros/cons of training through medicine, neurology, anesthesia?

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[SSdoc33]

MS3 here interested in interventional pain management, but I love autoimmune disease.
I'm thinking about doing medicine -> rheum -> pain. Plausible?
In doing so I would obviously need to train through internal medicine. What are the pros/cons of training through medicine, neurology, anesthesia?

internal med 3 years. rheum 2 or 3 years. then another year in pain? i guess it could be done. i dont know of ANY pain docs who have done this. i think your plans will change, despite your lust for autoimmune diseases.

 

[clubdeac]

Seems like a natural progression however oddly enough I've never heard of a rheumatologist doing a pain fellowship. Most rheum's I know are slammed monitoring 30-50 pts/day receiving biologics and DMARDs

 

[Dr. Ice]

MS3 here interested in interventional pain management, but I love autoimmune disease.
I'm thinking about doing medicine -> rheum -> pain. Plausible?
In doing so I would obviously need to train through internal medicine. What are the pros/cons of training through medicine, neurology, anesthesia?

You will also have to deal with a fair share of fibro/myofascial pain syndrome patients. Pain docs don't want to see it so they will refer to rheum and rheum will push lyrica or offer biologics and the patient won't agree to it and the merry-go-round will continue. You may have a zest for autoimmune disease now but realize that this is only one subset of patients that rheum sees. If I were you I would try to get exposure to rheum patients from an underserved demographic as well as a more affluent one to get more of a full spectrum of what you would be seeing on a day to day basis. I wish someone gave me this advice before I went into pain....

 

[Blitz2006]

Also, not sure how feasible it is do a ACGME pain fellowship after IM/Rheum?

Programs usually state you have to have Anesthesia/PMR/Neuro/Psych background. And this is just at face value, its relatively tougher for PMR, and extremely tough for Neuro/Psych (statistically at least). Granted, I've heard of a few Radiologists and ER docs in the mix, but this is the exception...so also consider this if you are really set on pain.

Maybe not impossible, but you might face an uphill battle...

 

[SSdoc33]

typical rheumatology encounter:

patient: doc, my joints, low back, neck, and muscles hurt

rheumatologist: ok. i will order 50 xrays and 100 blood tests.

3 months later.......

patient: i am still in the same pain. well, all of your tests came back normal.
rheumatologist: im not really sure what to do. you might have "seronegative RA". lets try a low dose plaquenil.

3 months later.......

patient: i still feel the same.
rheumatologist: huh. thats weird. did you see the opthalmologist yet about the plaquenil? lets try to add on some methotrexate

3 months later......

patient: i still feel the same
rheumatologist: ok. lets try some physical therapy

3 months later.......

patient: i still feel the same
rheumatologist: ok, lets stop the DMARDs and we will try 1 week of prednisone so see if there is an "inflammatory component".

3 months later......

patient: i felt better for a week, but now i still feel the same
rheumatologist: wow. this is really strange. lets start you on some opioids

3 months later......

patient: i still feel the same.
rheumatologist: are the pills working
patient: yes!!!!! but i still feel the same
rheumatologist: hmmm..... i think its time you see the "pain doctor"





dont get me wrong, if you have legitimate RA, lupus, or any of those weird rheumatology syndromes, a good rheumie is indispensible. but it is pretty disheartening to watch them work up a lot of what we do

 

[nvrsumr]

Rheum and pain could fit.

 

[drusso]

typical rheumatology encounter:

patient: doc, my joints, low back, neck, and muscles hurt

rheumatologist: ok. i will order 50 xrays and 100 blood tests.

3 months later.......

patient: i am still in the same pain. well, all of your tests came back normal.
rheumatologist: im not really sure what to do. you might have "seronegative RA". lets try a low dose plaquenil.

3 months later.......

patient: i still feel the same.
rheumatologist: huh. thats weird. did you see the opthalmologist yet about the plaquenil? lets try to add on some methotrexate

3 months later......

patient: i still feel the same
rheumatologist: ok. lets try some physical therapy

3 months later.......

patient: i still feel the same
rheumatologist: ok, lets stop the DMARDs and we will try 1 week of prednisone so see if there is an "inflammatory component".

