Monday, August 20, 2007

Pain Management Clinic

We actually had TWO patients for today, but I didn't help collect data on either one because I went to the Pain Management Clinic (PMC). It was a very eye-opening experience. My longitudinal preceptor sends patients to the PMC all the time, and I wanted to get a sense of what they do there. First of all, it's incredibly busy. One of the fellows told me that CCF's PMC is one of the largest and busiest in the entire country, and I believe it. I also got an appreciation for how much training it takes to become a pain management doctor. This particular fellow had gone through a year of internship, three years of anesthesiology residency, and is now doing the pain fellowship.

Mainly what they do is stick some really huge needles into people's backs, necks, and even heads. It's not acupuncture. They're injecting anesthetics like lidocaine directly into the spinal column or nerves of the scalp, which is called a nerve block. Some of the patients are addicted to narcotics, and the goal of giving them nerve blocks is to control their pain to the point where they can be weaned off the narcotics. The most fascinating patient I saw was one who gets constant headaches. The fellow injected anesthetic directly into the patient's scalp, and within 20 minutes, the headache was gone. The fellow said relief might last for several weeks or months, even though the anesthetic itself wears off after several hours. The doctors don't really know why these nerve blocks work, but I got the impression that it's sort of like rebooting a computer. Sometimes when the circuits are frozen and just not responding properly, you hit "restart," and suddenly it works fine.

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