Dr. JAIDEEP SINGH
ONE YEAR - FULL TIME - ADVANCE PAIN FELLOWSHIP (PAY FOR 6 MONTHS AND GET TRAINED FOR 1YEAR)
ADVANCE PAIN PAIN MEDICINE FELLOWSHIP
( course is designed to train candidates in the principles and practice of pain management )
2. Eligibility: (Basie Qualification for admission) - . MD/ DNB (Anaesthesiology) from a NMC/NATIONAL BOARD recognized college or institute
3. Number of Candidates: 2 per year. Course would consist of Theory and Practice of intervention for pain management
4. Admission: selection is based of Interview, biodata, work experience of the applicant ,
6. Duration of the course -1 year
Aims and Objectives of the Course
The aim of the course is to impart thorough and comprehensive training to the candidate in the various aspects of Pain specialty to enable him/her:
(a) To function as a faculty/consultant in the specialty
(b) To carry out and help in conducting applied intervention in the field of Pain Management
(c) To plan and set-up independent pain Unit setup.
(d) To increase standard of care for patients suffering from chronic pain conditions
Teaching Methods
During the period of training candidates gradually increasing responsibility for independently managing interventional procedure and OPD and IPD patients care.
The day to day work of the trainees will be supervised by the consultant Incharge and other faculties of International Pain College. The posting is so designed that the trainee get posted in various areas of the pain medicine like Pain operation theatre, OPD, and Pain and Palliative ward ,APS in various surgical and medical wards for management of in-house patients suffering from intractable pain due to medical conditions and management of cancer pain and palliative care to these patients, candidate can take rounds of differenct associated hospital for preparation and postop care of chronic pain patients under the supervision of Pain consultant.
Attendance:
Minimum 80 % attendance mandatory to appear in exit exam
Examination and Evaluation:
Internal assessment:
The internal assessment will be conducted on the basis of day to day work of the candidate in terms of patient care, teaching, management of patient’s bed side clinical discussions and research. Candidates will be counseled on their performance to get the best out of them.
Internal Assessment test: 3 monthly
Teaching Programme
The following teaching programme is prescribed for the course:
Operation theatre 6 days/week, Pain OPD 6 days/week Regular patient centeric one to one teaching, Seminar Once a week, Journal Club Once a week, Case Presentation once a week.Teaching to Junior students and other fellows is a part of the training,
Log Book
Entry of OPD data, Patient data, Pain procedures, seminars, workshops, journal club,CME and Workshop attended.
Research
The trainee shall be required to write one research paper under the guidance of consultant for publication in an indexed journal.
Apart from paper publication each candidate must wright atleast 2 articles for the awareness of pain medicine as a speciality.
Pain Medicine Curriculum:
The training program can be updated and modulation as and when required
Part 1
Basic Sciences
1) Applied Anatomy: Basic and correlative anatomy related to pain physiology and pain procedures, embryological development of brain, spinal cord, skull and spinal structures, neck anatomy and pain pathways.
2) Applied Physiology: Basic and correlative pain physiology
3) Applied Pharmacology: Basic and correlative pharmacology of drugs used for pain management and their clinical application.
4) Applied Bacteriology: Basic bacteriology and antibiotics usage in pain procedures.
5] Applied Radiology- To have basic understanding and reading abilities of X-ray/ MRI/ CT scans
5) Applied equipment: Concepts of fluoroscope, radiofrequency machine, ultrasound machine, ozone generator, percutaneous spine endoscopic instruments, spinal needles, radiofrequency needles.
Part II
Clinical Sciences
1) History and clinical examination methods for pain patients.
2) Clinical management of various chronic pain disorders.
3) Cancer Pain Management.
4) Palliative and end of life care.
5) Management of common emergencies.
Part III
Recent advancements in pain medicine which includes:
- Functional pain physiology
- All percutaneous, minimally invasive pain interventions as listed by Indian Society for Study of Pain (ISSP)
- Spinal card stimulation
- Percutaneous Endoscopic Procedures
- Intrathecal pumps/ Implants
- Percutaneous analgesics patches
- Neonatal and Paediatric pain management
- Regenerative medicine
- Stem cell therapy for pain control
10.Gene therapy and further research
CLINICAL SKILLS TO BE ACQUIRED BY THE CANDIDATES:
- History and clinical examination of pain patients.
- Pre procedure evaluation of pain patients.
