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Pain Management Service
Inpatient Service Members of the Group:
Inpatient ServiceConsultations are available for patients admitted to Strong Memorial Hospital, who are experiencing significant pain following surgery, trauma, or medical illness. This service is covered 24 hours, seven days a week by the Anesthesiology residents, the pain fellows and attending physician. We maintain ongoing interaction with the surgical, orthopedic services, and oncology services, providing excellent care of these patients, most of who have complex needs and need pain management while in the hospital. The pager number for this service is 275-1616 pager #7004.Pain Center at StrongIn the year 2000, the Pain Center relocated its Out-Patient Service from its old location at Clinton Avenue, to a new onsite location. Currently, The Pain Center is located in an attractive, patient- friendly clinical suite on the second floor of the Ambulatory Care Facility. This facility is located directly off the main lobby of Strong Memorial Hospital.The new Pain Center is available five days a week and offers an array of services to assist physicians in managing their patients with acute and chronic pain. The Pain Center specializes in a multidisciplinary approach to assessing and treating pain, with a dedicated staff of full time pain physicians. They are all board certified/board eligible in the primary specialty and have additional qualifications in pain management. They are supported by two full time nurse practitioners and two full time clinical psychologists. The Pain Center provides comprehensive pain management with psychology services, in addition to medical and interventional pain management. The services offered at the Pain Center are tailored to individual needs and include initial evaluation and treatment of a variety of pain syndromes. We work in partnership with our referring physicians who consist of neurosurgeons, orthopedic surgeons, primary care physicians, oncologists, urologists, and a multitude of other specialties. Services offered at the Pain Center at StrongWe are one of the two centers in Rochester to offer all advanced, recent interventional and non-interventional treatment under one roof. This includes spine procedures such as epidural injections, facet injections, intraarticular injections, sympathetic blocks including stellate ganglion, celiac plexus, thoracic and lumbar sympathetic ganglion, superior hypogastric plexus and ganglion impar blocks.In addition, the Pain Center at Strong offers advanced pain procedures such as Home epidural infusions, spinal cord stimulator trial and implantations, radiofrequency ablations, neurolytic procedures, trials of intrathecal medications, and implantations of intrathecal pumps for malignant and chronic non-malignant pain. The Pain Center at Strong is fully equipped with all state-of-the-art equipment, including our own fluoroscopic machine and a radio frequency ablation generator. The clinic has its own procedure and examination rooms located within our clinic suite. We also have "as-needed" access to the main operating rooms and full anesthesia services available for patients needing advanced interventional procedures. The multidisciplinary conservative pain management services for primary and consultative services include medication management and on site psychology services. The Center also works closely with the Physical Medicine and Rehabilitation Department providing patients with physical therapy services. Examples of the conservative management services provided are: Complex Medical Management: Both consultative and primary services are available. Simple Medication Management: Offering primarily consultative services for the primary care or referring physicians. This includes a comprehensive treatment plan that can be reviewed Q-6 monthly without having to generate a new referral. In this service, the care of the patient is overseen by the consulting pain specialist. We do not take over the management of the patient, so that they continue to get the best care possible by their primary care physician who is well-versed with their medical condition and disability issues. Psychological Services: Behavioral and cognitive therapies with our clinical psychologists include bio-feedback, hypnosis, and relaxation therapy. This is an integral part of pain management because chronic pain is a disabling disease and affects the person as a whole. These services are very important and very effective in improving the quality of life for patients. Regional Anesthesia ServiceDivision of Pain Management and Regional Anesthesia at the University of Rochester has five full time faculty members committed to the administration of regional anesthesia. The regional anesthesia helps provide an alternative to general anesthesia and is an effective way to provide perioperative pain management, resulting in efficient care to promote decreased length of hospital stay.We are one of five centers in North America States using ultrasound-guided plexus injection techniques. We are expanding this technique to the lower extremity as we gain skill and experience in applying this new technology to regional anesthesia. Additionally, our Department is one of two centers in North America with the facilities and personnel to create virtual reality simulators for regional anesthesia. Educational ActivityThere is a four-week rotation available for anesthesia residents in regional anesthesia. Through one-on-one training, they receive extensive