Pain Medicine Fellowship Program

We currently train three fellows per year in our ACGME accredited pain medicine fellowship. Fellows easily meet and exceed ACGME training requirements including those for interventional procedures. Fellows train at various locations including University of Maryland Rehabilitation & Orthopaedic Institute, the University of Maryland Medical Center (UMMC) and the Veterans Affairs Medical Center (VA). All are located in close geographical proximity.

Chronic Pain

Fellows will spend a majority of their time in the Pain Management Center at University of Maryland Rehabilitation & Orthopaedic Institute. This exposes the fellow to a wide variety of chronic pain conditions. Fellows are scheduled in the PMC at least three weeks out of every month unless they are assigned to other rotations. Fellows divide their time between seeing patients in the clinic setting or performing interventional pain procedures. Fellows work under the guidance of a pain medicine faculty member.

Our chronic pain patients are referred by physicians from Maryland and the surrounding states. Approximately 4,000 clinic visits occur annually. Fellows are involved in the patient evaluation and treatment planning process. These treatments may include medication management including opioid therapy, referrals to our pain management psychologist for behavioral services, and referrals to physical therapy. Fellows also identify appropriate patients as candidates for interventional therapies.

The various interventional treatments offered by our Center include nerve blocks, radiofrequency lesioning, discography, ultrasound guided procedures, and implantable therapies. Our Center is equipped with a fluoroscopy suite, a radiographer and a dedicated nursing staff. Approximately 1,400 fluoroscopically guided procedures are performed annually. In addition, our Center also offers advanced implantable therapies such as spinal cord stimulation and intrathecal pumps. Under the direction of the pain medicine attending, fellows are trained in surgical implants.

Adult and Pediatric Acute Pain

Fellows gain experience in acute pain medicine at UMMC and are assigned to this rotation for one week every six weeks. The Acute Pain Management Service (APMS) provides postoperative pain management for both adult and pediatric patients utilizing neuraxial and systemic Patient Controlled Analgesia (PCA) techniques. The acute pain service responds to inpatient consultations for the management of postoperative pain, malignant pain and other chronic and acute pain syndromes. The fellow will also get exposed to several regional procedures with our regional anesthesia-trained faculty.

We have a dedicated staff of Pediatric Anesthesiologists who provide specific training to our fellows. Over 500 pediatric patients per year are seen with a variety of diagnoses requiring pain management. Diagnoses include oncologic related pain, sickle cell disease and other pain conditions.

Overnight call is taken from home during this rotation. APMS nurses usually cover the pager at night and fellows serve as back up. A supervising pain medicine attending is always assigned to the service and fellows are encouraged to contact them when necessary. It is a very rare occurrence that the fellow needs to return to the hospital at night, although it may occur in an emergent situation.

Additional Rotations

The Pain Medicine Fellowship Program offers a well-established educational program that fulfills the requirements of the ACGME. These include:

• Daily teaching rounds on the acute pain service
• Weekly multidisciplinary case discussions
• Weekly pain medicine lectures
• Visiting lecturers in pain medicine
• Journal club
• Interdisciplinary meetings
• Quality Assessment/Improvement and M&M Conferences
• Practice management and compliance meetings

Fellows are expected to take an active role in teaching their colleagues and residents. Each fellow presents a Grand Rounds lecture as well as additional lectures including presentation of journal articles and continuing quality improvement processes.

Each fellow is expected to complete a research project related to either acute or chronic pain management. This includes preliminary literature review, writing of the research protocol, and submission of the protocol to the IRB by the end of the fellowship year. Each fellow is assigned dedicated research hours to devote to this activity. Fellows also meet regularly as a group with the PMC Research Coordinator who assists and guides the fellows through this process. In addition, each fellow is mentored by one of the Pain Medicine attendings who may assist with the selection of a research topic.

Additional Educational Opportunities

• Cadaver labs
• Neurostimulation seminars
• Fluoroscopic guided procedures using anatomic model