The Center for Pain Medicine

The Center for Pain Medicine in the Department of Anesthesiology comprises 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 fellowship 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.

Pain Medicine Fellowship Program

The Pain medicine fellowship program offered through the Department of Anesthesiology at Columbia University is a ACGME accredited one year program which provides eligibility for entry into the process for Subspecialty Certification in Pain Management of the American Board of Anesthesiology. During this highly selective fellowship in pain medicine, fellows are mentored to develop graduated autonomy in the setting of a finely structured multidisciplinary didactic curriculum. Experiential learning is attained through meaningful and responsible patient care and formal faculty supervision, in addition to informal daily interactions with rotating residents and faculty in an academic environment that uniquely blends community and hospital-based medicine and ultimately prepares a fellow for future practice. Patients are seen in the inpatient and ambulatory setting using an individualized multidisciplinary approach with interventions focused on functional restoration and analgesia. Immense patient diversity provides wide exposure that equips the fellows with skill sets which are transferable and are required to respond to the dynamic health care needs of patients that cross all cultural and socioeconomic boundaries.

The core faculty provides multidisciplinary care using stylistically distinct approaches to therapeutics and management of patient while staying bound by ethical, evidence based, compassionate, respectful, cost-effective patient centered care. The comprehensive training allows the fellows to broaden the perspectives available to them to develop awareness needed to identify and adopt practice styles that are consistent with their future career plans

Who can apply?

Residents who are completing a residency in any of the following fields may apply for a fellowship in Pain medicine:

• Anesthesiology
• Rehabilitation Medicine
• Neurology
• Psychiatry
  

Fellowship Experience:

The Pain Medicine fellow’s clinical experience comes through rotations divided into repeating cycles, comprising of 1 month in an outpatient office based practice, a month in the Interventional Suite and a month of chronic inpatient interspersed with 1- 2 week long external multidisciplinary rotations through out the year. The mandatory multidisciplinary rotations include Psychiatry, Electrophysiology, Palliative Care, Pediatric Pain, Neuro-radiology and Headache clinica. Additionally non anesthesiology trained fellows are trained in the core concepts of anesthesiology through a one month training program in the department of Anesthesiology to develop basic competency and understanding of emergency airway management, neuraxial techniques and to develop a basic familiarity with use of local anesthetics, intravenous analgesics and sedation techniques. All fellows are sent for cadaveric courses to enhance their understanding of the more advanced implantation techniques. On an as needed basis additional elective time may be arranged as well. In addition to clinical rotations, fellows are required to engage in an academic project in clinical or basic science for the year with faculty mentorship culminating in a presentation at the departmental academic evening and other meetings. Participation in state and national meetings is highly encouraged and meeting time is provided. A lecture series is in place to provide the didactic foundation for the fellowship and compliments the broad clinical experience which far exceeds ACGME criteria and numbers across the board. Through direct observation and feedback from faculty, the fellows are able to continually grow; self evaluate and improve their own skills.

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.

Journal Club: Monday 8:00 - 9:00 a.m.

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.

Bimonthly Behavioral Psychology Series: Tuesday 8: 00- 9:00

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.

Core Didactic Lecture Series: Wednesday 8: 00 – 9:00 AM

Provided by core faculty as well as guest speakers from basic research, epidemiology, addiction medicine, neurology, physical medicine and rehabilitation as well as critical care and neurosurgery. These lectures also address all the ACGME requirements in addition to basic science research and statistics. This series of one hour lectures covers the core curriculum in pain management required for training in pain management as outlined by the International Association for the Study of Pain. Lecturers include faculty in a variety of departments from all of the cooperating institutions as well as guest faculty. Topics include those of clinical and academic interest.

Anesthesia Grand Rounds: Thursdays, 7:00 - 8:00 a.m.

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

Quarterly: M &M rounds and Case Conference: Thursday 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.

Fellows Pain Board Review:

Held during the last month of fellowship, this session covers all the topics and questions relevant to the ABA pain management examination for certification in Pain medicine.

