The Multidisciplinary Anesthesia Pain Fellowship at Indiana University School of Medicine is a one-year, AGME-accredited post-residency program that provides comprehensive training in chronic pain management. It is conducted predominantly on the campus of IU Health University Hospital and the Roudebush VA Medical Center. A short amount of time is spent at Riley Hospital for Children to familiarize fellows with the potential needs of pediatric patients transitioning to adult care. The focus of the fellowship is the training for interventional pain management of the adult patient. Being multidisciplinary, fellows rotate through other departments to round out their knowledge of chronic pain rehabilitation, palliative care for terminal illness, neurology, neuroradiology, and psychiatry and addiction.
Focused Training
Elemental to interventional training is our emphasis on performing fluoroscopically directed interventional blocks at our campus same-day surgery center and the VA pain suite. We do many interventions such as Vertiflex and MILD procedures to treat lumbar spinal stenosis, as well as Kyphoplasty for vertebral fractures, and OsteoCool therapy for spinal metastatic disease. Additionally, peripheral pain syndromes are frequently managed with Sprint PNS therapy, epidural steroid injections, facet joint injections, medial branch blocks, radiofrequency nerve ablations, and SI joint interventions. Advanced pain therapies using long-term intrathecal spinal pumps and epidurally placed spinal stimulators are useful for advanced cancer pain, failed back syndrome, and chronic abdominal pain from a pancreatic disease.
Management of anterior column pain can also be achieved utilizing intradiscal hydration (ViaDisc) and radiofrequency basivertebral nerve ablation (Intracept). Clinic exposure will focus on understanding pathology, clinical presentation, management of a vast array of painful conditions, essential follow-up care, suturing and wound checks, intrathecal pump refills, and complex stimulator programming. As pain is often initially separated into spinal vs non-spinal pain, a rotation in neuroradiology will provide the fellow with excellent analytical skills in assessing spinal films, CT scans, and MRIs - all key to successfully interacting with neurosurgeons and performing appropriate advanced interventions.
Work Schedule
In addition to the nine months devoted to interventional pain in the clinics and three months rotating through physical medicine and rehabilitation, psychiatry and addiction, neurology, and radiation oncology/palliative care, the fellow should develop an understanding of functional restoration, psychiatric and substance abuse intervention, EMG analysis, headache management, and care of the terminally ill patient.Though not required, it is hoped that each fellow will pair up with a faculty mentor to engage in clinical research. Opportunities for basic science research also exist.
Fellows will have clinical responsibilities on weekdays and should be available for some phone consultations after hours.
Didactic Schedule
Our weekly didactic schedule focuses on interventional procedures, the neurophysiology of pain, appropriate opioid management, and specific pain syndromes such as myofascial pain, facial pain, neuropathic pain, headache, CRPS, and cancer pain. All discussions will be focused on clinical assessment and diagnosis, performing interventional procedures, and passing the pain boards. Additionally, there is a monthly journal club, M&M conference, and guest lecturers during the second hour of our weekly didactic schedule. (7am-9am every Wednesday)
The main textbooks used are Essentials of Pain Medicine (4th edition) by Benzon, Raja, Liu, Fishman, Cohen, and Atlas of Image Guided Intervention in Regional Anesthesia and Pain Medicine (2nd edition) by Rathmell.
Additionally, the Pain Pass Machine (The Pain Board Review) will be purchased for each fellow as specifically passing one’s boards is an essential goal of our program.
Salary and Benefits
Salary and benefits, including health insurance, vacation, and meeting days, are commensurate with the PGY-5 resident level at IU School of Medicine with an additional stipend for the mandatory research component. Find details about employment terms and benefits through the Office of Graduate Medical Education.
Application Information
Currently, we are accepting those who successfully completed an anesthesia or PMR residency program. All interested individuals are encouraged to submit a completed fellowship application, completion certificate of residency, USMLE scores, and three letters of recommendation to our fellowship program coordinator, Serena Mahoney, at 317-274-4343 or semmitch@iu.edu.
