Fellowship in Pain Medicine

One year full time post MD/DNB fellowship for super specialization in Pain Management

 Faculty

Dr. Sidharth Verma
MD DNB PDCC FIPP (USA) FIAPM
Assistant Professor Anaesthesiology & I/C Pain Clinic
DY Patil University School of Medicine

Program highlights

1. Module Based learning
2. Full time residential program including hands on experience with qualified dedicated faculty for the acute and chronic pain services.
3. Best & Latest equipment (Cooled Radio frequency, Ultrasound, Fluoroscopic, Endoscopes etc) available for teaching & training
4. Rotation in different departments for teaching and learning
5. Experience and Training in managing an Acute Pain Service
6. Compulsory training, participation and completion of one research paper as original research.
7. Regular didactic lectures
8. Benefit of working across centers in Mumbai
9. Possibility of linkage with Senior Residency in Anesthesiology

 

Certification

Fellowship in Pain Medicine

Awarded by: DY Patil University (accredited by NAAC with ‘A’ GRADE)

1. Gain proficiency in managing Chronic Pain

 

• The fellow will be exposed to the pharmacologic, interventional, as well as the nonmedical (psychologic, rehabilitation approaches) treatments of the non-cancer pain conditions like Low back pain, myofascial pain syndrome, headache, pelvic pain, neuropathic pain (postherpetic neuralgia, CRPS, etc) and cancer pain
• The fellow will have a clinical experience with patients with chronic benign pain syndromes during their outpatient clinic experiences and will document a minimum of 200 different patients over a 12 months period.
• He/she will also learn to interpret and become familiar with basic neuro-imaging, identify significant findings, including MR and CT of the spine and brain and/or MRI studies drawn from the examples within the following areas: brain, cervical, thoracic, and lumbar spine when assessing patients with chronic pain.
• Gain proficiency in interventional Fluoroscopy / Ultrasound Assisted Blocks/ interventional Procedures: The fellow will be exposed to interventional procedures such as discography, intradiscal techniques, radiofrequency ablation, vertebral augmentation, spinal cord stimulators, spine endoscopy and neuraxial opiate and long term management. Each fellow will document involvement of a minimum of 50 patients who undergo interventional procedures.
• Permanent implants (spinal cord stimulators, peripheral nerve stimulators, and

Intrathecal opiate infusion pumps, epidural ports) will also be shown and taught to the fellows.

 

1. Gain exposure to the Multidisciplinary treatments of pain.

 

• The fellow will rotate through the Hospice and palliative care service for management of cancer pain and palliative medicine experience. ln addition, other specialists (psychologists, physical therapists, neurosurgeons, neuroradiologists etc.) may also be invited to give lectures to the fellows.

 

Gain exposure to teaching, administrative aspects associated with practices of

Pain Medicine, Research and Projects:

 

• The fellow will present formal lectures to the residents rotating through the service.
• Depending on his/her expertise and enthusiasm, the fellow will have the opportunity

to present cases and lectures to the department.

• Each fellow must present one Morbidity/Mortality Case discussion to the section of pain medicine during the academic year. A post-lecture self-evaluation would also be completed by each fellow
• All fellows will gain exposure on the administrative aspects of pain management which include setting up a pain practice, conducting public awareness campaigns etc.
• The fellows will be involved with problem solving aspects and process improvement of the Pain Medicine practice and would also pursue, develop, plan and execute a project that will improve patient safety and promote “best practice” principles. A timeline for this project will be presented by the project guide. The project must be fully completed prior to completion of the fellowship. Failure to complete this project may result in probation or suspension.

 

 

1. Gain exposure to the Principles of Physician and Patient Safety:

 

• All fellows will participate in formal and informal lectures regarding radiation safety, addiction and or dependence issues in pain practice etc.

 

1. Optional exposure to Psychiatry, Occtupational Therepy & Physical Therapy

• Fellows will spend clinical time with other specialists like psychiatrists, occupational therapists or physiotherapists during their course.

 

Required Teaching List:

A schedule of lectures for the fellows and residents shall be made every month and distributed to the fellows. The schedule will be given to the fellow at the end of the previous month, All topics to be covered in the curriculum would be covered. The topics that can be covered throughout the year include, but should not be limited to, the following topics of pain assessment and treatment (70 hours):

 

1. Prevalence, magnitude of Problem of chronic non-cancer and cancer pain (0.5 hour)
2. Brief History of Pain Management (0.5 hour)
3. Anatomy and Physiology (2 hours)
   1. Peripheral Mechanism
   2. Central Mechanism
   3. Pain Modulation
   4. Pain Measurement
4. Pharmacology of pain transmission and modulation (2 hours)
   1. Peripheral Mechanism
   2. Synaptic transmission in dorsal horn
   3. Central sensitization
   4. Neurotransmitters in pain modulation
5. Psychosocial aspect of pain (2 hours)
   1. Definition and measurement of pain
   2. Individual differences
   3. Behavioral processes
   4. Emotional problem and psychiatric disorders associated with pain
6. General principles of pain evaluation (2 hours)
   1. Diagnosis
   2. Clinical History & Patient Examination
   3. Investigation: Interpretation in reference to various Pain Syndromes:
      1. PCR (Tuberculosis)/ Anti–ccp / HLA B-27/ Common blood investigations
      2. Radiological: X-Ray, MRI,CT, CT angio, Bone Scan, BMD/DEXA