3 months later......

patient: i felt better for a week, but now i still feel the same
rheumatologist: wow. this is really strange. lets start you on some opioids

3 months later......

patient: i still feel the same.
rheumatologist: are the pills working
patient: yes!!!!! but i still feel the same
rheumatologist: hmmm..... i think its time you see the "pain doctor"





dont get me wrong, if you have legitimate RA, lupus, or any of those weird rheumatology syndromes, a good rheumie is indispensible. but it is pretty disheartening to watch them work up a lot of what we do

Priceless...

 

[painfree23]

MS3 here interested in interventional pain management, but I love autoimmune disease.
I'm thinking about doing medicine -> rheum -> pain. Plausible?
In doing so I would obviously need to train through internal medicine. What are the pros/cons of training through medicine, neurology, anesthesia?

What do you like about interventional pain management and what exposure have u had as an ms3? Just curious about how med schools now expose students earlier and earlier

 

[jsaul]

typical rheumatology encounter:

patient: doc, my joints, low back, neck, and muscles hurt

rheumatologist: ok. i will order 50 xrays and 100 blood tests.

3 months later.......

patient: i am still in the same pain. well, all of your tests came back normal.
rheumatologist: im not really sure what to do. you might have "seronegative RA". lets try a low dose plaquenil.

3 months later.......







THIS IS SPOT ON. BUT OFTEN THEY KEEP THEM ON PREDNISONE LONG TERM

THIS IS SPOT ON BUT OFTEN THE RHEUMATOLOGISTS KEEP THEM ON PREDNISONE LONG TERM

 

[bronchospasm]

Rheum and pain= Norco train

at least in our community

 

[lobelsteve]

My experience differs. I work with Rheum everyday. I have the Rheumy who wrote the textbook 30 min from me. No opiates from them, no dumps from them. Only one guy in N Georgia who thinks Norco only comes in 180s and Prednisone is 30-60qd.

 

[bronchospasm]

We had to stop taking referrals from rheum because everyone was on norco for fibromyalgia.

 

[SSdoc33]

My experience differs. I work with Rheum everyday. I have the Rheumy who wrote the textbook 30 min from me. No opiates from them, no dumps from them. Only one guy in N Georgia who thinks Norco only comes in 180s and Prednisone is 30-60qd.

dollars to donuts that he wears a bow-tie

 

[lobelsteve]

http://www.calladoctor.net/Canton-Doctors-Physician/images/Victor-Chen.jpg

Scrubs on Fridays as he does US guided joints all day. Great tennis player, coaches travel baseball.

rheumatologist | WorkingLupie

Squash champ. Could quit practice and be professional scuba photographer. Way smarter than us combined.

 

[cowboydoc]

dont get me wrong, if you have legitimate RA, lupus, or any of those weird rheumatology syndromes, a good rheumie is indispensible. but it is pretty disheartening to watch them work up a lot of what we do

They would likely say the same about us, but fortunately most of us recognize a potential rheum issue and punt the patient to rheum quickly after a basic workup rather than pretending to be an expert.

 

[drpainfree]

They would likely say the same about us, but fortunately most of us recognize a potential rheum issue and punt the patient to rheum quickly after a basic workup rather than pretending to be an expert.

I don't think rheum guys do the same. Their solution to most if not all non-rheum pain is opioid meds.

I personally think these are two different fields. Rheum is very much an IM subspecialty. Interventional pain is definitely not an IM subspecialty. Although I think it would combine nicely with interventional pain in a multi-specialty group, like lobelstevel described.

 

[oreosandsake]

some of the larger pain programs are more open-minded about pain fellowship for non traditional backgrounds... Cleveland Clinic has a incredibly intelligent internist that did the fellowship a few years back and stayed on as faculty in the anesthesiology institute pain department.

 

[Nivens]

Our interventional pain-trained psychiatrist is slammed.

 

[bronx43]

I don't know of a single rheumatologist that went on to do pain fellowship.

I mean, we simply don't do a lot of axial pain stuff unless it's an autoimmune disease. I would recommend you pursue rheumatology if you want to treat autoimmune diseases and rote OA/MSK complaints. The core competencies of your training would be more medicine related, as opposed to pain.