What is most unique about interventional pain ?

[gh963817]

Hello, I am a current MS4 planning on applying PM&R this cycle. I love general PM&R, but also really liked the OR and spending more time doing complicated procedures, hence my interest in interventional pain. I love the idea of doing a ton of minimally invasive OR procedures.

One burning question I really wanted to ask the forum is about the propriety of interventional pain. At the hospital I am currently at- ortho will do most peripheral joint injections, rads will do flouroscopic injections, and IR does ESIs, kyphos and even put in a few SCS. With other specialties picking up the slack, I sometimes wonder what gap is actually being filled by a physiatrist doing IPM.

If I did land on this subspecialty, it would be very important to me to be able to carve out my own niche and be "the guy" for non-operative MSK related pain. Is this realistic? I'v asked around, but I don't have much exposure to interventional pain thanks partly to COVID restrictions. So what unique qualities am I missing about the IPM scene? Additionally, what procedures/conditions will IPM do/see that other specialties simply will not or cannot?

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[drusso]

Hello, I am a current MS4 planning on applying PM&R this cycle. I love general PM&R, but also really liked the OR and spending more time doing complicated procedures, hence my interest in interventional pain. I love the idea of doing a ton of minimally invasive OR procedures.

One burning question I really wanted to ask the forum is about the propriety of interventional pain. At the hospital I am currently at- ortho will do most peripheral joint injections, rads will do flouroscopic injections, and IR does ESIs, kyphos and even put in a few SCS. With other specialties picking up the slack, I sometimes wonder what gap is actually being filled by a physiatrist doing IPM.

If I did land on this subspecialty, it would be very important to me to be able to carve out my own niche and be "the guy" for non-operative MSK related pain. Is this realistic? I'v asked around, but I don't have much exposure to interventional pain thanks partly to COVID restrictions. So what unique qualities am I missing about the IPM scene? Additionally, what procedures/conditions will IPM do/see that other specialties simply will not or cannot?

With a PM&R/Pain background, your options will be practically limitless.

 

[chudat]

^ only limited by what the local orthospine/neurosurg allows you to do.

Good luck doing your advanced procedures if the local orthospine/neurosurg isnt willing to bail you out if complications arise.

 

[lobelsteve]

^ only limited by what the local orthospine/neurosurg allows you to do.

Good luck doing your advanced procedures if the local orthospine/neurosurg isnt willing to bail you out if complications arise.

You are so 1980s. Lots of PMR Pain guys own their own practice with ASC. Many are doing MIS.

 

[gh963817]

You are so 1980s. Lots of PMR Pain guys own their own practice with ASC. Many are doing MIS.

To this point, what MIS would be considered for reasonable for PM&R pain? I know of things like SCS, Kyphos, and MILD, which are fairly involved. Are there more interventions coming down the pike for pain?

 

[Gnarvin]

To this point, what MIS would be considered for reasonable for PM&R pain? I know of things like SCS, Kyphos, and MILD, which are fairly involved. Are there more interventions coming down the pike for pain?

There are a number of minimally invasive spine fusion devices that are either coming out or have been out for a while. There are little to no outcome based studies with them and how they fit into the treatment plan is up for debate. They could be a great thing or could be a bust.

 

[chudat]

I never understand how you guys are comfortable with doing 'minimally invasive surgeries' with no surgical background and no orthospine/neurosurg backup.

 

[Nodolor]

^ only limited by what the local orthospine/neurosurg allows you to do.

Good luck doing your advanced procedures if the local orthospine/neurosurg isnt willing to bail you out if complications arise.

If close to 20 years of doing procedures I have never needed the above to "bail me out"

 

[Ducttape]

treatments such as SCS, kyphos, MILDs are more appropriately considered "injections"

anethesiologists, critical care and ER doctors don't need vascular surgery back up to do art lines or central lines.

spacers and those devices I find more problematic

 

[Laryngospasm]

All specialties do procedures for which they sometimes need back up.. even the god like spine surgeons. It’s called medicine.