Training in Pain Medicine

Introduction

The College needs to be certain that all trainees have gained adequate experience in pain medicine to warrant the inclusion of this specialist area on the CST.  For this reason, the College has set down certain minimum standards regarding duration and structure of training in pain medicine.

All trainees should complete one 2-month period of modular training in pain management that includes regular attendance at a Pain Clinic.  They must also participate in a formal Acute Post-Operative Pain Service in at least two other hospital rotations.

  

Acute Pain

For the purposes of a Certificate of Specialist Training, training in Pain Medicine focuses primarily on the acute post-operative pain service although acute non-surgical pain (e.g.post-trauma) should also be addressed.

 

Trainees should have a sound knowledge of:

·   Anatomy, physiology and pharmacology relevant to pain management

·   Mechanisms of pain; somatic, visceral and neuropathic pain and pain pathways

·   Assessment and measurement of acute pain

·   Techniques for control of acute pain including elderly, children, neonates, patients who are handicapped, unconscious or    receiving critical care

·   Opioid and non-opioid analgesics, patient controlled analgesia, epidural analgesia and side effects

·   Pharmacology of local anaesthesias

·   Logistics of running an Acute Pain Service, the development of protocols and audit of the service.

 

Trainees should be skilled in:

·   Regional and local blockade relevant to post-operative pain management including the use

          of ultrasound techniques to facilitate blocks.

·   Explanation of analgesic methods: oral, sub-lingual, sub-cutaneous, IM, IV, inhalational

          analgesia, patient controlled analgesia, regional and local blockade, epidural analgesia and their possible side-effects and             complications

·   Management of side-effects of pain management procedures and analgesics

·   Enlisting the help of other professionals when appropriate

 

Chronic Pain

 

Trainees should have a sound knowledge of:

·   Basic assessment of patients with chronic pain or cancer pain.

·   Principles and practice of a chronic Pain Clinic and the multi-disciplinary team approach

·   Role of other medical/surgical specialties and healthcare professionals in chronic and cancer

          pain management

·   Pharmacological methods of pain control including conventional analgesics, antidepressants,

          anti-convulsants and other adjuvant medications

·   Non-pharmacological methods of pain control e.g. TENS, stress management techniques.

·   Nerve injury and its consequences

·   Principles of nerve blockade for pain management including sympathetic and somatic nerve

          blocks, and basic knowledge of principles of neurolytic blocks, implanted catheters and pumps

·   Principles and ethics of pain research including audit.

 

Trainees should be skilled in:

·   Basic assessment of patients with chronic pain and cancer pain -history taking, physical

          examination, interpretation of investigations and presentation of findings.

·   Effective communication with the chronic pain patient and members of the multi

          disciplinary team

·   Formulation of a basic treatment plan

·   Basic injection techniques relevant to chronic pain management e.g. epidural steroid

          injection, trigger point injections.