Multidisciplinary Pain Management - Anesthesiology 463

Welcome to the UC Davis Division of Pain Medicine. As a highly valued member of the Pain Management service, you will be expected to participate in all aspects of the service.  You are a primary member of the Division of Pain Medicine and must take on responsibilities and challenges in a manner that maintains high standards and integrity.  We consider you to be representatives of the Pain Management service to the entire UC Davis community. 
As you know, patients with acute, chronic and cancer pain present complicated therapeutic dilemmas and require a gentle, considerate and thoughtful approach. Attention to emotional/psychological issues is essential.  Your consideration and support will also be required for the staff that joins you in caring for these patients.

Course Goals:
From the experience on this rotation, students will be expected to have gained the following skills:
1. understand basic concepts of the physiology of pain,
2. understand and be able to perform a pain oriented evaluation and physical examination,
3. understand the known diagnostic classifications of pain and their treatments,
4. understand the complex interplay of medical, psychological and social issues with pain,
5. understand the basic indications for and practice of analgesic therapy.

Entry Level:
Third or fourth year students having completed basic internal medicine and surgery rotations are eligible. Students are accepted as space allows. The UC Davis Division of Pain Medicine accepts one medical student per month for a 4-week rotation. Extended rotations can be accommodated on a case-by-case basis. There is no on-call responsibility for this rotation.

The staff and fellows will work closely with the student, meeting on a daily basis. The student will be required to attend all daily didactic teaching sessions as well participate on the outpatient and inpatient chronic pain service.
In general, the student will spend three weeks in the outpatient clinic (seeing new and follow-up patients and interventional procedures) and one week on the inpatient service (seeing consults). The 4-week rotation, however, is flexible and can be varied to suit the needs of each student. Thus, we will try to accommodate students who wish to spend more time on a particular service.

Topic Outline:
Because pain is a prevalent feature in treating all patients, this rotation is intended to offer training for students interested in any clinical specialty. Students will be directly involved with the practice of contemporary multidisciplinary pain management including acute, chronic and cancer pain. Students will work with attending staff from disciplines of anesthesiology, internal medicine, physical medicine and rehabilitation, psychiatry, and neurology. Students will be part of the team that provides medical management for patients with chronic pain and cancer pain in both the outpatient continuity care setting and the inpatient consultation setting. Exposure to interventional procedures – trigger point injections, epidural steroid injections (e.g., interlaminar, transforaminal and caudal), sympathetic nervous system blocks (e.g., stellate ganglion, lumbar sympathetic ganglion, superior hypogastric ganglion and impar ganglion), facet joint procedures (e.g., intra-articular and medial branch nerve blocks/radiofrequency neurotomy), intra-articular peripheral joint injections (e.g., shoulder, sacroiliac, hip and knee joints), peripheral nerve blocks (e.g., occipital, ilioinguinal, genitofemoral nerves), implantable devices (spinal cord stimulators)  and intravenous lidocaine infusions – are an important part of the rotation. The program offers a daily mix of formal and informal educational experiences. Students are exposed to contemporary thinking in pain treatment from multiple disciplines.

Explanation of Potential Course Overlap:
No overlap is anticipated and to our knowledge no similar course is offered in the medical school.

Evaluation will be based on the final input from the rotation Director (Dr. Mahajan) as assimilated from staff, fellow, and resident input.

Suggested Reading:

Back Pain:  How to Relieve Low Back Pain and Sciatica by Loren Fishman and Carol Ardman, 1999, W.W. Norton.

The Body in Pain:  The Making and Unmaking of the World by Elaine Scarry, 1987, Oxford University Press.

Care of the Soul:  A guide for Cultivating Depth and Sacredness in Everyday Life by Thomas Moore, 1994, HarperPerennial.

The Culture of Pain by David B. Morris, 1993, University of California Press.

Dying Well:  Peace and Possibilities at the End of Life by Ira Byock, M.D., 1998, Riverhead Books.

Freedom from Headaches by Dr. J. Saper, Dr. K. Magee, and Kenneth R. Maggee, 1986, Simon & Schuster.

Full Catastrophe Living:  Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Jon Kabat-Zinn, Thich Nhat Hanh (Preface), and Joan Borysenko, 1990, Delta.

Headache Relief for Women:  How You Can Manage and Prevent Pain by Alan M. Rapaport, M.D. and Fred D. Sheftell, M.D., 1996, Little Brown & Company.

Healing Back Pain:  The Mind-Body Connection by John E. Sarno, 1991, Warner Books.

How We Die:  Reflections on Life's Final Chapter by Sherwin B. Nuland, 1995, Vintage Books.

Learning to Master Your Chronic Pain by Robert N. Jamison, 1991, Professional Resource Exchange.

Listening to Pain:  A Physician's Guide to Improving Pain Management Through Better Communication by Scott M. Fishman, M.D., 2006, Waterford Life Sciences.

Making Peace With Chronic Pain:  A Whole-Life Strategy by Marlene E. Hunter and Marlene E. Hunter, M.D., 1996, Brunner/Mazel.

Managing Pain Before It Manages You by Margaret A. Caudill, M.D., Ph.D., 1999, Guilford Press.

Mastering Pain:  A twelve-Step Program for Coping With Chronic Pain by Dr. Richard A. Sternbach, 1995, Ballantine Books.

Natural Pain Relief:  A Practical Handbook for Self-Help by Jan Sadler with Patrick Wall, 1997, Element.

On Death and Dying by Elisabeth Kubler-Ross, M.D., 1997, Collier Books.

Pain and Suffering by William K. Livingston and Howard L. Fields, 1998, International Association for the Study of Pain.

Phantoms in the Brain:  Probing the Mysteries of the Human Mind by V.S. Ramachandran and Sandra Blakeslee, 1999, Quill.

Suffering by Betty Rolling Ferrell (editor), 1996, Jones & Barlett Publishers.

The War on Pain by Scott Fishman, M.D., with Lisa Berger, 2000, HarperCollins Publishers.

When Bad Things Happen to Good People by Harold S. Kushner, 1992, Avon Books.

Wherever You Go, There You Are:  Mindfulness Meditation in Everyday Life by Jon Kabat-Zinn, 1995, Hyperion.

You Don't Have to Suffer:  A Complete Guide to Relieving Cancer Pain for Patients and Their Families by Susan S. Lang and Richard B. Patt, M.D., 1995, Oxford University Press.

Naileshni Singh, M.D.
Associate Professor
Medical Education Director