Pain Medicine (Multidisciplinary) Fellowship
The Pain Medicine (Multidisciplinary) Fellowship integrates several areas of pain medicine, including interventional pain management, chronic pain rehabilitation, cancer pain and palliative care, acute pain, pediatric chronic pain, neurology, psychiatry and clinical research. The fellowship is a collaboration between two of the main teaching centers at McGaw Medical Center: Northwestern Memorial Hospital (NMH) and Shirley Ryan AbilityLab.
Our faculty members are recognized experts in pain medicine, regional anesthesia and rehabilitation. They are active in the American Society of Regional Anesthesia, American Society of Anesthesiologists and American Academy of Physical Medicine & Rehabilitation. They are members of the editorial boards for Regional Anesthesia and Pain Medicine, Clinical Journal of Pain and MD Consult-Pain Medicine.
Faculty have authored and edited major textbook, including Practical Management of Pain, edited by Honorio T. Benzon, MD et al., and Essentials of Pain Medicine and Regional Anesthesia by Dr. Honorio T. Benzon. There is active clinical research in the division resulting in publication of papers, reviews, abstracts and book chapters. All fellows present at least one abstract at a national scientific meeting each year.
For additional information, please contact fellowship coordinator Alison Mah at email@example.com.
About the Program
Goals & Learning Objectives
Gain proficiency in understanding the underlying mechanisms of the different pain syndromes
The fellow will learn the pathways and the neurochemistry involved in pain propagation and transmission. The fellow will learn the mechanisms of the different types of pain and the management thereof. These include such pain syndromes as acute pain, back pain, neuropathic pain, myofascial syndromes, headache and cancer pain.
Gain proficiency in the management of acute pain
The fellow will learn to manage acute postoperative pain, postdural puncture headache and chest trauma (i.e., complex rib fractures/flail chest). Epidural opioid and local anesthetic infusions, peripheral nerve blocks and catheterization and intravenous patient-controlled analgesia (PCA) are utilized in postoperative pain management while epidural or intercostal nerve blocks are employed in chest trauma. The fellow will document involvement with at least 50 new patients in this setting.
The fellow will be involved in the assessment and treatment of inpatients with benign and cancer-related pain disorders (other than postoperative pain) while covering inpatient consultation service. Responsibilities to the consultation service are assigned on a rotating basis amongst all fellows. The fellow will document at least 15 new patients assessed in this setting.
Gain proficiency in treating cancer pain and palliative care patients
The fellow will learn the etiologies of cancer pain and gain exposure in the medical and interventional management of patients with cancer pain.
The fellow will have longitudinal clinical exposure to patients with cancer pain and will have longitudinal palliative medicine experiences.
The fellow will be exposed to multidisciplinary and interventional approaches to treating patients with cancer pain and patients with terminal diseases while in outpatient clinics, on inpatient consultation service and during outside rotations.
The fellow will document experience with a minimum of 20 longitudinal cancer pain patients and 10 palliative care patients during the year.
Gain proficiency in managing chronic noncancer pain
Low back pain, myofascial pain syndrome, headache, pelvic pain and neuropathic pain (e.g., postherpetic neuralgia, CRPS) are examples of chronic benign pain. The fellow will be exposed to the pharmacologic, interventional, as well as the nonmedical (psychologic, rehabilitation approaches) treatments of these syndromes.
The fellow will have a longitudinal clinical experience with patients with chronic benign pain syndromes during their outpatient clinic experiences and will document a minimum of 50 different patients over a two-month observation period.
Interpret and become familiar with basic neuro-imaging, identify significant findings, including MR and CT of the spine and brain and/or MRI studies drawn from the examples within the following areas: brain, cervical, thoracic and lumbar spine when assessing patients with chronic pain.
Gain proficiency in interventional fluoroscopy assisted blocks
At the Northwestern Medicine Lavin Outpatient Pain Medicine Center, there are two fluoroscopy suites with two dedicated fluoroscopy machines where interventional blocks are performed. There is a six-bed recovery room adjacent to the fluoroscopy rooms where the patients recover after their procedure(s). Fellows will be exposed to interventional procedures such as discography and intradiscal techniques, radiofrequency ablation (pulsed and thermal), intra-articular injections, vertebral augmentation, spinal cord stimulators and neuraxial opiate trials and long-term management. Each fellow will document involvement of a minimum of 25 patients who undergo interventional procedures.
