The Multidisciplinary Pain Medicine Program of the Department of Anesthesiology provides training to residents and fellows in anesthesiology in all aspects of adult and pediatric acute and chronic pain management in both the inpatient and outpatient setting. In addition, the Pain Center participates in joint ventures with the Dental School and Department of Orthopedic Surgery that form the Oral & Facial Pain Center and Sports Medicine Center at Chelsea Piers, respectively.

The learning experience for trainees includes aspects of medical, interventional, behavioral and alternative techniques to manage pain. These techniques include:

Medical management

Opioids
Antidepressants
Anticonvulsants
Antiarrythmics
NMDA antagonists
Calcium channel blockers
Topical medications

Radiographically Guided (x-ray and CT scan) spinal injections

Epidural block
Translaminar (conventional)
Transforaminal
Selective nerve root block
Facet block
Intra-articular
Medial branch
Sacroiliac joint block
Discography

Other radiographically (x-ray and CT scan) guided injections

Celiac plexus block
Hypogastric plexus block
Stellate ganglion block
Lumbar sympathetic block
Ganglion impar block
Peripheral nerve blocks
Neuraxial blocks (including neurolysis)

Other injections

Trigger point injection
Subcutaneous infiltration

Intravenous infusions

Sodium channel blockers
Alpha blockers
Intravenous regional sympathetic block

Neuromodulation

Spinal cord stimulation
Transcutaneous electrical nerve stimulation

Implantable technologies (in cooperation with specialized neurosurgical team)

Spinal cord stimulation
Intrathecal drug delivery system

Techniques in development

Spinal endoscopy (epiduroscopy)
Intradiscal electrothermal annuloplasty (IDEA)

Acupuncture

Approaches
Classical chinese
French energetics
Electroacupuncture
Auricular
Musculoskeletal Treatments

Surface Energetics
Trigger point deactivation
Tendinomuscular treatment
Percutaneous electrical nerve stimulation
Osteopuncture
Gua Sha

During the CB, CA-1, CA-2 or CA-3 year there are three four-week pain medicine rotations. Clinical experience is gained in both the inpatient and outpatient setting. Inpatient experience includes adult and pediatric acute pain mangement utilizing intravenous, epidural and perineural drug infusions. Cancer pain and symptom management is also an integral part of the inpatient service. Outpatient experience includes a wide variety of techniques (see above) to which the trainee will be exposed. Interventional techniques utilizing conventional radiography are performed in a suite containing a state of the art c-arm fluoroscopy unit (laser aiming and hard copy capable) and a four position bed recovery area. The entire spectrum of somatic and neuropathic pain problems are treated. In addition to conventional medical pain management techniques, behavioral therapy and acupuncture techniques are employed. The Pain Center staff includes a full-time fellowship trained pain psychologist and a physician licensed as medical acupuncturist.

CA-3 residents may elect to do additional rotations in pain management. During that time they can become increasingly adept at more complex pain management techniques. Additional patient care and teaching responsibilities are given.

A CA-4 fellowship in pain management is offered in cooperation with The Department of Anesthesiology at Cornell University Weill Medical College. This fellowship includes clinical rotations at Presbyterian Hospital, New York Hospital, Memorial Sloan-Kettering Cancer Center and Hospital for Special Surgery. Each institution offers training opportunities that combine to form a unique and superior overall training experience. This fellowship training program is ACGME accredited and provides eligibility for entry into the process for Subspecialty Certification in Pain Management of the American Board of Anesthesiology.

Pain Management Educational Activities

In addition to the extensive learning opportunities that take place during the daily clinical activities, the pain center has an extensive didactic schedule.

Interinstitutional Pain Management Conference
Wednesday 4:00 PM - 5:00 PM
Via Teleconference at PH, NYH, HSS

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.

Behavioral Medicine Rounds
Monday 12:00 Noon - 1:00 PM
CPMC Pain Center

These rounds, led by the pain center clinical psychologist, concentrate on behavioral issues pertaining to pain center outpatients and inpatients. The issues discussed and information presented are targeted for fellows, residents and medical students on the pain rotation.

Pain Board Review
Tuesday 8:00 AM - 9:00 AM
CPMC Pain Center

During these one hour sessions, topics and questions relevant to the ABA pain management examination are discussed. The session is led by a pain center attending and involves all trainees.

Team/M&M Conference
Thursday, twice monthly, 1:00 PM - 2:00 PM
CPMC Pain Center

This biweekly 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.

Pain Center Colloquium
Quarterly, date and time variable
Milstein Hospital Clark Conference Center/P&S Faculty Club

This quarterly conference is open to all members of the New York Presbyterian Faculty and Staff. At each colloquium, a visiting expert in the field is invited to discuss a topic of interest in pain management. Prior to the lecture, a luncheon is provided by the colloquium sponsor.

Faculty

Michael Weinberger, M.D.:
Director
Training Anesthesiology and Internal Medicine - Columbia
University/Presbyterian Hospital
Pain fellowship at Memorial Sloan Ketrering Cancer Center

Nomita Sonty, Ph.D.
Clinical Psychologist
Administrative Manager
Training Pain Management - Saint Louis University
For further information, write or contact:

Leena Mathews, M.D.
Associate Professor of Anesthesiology


Contact Information:

Michael Weinberger, M.D.
Assistant Professor of Anesthesiology
Director, Pain Management
Department of Anesthesiology
630 West 168th Street (PH505)
New York, NY 10032
Office: 212-305-7114
Fax: 212-305-8883
Email: mlw45@columbia.edu