• Neurological:NCV/ H-Reflex

5. Drug treatment (5 hours)
   1. Analgesics,* NSAID,* Antidepressant, anticonvulsant and miscellaneous agents :Narcotics Morphine, Oxycodone, Hydromorphone, buprenorphine, Methadone, Tramadol, Fentanyl
   2. Adjuvants: TCA, SSRI , Dothiapine, Milnacipram, Duloxitine, Gabapentin, Pregabalin
   3. Bisphosphonates, Calcitonin, Parath. Hormone
   4. Neurotropic / Vitamin: Methocobalamine, Vit E, Vit D, Folic Acid
   5. Muscle relaxants: Baclofen
   6. Miscellaneous: L-Carnitine, Botulinum Toxin, Hylaluronate
   7. Anti-rheumatoid(DMRD): Leflunamide, Methotrexate, Biologicals, Steroids
   8. Neurolytic Drugs: Alcohol, Phenol, Chloro-cresol, Hypertonic Saline, anhydrous Glycerol, Ozone , Radio-Frequency(Auto/Pulse) , Cryo-Lesion
   9. Anti-Tubercular Drugs
   10. Local Anaesthetics
6. Aetiopathogenesis, Clinical history, Examination, Diagnosis , D/D, Management , complications and Follow Up of following Pain Syndromes: (10 hours)
   1. Headache/ Migraine/ Trigeminal Neuralgia/ OroFacial Pain
   2. Discogenic Pain / IDD( Intradisclal Disc Disruption)
   3. Lumbar Canal Stenosis(LCS)
   4. Facet Joint Arthropathy, Kochs Spine, Discitis (tubercular/ Pyogenic))
   5. Osteoarthritis,Osteoporosis,Ankylosing Spondylitis,Rheumatoid Arthritis
   6. Sacroilitis, Coccidynia
   7. Urogenital Pain Syndromes / Pelvic Pain
   8. Lowbackache
   9. Neuropathic Pain including syndrmes like post herpitic neuralgia
   10. Complex Regional Pain Syndromes(CRPS)
   11. Vascular & Sympathetic Mediated Pain
   12. Pain during pregnancy
   13. Management of Cancer Pain: Magnitude of problem, Etiopathogenesis, Clinical presentation, Diagnosis and Management of Cancer Pain.
       1. Medication: NSAID, Narcotics( Morphine,Codiene, Tramadol,Oxycodone,Hydrmorphone,Methadone,Fentanyl( Patch/Nebulised)
       2. Adjuvants

• WHO Analgesic Ladder / WHO Cancer Pain relief Programme

1. Neuroablative Procedures
2. Vertebroplasty
3. Percutaneous Chordotomy

• Intrathecal/ Epidural Infusion Device

7. Non-surgical neuro augmentative techniques (2 hours)
   1. Nerve blocks
   2. Surgical approaches
8. Stimulation techniques (3 hours)
   1. Spinal Cord Stimulation
   2. DRG Stimulation
   3. Peripheral Nerve Stimulation
9. Physical medicine and rehabilitation (3 hours)
   1. TENS
   2. Acupuncture
   3. Vibration / USG
   4. Physiotherapy
10. Psychiatric and Psychological treatments (2 hours)
    1. Cognitive Behavioral Therapy
    2. Psychotherapy, Counselling
    3. Hypnotherapy, Yoga
11. Multidisciplinary management (2 hours)
12. Interventional pain management (12 hours)
    • Radiofrequency (RF) Ablation technique
    • Gasserian Ganglion RF Lesion
    • Balloon Compression of Trigeminal Ganglion
    • Cervical Discectomy ( Ozone/ RF/ MBB RF lesion
    • Stellate Ganglion RF lesion
    • Celiac Plexus Block ( Trans Discal/ Trans Aortic
    • Splanchnic Nerve RF lesion
    • Supra scapular RF lesion
    • Disc Procedures;
    • RF Discectomy/ Nucleotomy(APLD)
    • Disc Fix (Crvical/Lumbar)
    • PLED(Percutaneous Lumbar Endoscopic Discectomy)
      (TransLaminar/Trans foraminal)
    • Medial branch RF lesion
    • Sacroiliac Inj., Ganglion impar RF lesion
    • Superior Hypo gastric Plexus Block( Trans Discal)
    • Ganglion Impar RF
    • Intraarticular Inj
    • Platelet Rich Plasma( PRP) Therapy

13. Post-operative pain – PCA/PCEA (1 hour)
14. Acute Pain Service (2 hours)
15. Pain in children (1 hour)
16. Obstetric analgesia (1 hour)
17. Stem Cell Therapy/ Genetic Basis of Pain (1 hour)
18. Ethical aspect of pain management (1 hour)
19. Euthanesia (1 hour)
20. Research ( Pain management) (5 hours)
21. Palliative Care: Cancer/ AIDS/ Motor Neurone Disease: (6 hours)
    1. Cancer Pain: Prevalence, magnitude of problem , current status , WHO cancer Pain Relief Programme Definition , essentials of Palliative Care
    2. Physical aspect
    3. Disease process
    4. Symptom control: Pain,Anxiety, depression, anorexia, asthenia, Lymphoedema, ascites
    5. Pharmacological management of cancer pain
    6. Management of terminally ill patients- last 24 hours
    7. Family and social background
    8. Communication skills, breavement
    9. Religious and cultural aspects
    10. Ethical aspect
    11. Team work
    12. Organizational aspect: Home, Hospice and Hospital based Palliative care
    13. Research in Palliative care
    14. Hospice, End of Life Care
22. Rheumatology (2 hours)
23. Functional assessment and disability adjustment (1hour)