Permanent implants (spinal cord stimulators, peripheral nerve stimulators, peripheral nerve and/or field stimulators and intrathecal opiate infusion pumps, battery replacements, epidural ports) are performed in the Lavin Operating Rooms. On occasion, vertebral augmentation procedures will be performed in these locations, but are typically performed in the Anesthesiology Pain Medicine Center. Fellows will actively participate in these surgeries under the direct supervision of pain medicine attending and will also participate in the perioperative management of these patients (e.g., wound checks, suture removal, pump refills, pump and stimulator reprogramming, management complications).
A trend of progressive improvement in manual skills during the conduct of interventional procedures will be maintained by the fellow, with decreasing direct attending “rescue” during injection procedures.
Gain exposure to the multidisciplinary treatments of pain
The fellow will rotate through the Ann & Robert H. Lurie Children’s Hospital of Chicago for pediatric pain management and through the Shirley Ryan AbilityLab for rehabilitation, neurology and psychology exposure. Patients will interact with psychiatry service attending during their fellowship, and fellows will rotate through the Hospice and Palliative Care Service at NMH for management of cancer pain and palliative medicine experience. In addition, other specialists (psychologists, physical therapists, neurosurgeons, spine surgeons, neuroradiologists, urologists, chiropractors) are invited to give lectures to the service and will participate in multidisciplinary conferences and lectures.
Gain exposure to research design and statistical analyses and exposure to publications
The Section of Pain Medicine has monthly journal club meetings where research design and statistical analyses are discussed and analysis of classic or pertinent pain medicine papers are evaluated and discussed. These journal club meetings will be led by a pain medicine attending with active participation by the Pain Medicine (Multidisciplinary) fellows.
The Department of Anesthesiology has quarterly journal club meetings where research design and statistical analyses are discussed in the context of anesthesiology practice. All fellows and residents within the department, as well as pain attendings, attend these events.
Research seminar presentations are conducted throughout the year wherein an attending presents his research project(s). Depending on their participation, fellows may be invited as co-authors of case reports, review articles, original articles or book chapters written by the faculty.
There is a research requirement for all Pain Medicine (Multidisciplinary) fellows. Each fellow will be assigned a faculty mentor to guide and assist the fellow in a research project and assist in submitting an abstract, case report or case series to a regional or national pain meeting.
Gain exposure to teaching, administrative aspects and systems-based practices of pain management
The fellow will present formal and informal lectures to the residents and medical students rotating through the service. Depending on their expertise and enthusiasm, the fellow will have the opportunity to present cases and lectures to the department, including Department Grand Rounds.
Each fellow will present one Morbidity/Mortality Case discussion to the section of pain medicine during the academic year. A post-conference self-evaluation will be completed by each fellow.
All fellows will gain exposure on the administrative aspects of pain management, including setting up a pain practice, billing and coding, compliance and JCAHO standards.
Administrative responsibilities including fellow call schedules will be rotated among all Pain Medicine (Multidisciplinary) fellows.
The fellows will be involved with problem solving aspects and process improvement of the Anesthesiology Pain Medicine Center practice and will pursue, develop, plan and execute a project that will improve patient safety and promote “best practice” principles. A timeline for this project will be presented by the program director. The project must be fully completed prior to completion of the fellowship. Failure to complete this project will result in probation or suspension.
Gain exposure to the principles of anesthesiology and patient safety
A fellow who has completed an anesthesiology residency or has had significant knowledge and clinical experience in anesthesiology will be exempt from the supplemental OR Anesthesiology rotation during the Pain Medicine (Multidisciplinary) Fellowship.
The fellow will rotate through the Anesthesiology OR Service to gain clinical exposure to pre-anesthetic assessment, patient monitoring, principles of intravenous sedation, airway assessment and management (including mask ventilation and intubation). The fellow will gain practical experience in placing intravenous catheters, as well as performing spinal anesthetics and epidural catheterizations, and will gain experience in the management of perianesthetic complications of these modalities.
All fellows will be involved in the conscious sedation of patients undergoing interventional procedures in the Anesthesiology Pain Medicine Clinic and during the conduct of Acute Pain Service duties. They will provide safe and efficient care of these patients intra-procedurally and post procedurally.
All fellows will participate in formal and informal lectures regarding radiation safety and addiction/dependence issues in pain practice and will identify issues of physician impairment and fatigue.
