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pain Medicine

The Center for Pain Medicine

The Center for Pain Medicine in the Department of Anesthesiology is comprised of a multidisciplinary group, committed to excellence in clinical care while providing the highest caliber training to post graduate residents and fellows in all aspects of pain management. The fundamental goal of the pain medicine program  is to train the pain clinicians and researchers of the future, by exposure to comprehensive care in acute, chronic and cancer pain in adult and pediatric patients while providing opportunities and mentorship for basic and clinical research.

Medical Student Education:

The faculty and fellows play an active role in medical student education. With faculty mentorship, the pain medicine fellows prepare and present an introduction to pain management lecture to third year medical students during their rotation through Anesthesiology. Additionally, a month long elective course is also offered to fourth year medical students in Multidisciplinary Pain Medicine through the Department of Anesthesiology at Columbia University. This rotation is also offered to students from other medical schools. The rotating medical student meets with the Division / Program Director to establish goals and expectations of the rotation. During the rotation the student is encouraged to be an integral part of the team with the residents and fellows and to obtain exposure to all aspects of clinical pain medicine. During this time the student will also have directed meetings with core faculty to discuss their learning and address any concerns. At the end of the clerkship, the student will present a brief lecture on a pain management related clinical or research topic of their choosing.

Resident Education:

Anesthesia residents have 1- four-week rotation in inpatient and outpatient chronic pain, 1-four week rotation in acute peri-operative pain management and 2- two week rotations in acute and chronic pain medicine during the 4 years of anesthesia training. Residents work closely with fellows and faculty and are trained to become proficient consultants. During the rotation through pain medicine, the resident is exposed to a spectrum of pain syndromes; clinical experience is gained in both acute and chronic pain.  In the PGY2 year, the anesthesia resident gathers experience in the treatment of acute pain through a month-long rotation in acute pain.  In the subsequent years the resident gains experience in chronic pain moving in a graduated fashion through rotations in office based outpatient pain management, inpatient pain and the interventional procedural suite. The chronic inpatient experience encompasses adult care chronic and cancer pain settings. Residents learn a multidisciplinary therapeutic approach which includes behavioral modalities, functional rehabilitation as well as oral analgesics, intravenous therapies, neuraxial and peri-neural drug infusions and invasive modalities.  The outpatient experience includes seeing patients with the core faculty in a consultative capacity and exposure to a wide variety of interventional techniques utilizing ultrasound technology as well as conventional radiography. This is performed in an interventional suite containing a state of the art C-arm fluoroscopy unit and a two-bed recovery area. In addition to this exposure in the course of the residency, CA-3 residents exploring Pain management may elect to do additional rotations in pain management during which time the training focuses on increasing familiarity with complex conditions and advanced techniques in pain management or clinical research activity with faculty mentorship.

Pain Management Educational Activities

The strong and effective didactic curriculum at the core of the pain fellowship program is primarily based on the ACGME requirements for training in pain medicine and in association with clinical and research activities helps to develop all aspects of a consummate consultant.

Core Didactic Lecture Series: 1st and 3rd Fridays,  8: 00 – 9:00 AM

The didactics lectures are provided by core faculty as well as speakers from the fields of basic science, epidemiology, addiction medicine, neurology, physical medicine and rehabilitation, critical care and neurosurgery.  Other areas covered include basic science research and statistics. The series of one hour lectures throughout the academic covers the core curriculum in pain management required for training in pain management as outlined by the ACGME and the International Association for the Study of Pain as well as other topics of clinical and academic interest.

Journal Club: 2nd Friday  8:00 - 9:00 AM

Critical evaluation of the medical literature, understanding evidence based approach and current advances in the field of basic and clinical pain research is a key component of the fellowship. Fellows are encouraged to choose meaningful articles with faculty for discussion at journal club and spearhead discussions. Additionally residents are also expected to participate and engage fully in journal club presentations.

Case Conference: 4th Friday 8:00- 9:00 AM

This multidisciplinary conference includes all pain center faculty/staff, trainees and invited faculty/staff from other departments. Selected cases are presented and discussed. In addition to being an educational forum, this conference serves to improve patient care through the open discussion of treatment successes and failures. As such, this conference is an integral part of the QA process.

Monthly Behavioral Psychology Series: Tuesday 8: 00- 9:00 AM

This lecture series provides a structured curriculum to enable fellows to concentrate on psychopathology as well as behavioral interventions targeting patients with acute, chronic and cancer pain. The issues discussed and information presented are targeted for fellows, residents and medical students on the pain rotation.

Anesthesia Grand Rounds: Thursdays, 7:00 - 8:00 AM

The focus of grand rounds covers areas pertinent to Anesthesia, Critical Care and Pain Medicine. During the course of the year, the fellows in Pain medicine provide at least 1 grand rounds lecture pertaining to Pain management.

TREATMENT MODALITIES

Interventional Treatments are provided at the Center for Pain Medicine in a fully state of the art Interventional suite equipped with an Arcadis C – arm, Logiq GE Ultrasound, Neurotherm RF generator and a Cryo-ablation unit. Advanced invasive interventional procedures including implantable techniques are performed in the operating rooms.