Monthly Spine Conference: Tuesday

Residents and Fellows participate in spine conference conducted with neurosurgery and psychiatry.

Monthly Pain and Addiction Conference: Thursday

This is provided by addiction psychiatry faculty using the format of formal lectures as wells as case based discussion.

In addition to the above activities fellows hold daily sit down rounds from 7:30-8:00 AM with all the rotating residents and sequentially focus on all the ABA key words in pain which are pertinent to rotating residents. Pain fellows also provide a monthly introduction to Pain medicine lecture to rotating third year medical students in anesthesia.

TREATMENT MODALITIES

Interventional Treatments are provided at the Center for Pain Medicine in a fully state of the art Interventional state equipped with an Arcadis C – arm with 3 D functionality, Logiq GE Ultrasound, neurotherm RF generator and a cryoablation 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
• Trigeminal
• 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

Medical Student Education:

The faculty and fellows play an active role in medical student education. The fellows prepare and present an introduction to pain management lecture to the rotating third year medical students during their rotation through Anesthesiology. Additionally, a month long elective course is also offered for 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 students. The rotating medical student will meet with the program director to establish the 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 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 3 four week rotations in pain medicine during the 4 years of anesthesia training. Residents work closely with fellows and faculty and are trained to be proficient consultants. During the rotation through pain medicine, the resident will be exposed to the entire spectrum of pain syndromes and clinical experience is gained in 1 week blocks moving in a graduated fashion through rotations in acute pain, office based outpatient pain management, inpatient pain and the interventional suite. The inpatient experience encompasses adult and pediatric care in the acute, chronic and cancer pain settings, using a multidisciplinary approach of behavioral modalities and functional rehabilitation with oral analgesics, intravenous, neuraxial and peri-neural drug infusions. 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 performed in a comprehensive interventional suite containing a state of the art C-arm fluoroscopy unit and a two bed recovery area. In addition to this 3 month 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.

Faculty

David Bandola, MD
Assistant Clinical Professor in Anesthesiology
Fellowship: Columbia University
Board Certified in Anesthesiology and Pain Medicine

Anthony (Robin) Brown, M.B.Ch.B., F.F.A. (S.A.)
Clinical Professor of Anesthesiology and Vice Chair
Director, Acute Pain Management
Director, Orthopedic and Regional Anesthesia
Board Certified in Anesthesiology

Anis Dizdarevic, MD
Assistant Clinical Professor in Anesthesiology
Fellowship: Pain Management, Brigham & Women's Hospital, Harvard Medical School
Board Certified in Anesthesiology and Pain Medicine

Leena Mathew, MD
Associate Clinical Professor of Anesthesiology
Associate Fellowship Director, Pain Medicine
Fellowship: Columbia University
Board Certified in Anesthesiology and Pain Medicine

John M. Saroyan, MD, F.A.A.P.
Assistant Professor of Pediatric Pain Medicine in Anesthesiology and Pediatrics
Associate Medical Director, Pediatric Pain Medicine and Palliative Care Program Director for Palliative Care Fellowship
Fellowship: Pediatric Pain and Palliative Care, Columbia University
Board Certified in Hospice and Palliative Medicine and Pediatrics

William S. Schechter, MD, MS, FAAP
Clinical Professor of Anesthesiology & Pediatrics
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
Fellowship: Pain Management & Behavioral Medicine, St. Louis University Health Sciences Center

Michael L. Weinberger, MD
Associate Clinical Professor of Anesthesiology
Director, Pain Management Center
Fellowship: Pain Management, Memorial Sloan-Kettering Cancer Center
Board Certified in Internal Medicine, Anesthesiology, Pain Medicine, and Palliative Care

For further information, regarding applying to the Pain Medicine Fellowship please write or contact:

Stella Serpa
Coordinator, Pain Medicine Fellowship Program
622 West 168th Street (PH 5-Stem)
New York, NY 10032
Phone: 212.305.5232
E-mail: ss2733@columbia.edu