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Interventional spine fellowships focus on treating spinal column pathology with interventional techniques. Fellows will learn to perform epidurals, facet injections, MBB, RF ablation, hip, SI, shoulder, trigger points injections. Interventional spine centers should not advertise themselves as pain clinics. Medical management is usually referred back to patients’ primary care physician or pain physician. Fellows will utilize their PM&R backgrounds and perform comprehensive musculoskeletal exams to aid the diagnosis. EMGs, musculoskeletal and sports are likely to be incorporated to the fellowship. There are usually opportunities to work with Orthopedic and Neurosurgery. There are usually limited or no experience in implantable procedures.
Interventional spine fellowships are ideal for people who are not interested in seeing chronic pain patients, and would like to expand their PM&R background. Upon completion of the fellowship, fellows will feel comfortable to offer a variety of the bread and butter injections as options for alleviating spinal column pain in conjunction with physical therapy. Fellows are not eligible to take the ABPMR subcertification in pain medicine. There are 2 main types of pain medicine fellowships, ACGME accredited and non-ACGME accredited. I cannot comment on the non-accredited fellowships as I don’t have any knowledge about them. The majority of ACGME-accredited pain medicine fellowships are under the department of anesthesia. People who seek pain medicine fellowship training would like to be a leader in the field of pain medicine. In order to satisfy ACGME requirements, pain fellowship programs must cover a wide variety of interventional techniques, chronic pain, acute pain, didactic curriculum for cancer pain management and principles of multidisciplinary approaches, etc. However, just because programs are ACGME accredited, it doesn’t mean that all programs will provide top quality training. Fellows' experience may vary widely in different programs. Upon completion, fellows are eligible for board subcertification in pain medicine through ABA, ABPMR, or ABPN. Anesthesia based pain medicine programs
There are currently 93 ACGME accredited pain medicine fellowship programs operated by anesthesia. The number of programs is down from 100 from the year of 2000. There are approximately 160 positions in these 93 programs. Aside from interventional procedures, a well structured and balanced program should provide some rotations like behavioral and multidisciplinary pain management, hospice, PM&R, cancer, radiology, etc. The program should have some flexibility in tailoring the experience to satisfy the fellow’s areas of interest. Some programs may have more acute pain coverage than others. Competition for procedures may be a problem for larger programs. Regional anesthesia is usually part of the training, but the extent of exposure will vary from program to program. PM&R based pain medicine programs
10 programs are accredited through PM&R, and the number may continue to grow. According to the RRC memorandum from Jan, 2000, the expected number of fellows in PM&R pain programs will eventually reach 35. Most of these programs started as spine/musculoskeletal/sports fellowships. PM&R pain programs will tend to have a bias by taking advantage of faculty and fellows background in musculoskeletal medicine, electrodiagnostics, sports medicine, and rehabilitation. Therefore, fellows may expect to do EMGs, covering sports clinic/events, seeing musculoskeletal patients. In general, the experience in implantable devices are not as good as the top anesthesia pain programs. Regional anesthesia experience is minimal or not available. The idea of acute pain service/consult is also very different from anesthesia programs. It’s unlikely that fellows will gain experience in airway management. Most fellows should feel extremely comfortable in the commonly performed pain management procedures after completion. Neurology and Psychiatry based pain medicine programs are still in the early stages of development. There are currently 2 accredited programs. Depending on the program, vertebroplasty/kyphoplasty may be performed. Unproven procedures like LASE, epiduroscopy, IDET, nucleoplasty may be performed by some programs. Pain medicine fellowships are strongly encouraged for those who would like to devote a significant amount of their practice to see pain patients. They will be considered as the pain specialist among their peers. Pain medicine fellowship graduates will be very competitive in obtaining academic positions and they will have a bright future in this emerging field of medicine. Please contact us if you have any questions or comments about this article. |
Fellowships 