Interventional Techniques:

Cervical Procedures

  • Cervical Epidural Steroid Injections
  • Cervical medial branch nerve blockade
  • Radiofrequency ablation of the medial branch nerve
  • Cervical selective nerve root blocks
  • Cervical Discography
  • Stellate ganglion blockade
  • Ultrasound guided brachial plexus blockade for acute, chronic and cancer pain management

Thoracic Procedures

  • Epidural steroid injection
  • Intercostal nerve blockade
  • Ultrasound guided paravertebral blockade and catheter placement
  • Radiofrequency and cryoablation

Lumbar Procedures

  • Epidural steroid injections
  • Selective nerve root blocks
  • Medial branch blockade and Intraarticular facet injections
  • Radiofrequency ablation of medial branches
  • Discography
  • Intradiscal procedures
  • MILD – Decompression for spinal stenosis
  • Sacroiliac joint blocks
  • Piroformis injection
  • Vertebral augmentation procedures
  • Lumbar sympathetic nerve blocks

Abdominal and Pelvic Procedures

  • TAP blocks for acute, chronic and cancer pain with ultrasound guidance
  • Celiac plexus and splanchnic nerve blockade
  • Hypogastric plexus block
  • Pudendal nerve block
  • Ganglion of Impar block
  • Neurolysis
  • Peripheral nerve blockade and radiofrequency ablation

Intrathecal Pumps

  • Intrathecal and epidural trials
  • Intrathecal pump placement for cancer pain management

Neuro-modulation Techniques:

  • Spinal cord stimulator trial and implantation
  • Occipital nerve stimulators

 Nerve blocks

In addition to diagnostic peripheral nerve blocks and perineural catheter placement for infusion therapy for pain management, radiofrequency and cryoablation techniques are also employed in the following areas:

  •  Occipital
  • Supraorbital, infraorbital and supratrochlear
  • Mandibular 
  • Suprascapular
  • Femoral
  • Sciatic
  • Popliteal
  • Saphenous
  • Genitofemoral
  • Ilioinguinal
  • Iliohypogastric
  • Brachial and lumbar plexus

 Musculoskeletal Blocks

  • Ultrasound and fluoroscopy guided joint injections
  • Bursa injections with ultrasound and fluoroscopy guidance
  • Trigger point injections

 Others

  • Epidural blood patch
  • Botox for migraines and musculoskeletal pain syndromes

In addition to interventional techniques the following modalities are also offered at the Center for Pain Medicine

Behavioral modalities

  • Psychotherapy
  • Cognitive behavioral therapy
  • Biofeedback

 Medical Management

  • Non steroidal anti-inflammatory agents
  • Steroids
  • Opioids
  • Antidepressants
  • Anticonvulsants
  • Antiarrythmics
  • NMDA antagonists
  • Calcium channel blockers
  • Topical agents
  • Muscle relaxants
  • Bisphosphonates

Others:

  • Acupuncture
  • TENS trials

Faculty

Anthony (Robin) Brown, M.B.Ch.B., F.F.A. (S.A.)
Professor of Anesthesiology at CUMC and Vice Chair
Chief for Division of Orthopedic and Regional Anesthesia
Board Certified in Anesthesiology
 
Anis Dizdarevic, MD
Assistant Professor of Anesthesiology at CUMC
Fellowship: Pain Management, Brigham & Women's Hospital, Harvard Medical School
Board Certified in Anesthesiology and Pain Medicine
 
Robert Maniker, MD
Assistant Professor of Anesthesiology at CUMC
Director, Acute Perioperative Interventional  Pain Program
Fellowship: Pain Management, Brigham & Women's Hospital, Harvard University
Board Certified in Anesthesiology and Pain Medicine
 
Leena Mathew, MD
Associate Professor of Anesthesiology at CUMC
Director, Pain Medicine Fellowship Program
Fellowship: Columbia University
Board Certified in Anesthesiology and Pain Medicine
 
William S. Schechter, MD, MS, FAAP
Professor of Anesthesiology & Pediatrics at CUMC
Chief, Division of Pediatric Pain Medicine, Symptom Management and Palliative Care Director, the Pediatric Pain Medicine Program and Advanced Care Team
Board Certified in Pain Medicine, Critical Care Medicine, Pediatrics and Anesthesiology
 
Nomita Sonty, PhD
Associate Professor in Medical Psychology (in Anesthesiology & Psychiatry) at CUMC
Fellowship: Pain Management & Behavioral Medicine, St. Louis University Health Sciences Center
 
Michael L. Weinberger, MD
Professor of Anesthesiology at CUMC
Chief, Division of Pain Medicine 
Fellowship: Pain Management, Memorial Sloan-Kettering Cancer Center
Board Certified in Internal Medicine, Anesthesiology, Pain Medicine, and Palliative Care
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Columbia University Medical Center Department of Anesthesiology