Chronic Pain

I started my chronic pain rotation this month. Pain is truly a multidisciplinary field. Although anesthesiologists bring certain skills like regional nerve blocks, epidural and spinal interventions, and knowledge of pain medication pharmacology, there are many aspects of chronic pain outside our scope. For example, pain and psychological conditions often go hand in hand, headaches are a common chronic condition that doesn't respond well to our normal armamentarium, and diagnosis of musculoskeletal complaints often requires examination skills and tests perfected by physical medicine and rehabilitation doctors. Thus, it is truly a multidisciplinary gathering where each specialist brings something to the table and where residents and fellows try to shore up our weaknesses.

Chronic pain is a clinic based rotation, which is also very different from an anesthesiologist's usual setting. Stanford's pain clinic is located in a beautiful new facility with floor to ceiling windows, plenty well-designed examination rooms, a procedure area, and computers for patients while waiting. I'm slowly getting used to the tie and white coat rather than my usual scrubs. The fellows and attendings are from many different backgrounds; some have been surgeons, internal medicine physicians, traditional Chinese medicine doctors. Patients have often seen pain physicians in the past, so cases can be particularly complex. As residents, we rotate through the clinic, the procedures, and a few psychiatric and private practice settings. Clinic is not my usual habitat and chronic pain patients aren't my usual crowd, so we'll see how this month goes.