hands-on experience with a regional anesthesia attending. The volume, diversity of blocks, and diversity of techniques, including paresthesia, nerve stimulator and ultrasound sets us apart from many similar programs. In addition a successful annual cadaver workshop in regional anesthesia reflects our strong commitment to teaching regional anesthesia.Educational/Teaching activities in Pain Management for Students and ResidentsThe Division of Pain Management in the Department of Anesthesiology, University of Rochester, is involved extensively in fulfilling the educational mission of the institution with regards to medical students, residents, fellows, and the service needs of the community.Anes 606: A two to four week course in Pain Management is available for medical students in their third and fourth year. The course includes directive conferences, readings, and hands on teaching that address the basics of assessment and management of pain in a comprehensive, multidisciplinary setting. Written evaluations, based on direct observation and feedback from the residents, fellows, and other pain faculty, are prepared at the end of each rotation. Rotation in Pain Management for Physical Medicine and Rehabilitation Residents: The rotation lasts for 4-8 weeks. The principal focus for this rotation is outpatient pain management in a multidisciplinary setting. This includes the assessment and management of chronic pain, which entails pharmacological/non pharmacological and invasive modalities. Again, it is achieved through directive lectures, readings, and hands on teaching. We work closely with the Director of Physical Medicine and Rehabilitation residency program in designing this rotation and also adapting it to their needs. Pain Management rotation for non-anesthesia residents: To complete rotation requirements for surgical/orthopedic/neurosurgery/ENT residents, this rotation is based primarily on inpatient pain management. It involves the learning of issues with neuraxis analgesia from a surgeon's perspective and pharmacological management of pain, and includes the management of intravenous patient-controlled anesthesia. This rotation is available to trainees in the institution with prior planning and approval. Efforts are made to fashion the rotation to the needs of the trainee with the cooperation of the parent program director and the pain program director. Pain management Rotations for Anesthesia Residents: There are three rotations offered for the anesthesiology residents: A three week introductory rotation for CA-1 residents is designed to teach the basics of acute postoperative and post trauma pain management in an inpatient setting. The residents are exposed to a large variety of cases and are initiated into a consultant role by providing consultations under the guidance of subspecialty trained faculty for all hospital-based clinical services. A mandatory one-month rotation is offered to residents in their CA-2 year. Residents are involved in both the outpatient pain clinic and the inpatient pain service. Daily Inpatient Pain Service Rounds give the resident a thorough and intensive experience managing a busy inpatient service that includes both acute and chronic pain patients. Residents are exposed to all modalities available for acute pain management in adults and children, and develop a thorough understanding of the physiology of acute pain and the perioperative stress response. More than 1,000 patients of all age groups (neonates included) are admitted to the Acute Pain Service each year. Routine management methods include thoracic, lumbar, and caudal epidural analgesia, patient-controlled analgesia, intrapleural analgesia, and peripheral nerve and plexus catheters. Out patient pain clinic is scheduled several times each week, and approximately 110 new evaluations and 450 follow-up visits each month provide an outstanding opportunity to gain intensive experience in the evaluation of outpatients with various pain syndromes, and in the formulation and implementation of treatment plans. Residents learn about the physiology of chronic and cancer pain, and the use of invasive and non-invasive modalities for its treatment. Block Clinic is scheduled three times a week, and offers a hands-on experience performing many procedures designed to help alleviate pain, including neuraxial and peripheral blocks, sympathetic blocks, radiofrequency ablation, neurolytic blocks under fluoroscopic guidance and surgical implantation of spinal cord stimulators and intrathecal pumps. During the CA-3 year, residents may elect further advanced experience in pain management with individualized learning objectives, focused on learning the administrative, compliance and financial aspects of an academic pain practice. Residents spending 12-24 weeks assume responsibilities of a junior fellow and are involved actively in teaching medical students, and nursing staff. Residents interested in research in the field of pain management may join several ongoing projects in this Division. There are weekly two-hour long didactic sessions covering the basics and the advanced topics in the field of pain management. These sessions are held every Monday morning and are provided by sub-specialty-trained faculty; fellows; clinical psychologists, and a variety of guest speakers from various disciplines involved in the field of pain management. During these sessions, the clinical activity is minimal to optimize the resident's learning experience. These sessions are in addition to the didactic lectures offered by the Pain Division as a part