Objectives

Educational objectives for the chronic pain resident rotation

1. KNOWLEDGE

The resident will gain an understanding of the following:

  • Anatomy and physiology of pain pathways.
  • Pathophysiology and mechanisms of neuropathic and nociceptive pain.
  • Etiology, pathogenesis, diagnostic and therapeutic options for the following diseases or syndromes:
  • Complex regional pain syndrome
  • Post-herpetic neuralgia
  • Failed back syndrome
  • Myofascial Pain Syndrome
  • Fibromyalgia
  • Low back pain
  • Painful neuropathies
  • Understand the biopsychosocial model of pain
  • Understand the indications for and use of the following drugs
  • Narcotics with an emphasis on oral preparations
  • Antidepressants
  • Anticonvulsants
  • Sodium channel blockers
  • The role of other health care professionals in the management of chronic pain

2. TECHNICAL

  • The resident will be expected to conduct a history and physical exam on chronic pain patients and be able to arrive at a differential diagnosis of the cause of the pain and to be able to discuss diagnostic and therapeutic options.
  • While the use of nerve blocks in chronic pain remains controversial and taking into account that in a three week rotation, it may not be possible to gain competence in these blocks, the resident should be familiar with the approach to and attempt to get hands on experience with the following anesthetic procedures:
    • Stellate ganglion block
    • Lumbar sympathetic block
    • Celiac plexus block
    • Epidural steroid injection