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As many students of medicine, I have debated my career path into residency from the start of this journey. At the beginning of my third year, I discovered that I enjoyed certain aspects of internal medicine; in particular, acting as a diagnostician and the rapport created with patients through the continuity of care. In the middle of my third year, I received the opportunity to take an anesthesiology rotation and was enamored by it. I was captivated by the procedures and admired the solid foundation in physiology it required to allow patients a smooth and safe experience. Treating patients in real time with instant results was a factor that drew me to the field.
During my rotation I met an anesthesiologist working in the hospital who specialized in pain management and described their work in a clinic with their own patients. He noted that he enjoyed the patient interaction in this long-term setting as well as the acute setting in the hospital. As I appreciate patient interaction, I decided to take a 4th year elective in pain management out of interest and gained insight into the complicated treatment of pain.
Chronic pain is prevalent in 20.4% of U.S. adults according to a CDC 2016 survey. This is equal to 50 million people in the U.S. and is a common complaint of many patients. One of the goals when dealing with these patients is to treat them as a whole and work together to improve their day-to-day life with specific goals, whether that is focusing on providing a way to cope with their chronic pain or even being able to take a short walk. The continuity of care introduced in pain management allows a patient-doctor relationship to build on these goals.
At patient visits, I found that I used the previous training built on my third year of medical school in detailed history taking and focused physical examination. With multiple full MSK and neuro examinations, I was able to hone my skills in physical exams. I could see that the patients formed a connection with the pain physician and a rapport that is difficult to obtain in the acute OR hospital environment.
The path to pain management is an ACGME-accredited fellowship with 1 year of training after completion of an anesthesiology residency. There are 78 acute pain/regional anesthesia and chronic pain fellowships available in the U.S. combined. Pain management is implemented in an outpatient environment as well as inpatient and intensive care with consultant inpatient services. The practice encompasses the treatment of acute pain, chronic pain and cancer pain that is addressed using a multidisciplinary approach, including but not limited to interventional procedures, pharmacological treatment, physical therapy and rehabilitation and psychological therapy. Other interventions such as surgical procedures include kyphoplasty, intrathecal drug delivery systems and spinal cord stimulator implantation are also learned during the fellowship. In addition, pain is a wide and diverse topic in which research is encouraged.
The American Society of Regional Anesthesia and Pain Medicine (ASRA) is a resource for the fellowships available in the U.S. and Canada. They also host two annual meetings a year in the spring and fall where trending topics are discussed that medical students may attend. For residents, there are options to attend hands-on training sessions in subjects such as PoCUS as well as ultrasound guided nerve blocks.
For those who enjoy multiple aspects of medicine and the option to have a long-term relationship with patients, I would consider this subspecialty. Pain medicine has captured my attention with the individualized investigative approach to subjective pain as well as history taking and patient interaction. If you are in the same boat of debate, I would recommend trying an elective pain management rotation to get an early insight of your possible future!
Resource: ASRA
Reference: Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: http://dx.doi.org/10.15585/mmwr.mm6736a2
posted May 28, 2020
