Stanford Chronic Pain Management Resident Rotation Syllabus Version 2009-10 Updated December 1, 2010 http://paincenter.stanford.edu Contents Pain Management Faculty .................................................................................................................................... 3 Volunteer Clinical Faculty .................................................................................................................................. 3 Goals & Objectives ............................................................................................................................................... 3 Patient Care ...................................................................................................................................................... 3 Medical Knowledge ........................................................................................................................................... 4 Practice-Based Learning & Improvement ......................................................................................................... 4 Interpersonal & Communication Skills .............................................................................................................. 5 Professionalism ................................................................................................................................................. 5 Systems-Based Practice ................................................................................................................................... 5 Procedural Rotation .......................................................................................................................................... 5 Patient Care ................................................................................................................................................... 6 Medical Knowledge ....................................................................................................................................... 6 Practice-Based Learning & Improvement ...................................................................................................... 6 Interpersonal & Communication Skills ........................................................................................................... 6 Professionalism ............................................................................................................................................. 7 Systems-Based Practice ............................................................................................................................... 7 Pathophysiology ................................................................................................................................................... 7 Cancer-related Pain .............................................................................................................................................. 7 Neuropathy ........................................................................................................................................................ 7 Metastatic cancer-induced bone pain ............................................................................................................... 8 Directly tumor-related pain ................................................................................................................................ 8 Chemical ........................................................................................................................................................... 8 Chronic Pain States .............................................................................................................................................. 8 1 | Page Stanford Chronic Pain Management Resident Rotation Syllabus Acute and Chronic Neck and Low Back Pain .................................................................................................... 8 Neuropathic Pain States ................................................................................................................................... 8 Complex Regional Pain Syndromes, Types 1 & 2 ......................................................................................... 8 Postherpetic Neuralgia .................................................................................................................................. 9 Phantom Limb Pain ....................................................................................................................................... 9 Peripheral Neuropathies (e.g., Diabetic Neuropathy) .................................................................................. 10 Somatic Pain Conditions ................................................................................................................................. 10 Facet Arthropathy ........................................................................................................................................ 10 Myofascial Pain: .......................................................................................................................................... 19 Fibromyalgia ................................................................................................................................................ 20 Further Reading: .......................................................................................................................................... 31 Treatment ........................................................................................................................................................... 31 Cancer-Related Pain .......................................................................................................................................... 31 Cancer Bone Pain ........................................................................................................................................... 31 Spinal Anesthesia ........................................................................................................................................... 34 Neurolysis ....................................................................................................................................................... 37 World Health Organization (WHO) 3-step Analgesic Ladder (1984 ................................................................ 40 Chronic Pain (Non-Cancer Related) ................................................................................................................... 43 Opioid Analgesics – Incl. Tolerance & Addiction ............................................................................................. 43 Anticonvulsants ............................................................................................................................................... 43 Muscle Relaxants for Back Spasms ................................................................................................................ 43 Epidural Analgesia .......................................................................................................................................... 44 Peripheral Nerve Blocks for Chronic Pain ....................................................................................................... 48 Sympathetic Nerve Blocks .............................................................................................................................. 51 Transcutaneous Nerve Stimulation ................................................................................................................. 55 Spinal Cord Stimulation ................................................................................................................................... 56 Radiofrequency ............................................................................................................................................... 59 Other General Components ................................................................................................................................ 61 Physical Examination ...................................................................................................................................... 61 Outcomes in Pain Medicine ............................................................................................................................ 63 Radiation Risk and Interventional Pain Procedures ........................................................................................ 71 2 | Page Stanford Chronic Pain Management Resident Rotation Syllabus Pain Management Faculty Sean Mackey, M.D., Ph.D., Chief, Division of Pain Management, Associate Professor Raymond Gaeta, M.D., Associate Professor, Medical Director, Pain Management Center Ravi Prasad, Ph.D., Clinical Assistant Professor, Assistant Director, Division of Pain Management Wendye Robbins, M.D., Clinical Assistant Professor Ian Carroll, M.D., Clinical Instructor Kale Wedemeyer, M.D., Clinical Instructor Vanila Singh, M.D., Clinical Assistant Professor Josh Kirz, Ph.D., Clinical Assistant Professor Tim Dawson, M.D., Clinical Assistant Professor Alpana Gowda, M.D., Clinical Instructor Meredith Barad, M.D., Clinical Instructor Mike Brook, M.D., Clinical Assistant Professor Michael Leong, M.D., Clinical Assistant Professor Einar Ottestad, M.D., Clinical Instructor Stephen Coleman, M.D., Clinical Assistant Professor Jiang-Ti Kong, M.D., Clinical Instructor