of the general morning lecture sessions for the residents. Fellowship Training: A twelve-month clinical fellowship in Pain Management is available. Currently, we accept three trainees per year who have a variety of backgrounds, including Anesthesiology, Physical Medicine and Rehabilitation, Neurology, Internal Medicine, etc Nursing Education: The three full-time nurse practitioners are on Faculty with the University's School of Nursing (SON), and provide clinical rotations for nursing students. They also teach a Nursing Elective NUR 333, Interdisciplinary Management of Pain at the SON. In addition, the nurse practitioners present guest lectures on all aspects of pain management at the local, regional and national level. SMH JCAHO Pain Management Initiative: The goal of this initiative is to formulate uniform pain management guidelines across the institution, and to improve pain management in keeping with the JCAHO directive making pain the fifth vital sign. Our division actively participated in developing the self-learning modules, patient brochures, revising patient's bill of rights, and the SMH pain and sedation resource manual. This involved extensive work and multiple revisions and readings with a multidisciplinary team across the institution. This manual is now available in every inpatient and outpatient unit at Strong Memorial Hospital. The Department of Anesthesia Pain Services will be an integral participant of the ongoing implementation of the guidelines established by the initial committee. The Division of Pain management was involved in founding the "Strong Collaboration for Excellence in Pain Treatment, Education, and Research" (SCEPTER). This recently founded project, still in its infancy, is an ongoing collaboration between a group of specialists within the University system who facilitate the efforts, treatment, education, and research concerning pain management. The activities of this group involve ongoing readings, presentations, workshops, and the generation of extensive academic and clinical discussions regarding the field of pain management. This project is directed toward the goal of achieving a functional center of excellence in pain management. Educational Contributions at Regional, National and International LevelsPain faculty in the Division of Pain Management are actively involved in educational efforts in the community at the national and international levels. Dr. Thakur works closely with the CME office at the University of Rochester to provide this service to the community and to the region around the greater Rochester area. She was the first director in the Second Annual Neuropathy Pain Symposium in Rochester New York sponsored by the Trinity Nursing Center in April 2002.Dr. Thakur was a member of New York State Society of Anesthesiologists' Committee on Pain Management and Critical Care Medicine for the year 2003-04. Under Dr. Dworkin's direction and the International Association for the Study of Pain, a Seventh Neuropathic Pain International Conference is being organized in San Fancisco in November 2005. This conference is jointly sponsored by the University of Rochester and International Association for the Study of Pain. Over 250 healthcare providers attended the sixth conference on management and treatment of neuropathic pain in Bermuda November 2004. In addition to these national and international meetings, Dr. Dworkin is a world class expert, extensively lecturing at the national and international level focused specifically on the treatment of post-herpetic neuralgia. ResearchResearch activities within the Department of Anesthesiology Pain Services Division have been active for the past few years. We have an active center for analgesic trials involved in a large number of industry-sponsored trials for development of new analgesic drugs and in the testing of analgesic indications for existing medications. Dr. Thakur and Dr. Dworkin are involved as principal investigators for a number of pre-clinical protocols for neuropathic pain, malignant and non-malignant pain syndromes.The research staff developed a "Coordinating Research Center" to oversee a four-site Shingles Trial of Oral Medications to Prevent Postherpetic Neuralgia Pilot Study (STOMP). This study is complete and currently we are analyzing the data. Clinical Activity
Plans for the FutureThe last two years have witnessed substantial growth and progressive development for the Pain Service and the Pain Center at Strong Hospital. Our outpatient services have been refined and streamlined to provide comprehensive, efficient, state of the art care. We are planning to introduce more advanced spine interventional techniques e.g. discography, nucleoplasty, annuloplasty and laser-assisted diskectomy. We have been working closely with our referral sources to meet the needs of their patient population. We have made significant progress in use of peripheral regional techniques for perioperative pain management. In the next year, we hope to further optimize our perioperative pain management services focusing on enhanced utilization of peripheral regional anesthesia techniques . We are planning to have these services available across all three facilities namely Strong Memorial Hospital; Highland Hospital and Lattimore Road Surgicenter. We will continue to facilitate seamless care for those patients who may need ongoing follow-up after hospital discharge regarding their pain management needs. We will strive to promote excellence in all aspects of pain management, from clinical care, research and academic pursuits. |
