The Pain Medicine rotation is required during the CA-2 year and it is two months in duration. The rotation may be taken as an elective during the CA-3 year for one to three months. During this rotation the resident will gain experience in the evaluation and management of patients with acute and chronic pain. Pain management techniques of epidural analgesia and nerve blocks will be emphasized. The resident will become familiar with management of postoperative pain using patient controlled analgesia. The resident will learn how to convert a patient from intravenous analgesia to oral analgesics. The resident will also obtain exposure to patients with cancer related pain and the unique management of their pain. The resident will become familiar with treatments of pain syndromes utilizing major nerve root injections and nerve ablations. The abbreviations in parentheses correspond to the six competencies.

CA-2 Pain Medicine Goals and Objectives

Acute Pain

• Perform lumbar, and thoracic epidural blocks and all of the other most common blocks.
• Learn to evaluate appropriate patients for interventional procedures placed preoperatively for post operative analgesia.
• Demonstrate good relationships with patients and hospital personnel, behavior is dependable and ethical (ICS, P, PC)
• Demonstrate good relationships and ability to communicate effectively with referring physicians and services.
• Learn and be familiar with risks of regional anesthesia in the anticoagulated patient.
• Learn the use of stimulators and sonographs as an aid to placement of regional blocks.
• Increase knowledge and skills needed to perform various regional blocks.
• Learn about the treatment of side effects and complications of epidural analgesia in post operative patients.
• Learn about the treatment of side effects and complications of short and long acting epidural opioids for post operative analgesia.
• Learn the principles of and indications for patient controlled analgesia for the control of post operative pain.
• Learn about opioid conversion from intravenous to oral opioids.
• Present to an attending an acute pain patient in a concise manner, including all the relevant factors and problems that affect the management of that patient�s pain.

• Learn how to obtain a pain history and perform a physical examination for the patient with chronic pain.
• Prepare, research and present to a group at least one 15 minute talk on an assigned topic in pain medicine.
• Demonstrate appropriate behavior in emergency situations.
• Demonstrate good relationships with patients, clinic and ambulatory surgery personnel, behavior is dependable and ethical.
• Learn and review basic pain mechanisms.
• Learn how to assess pain.
• Get exposure to basic interventional therapies for patients with chronic pain.
• Learn basic radiation safety as it relates to performing procedures under fluoroscopic guidance.
• Have a basic understanding of diagnostic testing, radiographic testing, laboratory testing in the chronic pain patient.

CA-3 Pain Medicine Goals and Objectives

Acute Pain

• Perform lumbar and thoracic epidural blocks and all of the other most common blocks.
• Learn to evaluate appropriate patients for interventional procedures plased preoperatively for post operative analgesia.
• Demonstrate appropriate behavior in emergency situations.
• Demonstrate good relationships with patients and hospital personnel, behavior is dependable and ethical.
• Demonstrate good retlationships and ability to communicate effectively with referring physicians and services.
• Learn and be familiar with risks of regional anesthesia in the anticoagulated patient.
• Learn the use of stimulators and sonographs as an aid to placement of regional blocks.
• Increase knowledge and skills needed to perform various regional blocks.
• Learn about the treatment of side effects and complications of epidural analgesia in post operative patients.
• Learn about the treatment of side effects and complications of short and long acting epidural opioids for post operative analgesia.
• Learn the difference between epidural opioids of varying lipophilicity.
• Learn the principles of and indications for patient controlled analgesia for the control of post operative pain.
• Learn how to assess pain in the patient with acute pain.
• Learn about opioid conversion from intravenous to oral opioids.
• Present to an attending an acute pain patient in a concise manner, including all the relevant factors and problems that affect the management of that patient�s pain.

• Learn how to obtain a pain history and perform a physical examination for the patient with chronic pain.
• Prepare, research and present to a group at least one 15 minute talk on an assigned topic in pain medicine.
• Demonstrate appropriate behavior in emergency situations.
• Demonstrate good relationships with patients, clinic and ambulatory surgery personnel, behavior is dependable and ethical.
• Learn and review basic pain mechanisms.
• Learn how to assess pain in the patient with chronic pain.
• Become comfortable with basic interventional therapies for patients with chronic pain.
• Get exposure to more advanced interventional therapies for pain such as radiofrequency denervation.
• Learn basic radiation safety as it relates to performing procedures under fluoroscopic guidance.
• Learn about appropriate candidates for basic interventional vs. medication therapies for pain.
• Understand the indications for advanced interventional pain therapies such as spinal cord stimulation and intrathecal techniques.
• Understand the principles of diagnostic testing, radiographic testing, laboratory testing in the chronic pain patient.
• Increase knowledge of the normal anatomy of the back and neck.