ROTATION: Pain Management (Shands Hospital (PC) and Veterans Administration Medical Center rotations (VAC));
TYPE:  Elective
DURATION: 1 month - 6 months 
FACULTY:  Robert Guskiewicz, MD (Shands);  Segudina Saga-Rumley, MD (VA)
PREREQUISITES:  CA-3 level in good standing

 CA3 ADVANCED CLINICAL TRACK ROTATION IN PAIN MANAGEMENT

CA3 rotations in Chronic Pain Management are available at the VA Medical Center, and Shands at UF.  Goals and Competencies are the same for all three locations, but the types of patients seen are different at each location.  For residents rotating in pain management rotations for 4-6 months, a clinical research project must be designed, initiated, and preferably completed with the assistant of a pain management faculty member.  These residents will also be directly instructed in the management and administration of a pain clinic.

• VA Medical Center - same as described above - primarily elderly male veteran patients
• Shands at UF:  This rotation will take place at the comprehensive spine center at located in the Ayers Plaza at Shands at AGH.  The patient population will be primarily those patients with chronic pain disorders relating to congenital, acquired, and degenerative diseases of the spine.  Residents rotating here will be exposed to spinal cord stimulation and morphine pump placement (only location where this is currently done)
• Shands Jacksonville:  General pain management clinic with patients of all ages and both sexes

PATIENT CARE SKILLS:

• Be able to independently evaluate and develop a treatment plan for patients with common pain syndromes including:
  • Trigeminal neuralgia
  • Post-herpetic neuralgia
  • Phantom limb pain
  • Diabetic neuropathy
  • Sympathetically mediated pain
  • Low back pain
  • Myofascial pain
  • Inflammatory mediated pain such as bursitis, carpal tunnel syndrome, arthritis related pain
  • Visceral pain
• Evaluate and prepare patients for more invasive pain management modalities including
  • Facet injections
  • Racz catheter insertion
  • Radiofrequency lesions
  • Selective nerve root injections
  • Dorsal column stimulation and stimulator implantation
  • Morphine pump implantation
  • Deep Brain Stimulation (theoretical knowledge only)
  • Celiac plexus block
  • Vertebroplasty
  • Intradiscal Electrothermal Therapy (IDET)
• Participate in the following pain procedures
  • Facet injections
  • Racz catheter insertion
  • Radiofrequency lesions
  • Selective nerve root injections
  • Dorsal column stimulation and stimulator implantation
  • Morphine pump implantation
  • Deep Brain Stimulation (theoretical knowledge only)
  • Celiac plexus block
  • Vertebroplasty
  • IDET
  • All procedures listed above for the primary rotation

MEDICAL KNOWLEDGE

• Know indications, efficacy, contraindications, and complications of the following pain procedures:
  • Facet injections
  • Racz catheter insertion
  • Radiofrequency lesions
  • Selective nerve root injections
  • Dorsal column stimulation
  • Morphine pump implantation
  • Deep Brain Stimulation (theoretical knowledge only)
  • Celiac Plexus block
  • Vertebroplasty
  • Intradiscal Electrothermal Therapy (IDET)
• Know supportive neuroanatomy to facilitate performance of these more invasive blocks:
  • Facet injections
  • Racz catheter insertion
  • Radiofrequency lesions
  • Selective nerve root injections
  • Dorsal column stimulation
  • Morphine pump implantation
  • Celiac Plexus Block
  • IDET
  • Vertebroplasty
  • Deep Brain Stimulation (theoretical knowledge only)
• Organization and administration of a Pain Clinic

Dr. Saga-Rumley is responsible for the CA-3 rotation at the VA.  Dr. Guskiewicz is responsible for the CA-3 rotation at Shands Hospitals.