The Arnold Pain Management Center at BIDMC provides comprehensive diagnostic and treatment plans for patients with acute and chronic pain. A multidisciplinary approach is used to provide optimal care for complex patients. Residents will gain experience in doing commonly utilized invasive procedures including epidural steroid injections, trigger point injections, selective nerve root blocks, placement of spinal cord stimulators and implanted epidurals. Residents participate in the daily, formal didactic sessions during their pain rotation. Two months on the pain service are completed during the first 2 years of residency, with an option to complete up to an additional 6 months as a CA-3.
The pain rotation is divided between the acute pain service and the chronic pain service. The acute pain service is mainly concerned with managing pain in the immediate post-op period, with an emphasis on management of epidurals, PCA, and IV infusions. You take pager call from home during the acute pain service (APS) rotation. Most calls for APS can be managed from home, occasionally you will come into the hospital to assess a patient. You work 2 weekends during the pain rotation month, which mainly involves rounding on the pain service patients. On the chronic pain service you work in the pain clinic and participate in procedures. Interested residents can also learn acupuncture, which is taught by a certified acupuncture specialist.
A Day in the Life
"Residents arrive at the pain clinic at 7am for didactics, and the first patients of the day are scheduled for 8am. The exception to this is on Wednesdays, where residents report to clinic for a 9am start after the department's Grand Rounds/Morbidity and Mortality conference. Prior to starting the rotation, residents receive a schedule of the month's didactic topics, as well as a schedule of daily assignments, i.e. evaluation rooms or procedure rooms. Additionally, a daily email is sent with the following day's updated assignment, which is divided into a morning assignment and an afternoon assignment, with a one-hour lunch break in between. The day typically concludes between 4pm and 5pm.
When working in the evaluation rooms, residents will function just like the fellows, seeing a mix of patients either for new evaluation, follow-up visits, or non-fluoroscopic procedures, which can include trigger point injections, Botox injections, occipital nerve blocks, bursa injections, etc. Typically, there are one or two residents and fellows working with each attending. After completing a history and physical examination, the resident presents the findings to the attending, at which point they both go in to assess the patient together and discuss a plan with them. The resident then writes or dictates a note, and proceeds to see the next patient on the list.
The procedure rooms are more variable. Here, a wide variety of ultrasound or fluoroscopy-guided interventional procedures are performed, including epidural steroid injections, medial branch blocks, radiofrequency ablations, etc. The resident generally performs a focused history and physical, obtains consent for the indicated procedure, and then awaits further guidance as to their role in the procedure. Whether or not the resident performs the procedure depends on many factors, including the complexity of the procedure, the complexity of the patient, and ultimately the willingness of the attending and fellow to supervise it rather than perform it themselves. Depending on the circumstances, the resident or the fellow will complete the procedure note." - Ravi Bhalodia, CA-2