1. Definition:

A Physician Fellowship in Pain Management is a period of specialized postgraduate training for physicians which will enable the graduate of such a program to properly assess and manage patients with chronic pain of all types and to understand the sciences basic to the practice of Pain Management.

2. Duration:

A Fellowship in Pain Management should be a minimum of one year of full time clinical training. Additional research training may be desirable, depending upon the Fellow’s career goals, but this should not erode the clinical training period.

3. Prerequisites for Fellowship in Pain Management:

To be eligible for a fellowship in Pain Management, the candidate must be Board eligible or Board certified in one of the recognized specialties of Medicine; furthermore, the specialty area must involve patient care experience. The Fellow must be a graduate of an approved school of medicine. The Fellow must provide at least three letters of reference and a curriculum vitae when applying for a fellowship position. The Fellow must be licensed to practice medicine by the appropriate governmental agencies.

4. Resources:

The Fellowship must occur within a medical institution capable of providing a suitable educational environment. The institution must have a medical library with appropriate resources for this level of training. The clinical pain treatment program or its parent institution must be accredited by the appropriate governmental agencies. The pain treatment facility must have suitable space allocated for its clinical and educational activities. It must have a sufficient volume and variety of patients to provide the Fellow(s) with adequate educational opportunities. The pain treatment facility must see at least 100 new patients per annum per Fellow; there must be at least 500 patient visits per year per fellow. Pain treatment facilities which specialize in one region of the body or one type of disease are by themselves not adequate as a training resource.

5. Director:

There must be a designated Director of the Pain Management Fellowship. The Director shall be a physician who participates in the diagnosis and treatment of patients within the Pain Management facility which offers the Fellowship in Pain Management. The Director of the Fellowship need not be the administrative or medical chief of the pain treatment facility, but the Fellowship Director and the administrative and medical chiefs, if they are not the same individual, must demonstrate the ability to interact in such a way as to be conducive to the education of Fellows. The Director shall be responsible for the design and implementation of the fellowship; he or she will be responsible for certifying that a fellow has successfully completed his or her training period and has mastered the requisite knowledge, skills and attitudes.  It is desirable that the Director have extensive experience in the management of patients with the complaint of pain; it is also desirable that he or she have educational and administrative experience above and beyond the Fellowship in Pain Management. The Director shall be responsible for maintaining an up-to-date file on each Fellow, documenting his or her educational progress and any deficiencies.

6. Faculty:

There shall be at least three members of the pain treatment facility staff who are designated as faculty in addition to the Director. Faculty members shall be appropriately certified in a patient care specialty.  Faculty members shall also be members of the WIP and a national chapter. Faculty members of a Fellowship in Pain Management shall represent at least three health care delivery specialties. Other types of health care providers in addition to physicians and psychologists may also be members of the faculty. Faculty members must spend a major part of their professional time working within the pain treatment facility.

CLINICAL TRAINING SUBJECTS

Although not every Fellow will be fully trained in every area listed below, he or she should at least have had some exposure to patients whose care involves all of these areas.

1. Medical diagnosis and therapy

(a) History and physical examination
(b) Measurement of pain
(c) Physical therapies
(d) Vocational/rehabilitation assessment and management
(e) Participation in multidisciplinary assessment and treatment
(f) Anesthesiologic procedures (when appropriate for Fellow’s prior training)
(g) Surgical procedures (when appropriate for Fellow’s prior training)
(h) Other procedures appropriate to the Fellow’s prior specialty training

2. Psychologic diagnosis and therapy

(a) Use of diagnostic tests
(b) Collection of data from interview and standard forms
(c) Comprehensive assessment
(d) Treatment options:
(i) Individual, group and family psychotherapy
(ii) Cognitive-behavioral therapies
(iii) Biofeedback and relaxation techniques
(iv) Hypnotherapy

3. Pharmacotherapy

(a) Analgesics:
(i) Non-narcotics
(ii) Narcotics
(iii)Adjunctives
(b) Antidepressants
(c) Sedative-hypnotics
(d) Benzodiazepines
(e) Others

4. Specific types of painful conditions to be included in Fellow’s educational program

(a) Pain associated with cancer, including issues of death and dying, palliative care and hospice.
(b) Post-operative and post-trauma pain
(c) Pain associated with nervous system injuries
(d) Pain associated with chronic disease
(e) Pain of unknown etiology
(f) Pain in children
(g) Pain in the aged

5. Regional Pain Syndromes to be included in Fellow’s educational program

(a) Headache
(b) Facial Pain syndromes
(c) Neck and upper back pain
(d) Low back pain
(e) Extremity pain syndromes
(f) Thoracic and abdominal pain
(g) Pelvic and perineal pain

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