- Perioperative management of pain procedures
- Proficiency in Interventional pain procedures
- Non-surgical percutaneous minimally invasive techniques-
- Stimulation techniques
- TENS
- Physical medicine and rehabilitation Basics
- Psychiatric and Psychological treatments
- Multidisciplinary management
- Diagnosis and management of following pain syndromes/painConditions
- acute and chronicLow back pain
- Myofascial pain
- Neuropathic pain
- Headache
- Rheumatological pain
- Cancer pain
- Hospital based hospices services
- Post-operative pain – PCA/PCEA
- Pain in children
- Ethical aspect of pain management
- Radiofrequency (RF) Ablation techniques
- Interventional pain management
- Cervical chordotomies
- Gasserian Ganglion RF Lesion
- Balloon Compression of Trigeminal Ganglion
- Cervical Discectomy ( Ozone/ RF)/ MBB RF lesion
- Satellite Ganglion RF lesion
- Vertebral augmentations
- Endoscopic discectomies
- Endoscopic pain management procedures
- Celiac Plexus Rhizolysis (classical/Trans Discal/ Trans Aortic) Splanchnic Nerve RFA
- Suprascapular RF lesion
- RF Discectomy/ Nucleotomy
- Medial branch RF lesion
- Sacroiliac Inj.,
- GanglionImpar RF lesion
- Superior Hypo gastric Plexus Rhizolysis
- And all other MIPSIs in the mandate of Indian Society for Study of Pain (ISSP) and as medicine is continuously evolving science, as and when new interventions will evolve, will be added in the curriculam.
- Proficiency in acute pain management of post operative patients.
- Multimodal analgesic regimes
- Palliative care:
- WHO analgesic ladder for Cancer pain
- Intensive care of sick pain patients
- Peri-procedure fluid and electrolyte management
- Proficiency in sympathetic interventions
- End of life care
- Management of complication in terminal cancer patients
- Advanced Cardiac Life Support
- Understanding of the terms “palliative care” and “terminal illness
- Describe the evolving nature of palliative care the course of an illness
- Explain the importance of “by the clock” drug therapy to a patient or relative
- Counsel a patient or family who are confused about definitive treatment and palliative care
- Understand the pathological process and principles of management of Non-communicable diseases, including Cancer,
- Cancer pain management including principal, practices and problems associated with Radiotherapy ,Chemotherapy ,Surgery
- Hormone treatment
- End of life care in patients with- heart disease, lung disease, liver disease, other non-communicable diseases
- Understand the relevance of affordability of treatment measures, particularly in the context of the developing word.
Final Exit Examination
Eligibility
Candidate will be allowed to appear after one year of training, with minimum 80% attendance
Board of Examiners
The final assessment will be doing by board of examination including 2 Internal and 2 External Examiner concern to Pain specialty, experience of examiners shall follow the same rules as applicable to other examiners of DM or DNB courses in the country
Theory Papers
There shall be Two theory papers with the following titles
- Basic sciences and anatomy related to pain management.
- Clinical aspects and recent advances of pain management.
Clinical Practical and Viva Voice
One long and two short cases will be given to candidates for presentation and discussion.The candidates will also be given radiological images (CT,MRI, X-Ray etc), investigations (NCV, electrophysiological monitoring etc) reports to interpret.
Various equipment used in operation rooms, drugs and neurolytic agents will be exhibited for discussion. A grand viva
PASSING PERCENTAGE OF EXIT EXAM : 50%
REASONS FOR – TRAINING OF PAIN MEDICINE IN INDIA
“Pain is a more terrible lord of mankind than even death itself” said nobel laureate Albert Schweizer in 1931.
Today proper teaching and management of pain remains one of the most important and pressing responsibilities of the society in general, the medical institutions and personnel in particular.
Specialist pain clinics are the norm in developed countries with cutting edge of technology, dedicated Pain specialists and state of the art facilities.
Pain is as major a problem in our country as anywhere else but the lack of a formal teaching and treatment strategy has been major lacuna in health care of our country. Statistics from advanced countries show that 15-20% of population have Acute pain (medical & surgical emergencies, Postoperative pain, after accidents and injuries) and 35-40% of all population have chronic pain (As in chronic backache, cancer pain, migraines, arthritis, neuropathic pain etc). Because it impairs the ability to work and have a productive life, Pain has serious economic and social consequences.
For example half to two third of all chronic pain sufferers are totally or partially disabled for days (headache, migraine), weeks or months (those with CRPS) and some permanently (like low backache, cancer pain and arthritis).
JUSTIFICATIONS : Pain has been defined as a 5th vital sign and Joint commission for Accreditation of Health Care organization (NABH) has made it compulsory to be monitored in all surgical settings in the postoperative period.
Therefore running of Acute Pain service is a must for accreditation of any health care organization.
There is a pressing need of trained physicians who could diagnose and treat these chronic pain conditions.