Pain Management Fellowship

The Pain Treatment Center of the Department of Anesthesiology, SUNY HSC at Syracuse is one of the largest and oldest established services of its type in the upstate area. The chronic pain division was established in 1977 and was expanded in its scope and service to include the acute pain division in 1988. As the setting of the Center is a University Hospital, staff consists of Attending Anesthesiologists with certification in pain management, Fellows in pain management, residents in anesthesiology, Nurse Practitioners in both Chronic and Acute pain and support staff. The Center provides patient care in three settings at the present time with a fourth area to open in January 1998. The center utilizes a number of techniques not previously available for the diagnosis and therapy of acute and chronic pain. The pain Treatment Center is the only such totally comprehensive service in the Central New York area, and is one of a few in the country to offer integrated services for patients with both acute and chronic pain syndromes.

The Pain Treatment Center provides for evaluation and treatment of patients who suffer from chronic intractable pain, which has not responded to conventional therapy. The center also provides treatment for specific pain syndromes. Chronic pain is a long-term problem requiring the use of a number of techniques to establish the diagnosis and plan of appropriate treatment directed toward:

1. prolonged, tolerable pain relief
2. reduction of dependency on medications, particularly narcotics
3. enabling the patient to lead a more productive and active life

Patients are accepted by physician referral only. Some of the common syndromes seen at the Pain Treatment Center include chronic low back pain syndromes, sympathetically medicated pain syndromes e.g., RSD and causalgia, post-herpetic and diabetic neuralgias, post-operative neuralgias, deafferentation pain syndromes e.g., phantom limb pain, cancer pan and various myofascial pain syndromes. A variety of invasive and non-invasive modalities are utilized for therapy including Pharmacological intervention, drug detoxification, various nerve blocks, neuro stimulators (spinal cord and peripheral nerve), cryoanalgiesia and radiotherapy and intrathecal and epidural narcotic infusion devices.

The Acute Pain Service provides for pain management for patients in the hospital who are experiencing acute pain resulting from trauma, surgery or acute exacerbation of pain from a chronic syndrome such as cancer or vaso-occlusive disease. The Acute Pain Service also provides multiple modalities for treatment of these occurrences, including PCA, regional catheters e.g. epidural, intrathecal, axillary and intrapleural. regional blocks and pharmacological manipulation. Due to the integration of the acute and chronic services, it is routine to transfer a patient to the chronic service once the acute episode is concluded. This provides a smooth transition and continuity of care for these patients.

Description of Clinical Training Experience and Rotations

Pain Management Fellowship

Twelve months are spent on clinical training experience in Acute and Chronic pain Management with direct daily supervision provided the attending anesthesiologists. Supervision progresses from direct to indirect as required, as the clinical and managerial skills of the Pain Management trainee progress.

Clinical Experience:

Pain Management trainees rotate two to three weeks with Neuroradiology in MRI and CT in direct contact with Neuroradiologists for specific instruction. They are also involved with the Spine Institute's orthopedic surgeons in evaluation and diagnosis of common back conditions. The trainees are also involved in the surgical procedures of Dorsal Column Stimulator, Intrathecal/epidural port-a-cath and Intrathecal Infusion pump implantation's with anesthesiologists and with neurosurgeons. They are also involved in the surgical procedure of open cryoanalgesia.

Daily Routine:

Supervise CA2/CA3 anesthesiology residents with Acute Pain Service coverage with Nurse Practitioner and Attending Support

Ongoing research project activities as required.

Pain Management Trainee

• Alternating non-clinical day per week
• Involved in teaching, lecturing to medical students, residents of other specialties, nursing and other personnel as required.
• Teaching and physical dissection in regional block cadaver dissection course.
• Ongoing involvement in various research projects.
• Evaluation of trainees is ongoing with daily feedback in addition to 1-3 month evaluations based on ABA Clinical Competency Standards.

Selection Process for Pain Management Trainees

Pain management trainees are recruited through advertisements in various journals where there are requested to apply for a position by sending a complete CV and at least three letters of recommendation. The candidate must be expected to satisfactorily complete a residency in anesthesiology and be board eligible. Following screening of all candidates by the Director and partial review by other faculty, appropriate candidates are scheduled for interviews. The interview process consists of at least one full day in parent institution, on and off campus clinic sites where the candidate may inspect the facilities and meet with the staff. They are then interviewed by the Director of pain Management, one or two other associates, director of the Core anesthesia program and present Fellows. Candidates who express continued interest, after this section of the process are reviewed and subjectively discussed. The appropriate candidates are then sent letters of selection.

The following procedures are available within the institution

• Radiographic study, fluoroscopy, CAT scanning, laboratory facilities, psychiatric, psychological testing, physiatry, EGG, MRI
• Conference facilities and research space and opportunity also are abundant within the institution
• In addition to a comprehensive Anesthesiology library, the candidates have full access to the institution library

Faculty

P. Sebastian Thomas, MD, Professor and Director

Syed Ali, MD, Assistant Professor, Assistant Director of Pain Treatment Services

Donna-Ann Thomas, MD, Instructor, Director of Acute Pain Service, Assistant Director of Pain Treatment Services