What are the different paths for Pain Medicine?

[Suenya]

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Could anyone tell me what the paths are to pain medicine? In terms of what residency training options lead to it, and what additional training is needed? Pediatric pain medicine as well, if that differs in any way.

Compared to most other areas, I have had a lot of trouble finding a good resource for this information.

Thank you kindly in advance.

 

[Suenya]

I've heard that pain doctors can be anesthesiologists, physiatrists, neurologists, and even psychiatrists. Is this true?

I've also seen alot of things that only mention the first two options, especially when I've read information about pain fellowships. Are the last two options really possible (or competitive) and if so can they have a similar practice or are they more limited?

If there is anyone that could explain it to me I would really appreciate it. It's surprisingly hard to find a good comprehensive source about these particular questions.

 

[Aether2000]

There is effectively a unified subspecialty approach to pain now....there is no residency program for pain medicine currently. However, there is a one year fellowship program in pain medicine, not nearly enough to be proficient as one would finishing a full residency program, but it at least is a start. Any specialist, including medical geneticist, allergist, obstetrics, must be considered if they apply to the pain fellowship programs. It is a laughable situation, but this is what the ABMS has done to pain medicine.
So you can acquire certification after fellowship training in pain coming in from any specialty area.

 

[PMR 4 MSK]

I've heard that pain doctors can be anesthesiologists, physiatrists, neurologists, and even psychiatrists. Is this true?

Historically/statistically anesthesia makes up the vast majority of pain docs, with PM&R a distant 2nd. There are neurologists that do pain, probably more headache than sub-foramen magnum, and I knew one psychiatrist who did pain when I lived in Texas, I've heard others exist, but they are likely zebras in the herd of pain docs.

One does not currently have to be fellowship-trained to be consider a pain doctor, or pain specialist, although some states have rules against advertising yourself as in a specialty without board-certification, and then differ on what they accept - I don't believe any currently accept ABPMan, some accept ABPMed, many accept sub-specialty boards, such as through ABAnesth, ABPMR, and I believe also through ABPsych&Neuro. In reality, right now anyone can say they are a pain doctor, sports med or other sub-specialties that are still trying to define themselves without fellowship training. In the future, that may change.

If you think about it, almost all docs do pain medicine - we all treat painful conditions - that's why patients come to us. The idea of pain medicine more traditionally seems to apply more to chronic pain and/or difficult patients, or sometimes to spine-related pain, or even other MSK pts. The problem is usually seen as one of lack of training - PCPs traditionally get minimal training in MSK or spine and certainly in chronic pain managament. So these pts go to specialists who consider themselves pain docs.

 

[Suenya]

Thank you kindly for the responses.

If someone were to want to do a pain fellowship, should they take an anesthesiology residency, or is there a legitimate chance from, for example, neurology or pediatrics?

I think chronic pain treatment sounds good, but what (relatively little) I know about day-to-day practice of anesthesiology just does not seem like it would be right for me. I am interested in both those routes and psychiatry, so that it if turned out I didn't like pain medicine, I could retreat to my previous training.

Thank you again for the information, it is really, really helpful.

 

[Ligament]

Thank you kindly for the responses.

If someone were to want to do a pain fellowship, should they take an anesthesiology residency, or is there a legitimate chance from, for example, neurology or pediatrics?

I think chronic pain treatment sounds good, but what (relatively little) I know about day-to-day practice of anesthesiology just does not seem like it would be right for me. I am interested in both those routes and psychiatry, so that it if turned out I didn't like pain medicine, I could retreat to my previous training.

Thank you again for the information, it is really, really helpful.

Stop wasting your time. You are not even in medical school yet. Get accepted first, then after your third or fourth year of medical school hopefully you will have an idea of what you like in medicine. Right now there is absolutely no point in pondering this issue. Enjoy your life while you can.

 

[jsaul]

Stop wasting your time. You are not even in medical school yet. Get accepted first, then after your third or fourth year of medical school hopefully you will have an idea of what you like in medicine. Right now there is absolutely no point in pondering this issue. Enjoy your life while you can.

best advice of the day

 

[Aether2000]

Ditto.
Medical school will be difficult, residency will be even more difficult. Live as much as you can while you still have the chance to do so. Once you are in medical school, a career choice will become less important than memorization of all the branches of the abdominal aorta or the innervation of the teres major muscle. Minutia will consume you for awhile in medical school whereas time constraints will consume you in residency. Try to experience as broad a swath of medicine as you can when in medical school so you can rule out the more distasteful specialties or those that don't float your boat. Have fun while you can.

 

[Mister Mxyzptlk]

I wanted to be a pediatrician when I applied to med school.

 

[lobelsteve]

I wanted to be a pediatrician when I applied to med school.

Punchline: Can't get the bloodstains out of the clownsuit?

 

[Tenesma]

i remember all the girls wanted to be pediatricians... all the guys wanted to be cardiac surgeons... (talk about stereotyping... and no offense, gorback)... i don't remember ANYBODY talking about pain until i was in my 4th year of med school... i can't believe that it is truly that popular...

i personally wish that the 2nd year of med school could last forever and come with a high salary - that was the best year ever: you get to learn some clinical medicine WITHOUT ANY real responsibilities.... boy, do i miss those days when all that was expected of me was to: study, party, study, party, study, party.... what made it even better was the new LAN connection at school that allowed us to play multi-player games against each other during class...

 

[Aether2000]

Our first clinical experience was learning as a group of 4 how to perform a history and physical exam on a 72 year old lady. She continued pointing out breast lumps for hours which we had to describe in texture, character, mobility, size, shape etc. This first H and P took 5 and a half hours.

Most of our clinical work was 3rd and 4th year. Video games available on campus were: Asteroids, PacMan, and Defender. Only Pong was available in the dorms.

 

[drusso]

We learned how to do GYN exams on "cosmetology school students." Those were some hard-looking chicks...that's when I decided on Pain Medicine....😀