Fellows will be directly involved in monthly morbidity and mortality discussions of the section of Pain Medicine under the direction of an attending.
Optional exposure to psychiatry
Fellows may spend clinical time with other specialists including addictionologists and psychiatrists at NMH. This will involve evaluation of patients with psychiatric or addiction disorders. Fellows will perform 15 mental status examinations during this experience; five of these examinations will be directly supervised by a psychiatry attending physician.
Operative Services, Department of Anesthesiology, NMH
During the consecutive four-week rotation, the fellow will demonstrate competency in:
- Obtaining IV access in a minimum of 15 patients
- Basic airway evaluation and management including mask ventilation in a minimum of 15 patients and endotracheal intubation in 15 patients
- Management of sedation, including direct administration of sedation to a minimum of 15 patients
- Administration of neuraxial analgesia, including placement of a minimum of 15 thoracic or lumbar epidural injections via interlaminar technique
- The fellow will obtain a medical history pertinent to the delivery of anesthesia services and relay this information in an appropriate manner to the supervising Anesthesiology Attending
- The fellow will describe the anesthesia plan and/or anesthetic treatment options to patients and family prior to surgery/procedure
- The fellow will communicate patient’s history and perioperative course to PACU staff in the postoperative period during “sign out” exercise
- The fellow will communicate appropriately with ancillary staff and attending staff in the OR, will participate in Pre-Operative Team Briefing and “Time-Out” exercises in addition to any other pertinent patient safety procedures
- The fellow will accept guidance and instructions from Anesthesiology Attendings
Cancer Pain Program, NMH Palliative Care Unit
During the intensive, consecutive two-week rotation, the fellow will:
- Assess and manage pain and non-pain symptoms experienced by patients with terminal disease(s)
- Maintain longitudinal clinical involvement in the management of cancer patients and hospice patients
- Understand the clinical approach to the treatments that comprise multidisciplinary cancer pain care
- Understand strategies to integrate pain management into this multi-dimensional treatment model, which may be integrated with continuity experience or inpatient experience
- Identify issues associated with the prognosis and terminal care of patients with cancer and non-cancer diseases
- Know the current literature related to pain management in the terminally ill patient
- Learn the cultural factors involved in palliative care and various communication techniques used to overcome these boundaries
- Examine the legal and ethical concerns related to pain control at the end of life care as well as the administrative and logistic issues that may affect treatment(s)
Shirley Ryan AbilityLab, Multidisciplinary Rehabilitation
This four-week rotation is followed by a once-weekly rotation for one month. During these rotations, the fellow will:
- Conduct a complete psychiatric/psychological history with special attention to psychiatric and pain co-morbidities
- Conduct complete mental status examinations and demonstrate this ability to a faculty observer
- Understand how to perform a full musculoskeletal history and the appropriate components of a neuro-musculoskeletal examination as they related to pain problems
- Gain significant hands-on experience in the neuromusculoskeletal history and physical examinations and demonstrate proficiency in the clinical evaluation of these patients
- Observe and perform a comprehensive musculoskeletal and appropriate neurologic history and examination with emphasis on both structure and function as it applies to diagnosing acute and chronic pain problems and developing rehabilitation programs for them, including assessments of static and dynamic flexibility, strength, coordination and agility for peripheral joint, spinal and soft tissue pain conditions
- Gain an understanding of the natural history of various musculoskeletal and neurologic pain disorders and be able to appropriately integrate therapeutic modalities and surgical intervention in the treatment algorithm
- Understand the indicators and interpretation of electro-diagnostic studies; fellows will gain significant hands-on experience in the musculoskeletal and neuromuscular assessment and demonstrate proficiency in the clinical evaluation and rehabilitation plan development
- Discuss with a physiatrist/neurologist the issues associated with pharmacologic management of pain
- Understand the role of psychological testing as part of assessment of patient’s suitability for interventional procedures; observe with a licensed psychologist some of the psychological treatments of pain, including biofeedback therapy, psychosocial therapies, behavioral and cognitive therapies and relaxation techniques
- Observe psychological evaluations as performed by a psychologist with expertise in pain management
- Observe physical therapy treatments of patients with back pain and other chronic pain syndromes and understand how therapeutic modalities integrate into treatment plans
- Become familiar with basic neuroimaging; identify significant findings on MR, CT and radiographs
- Participate in multidisciplinary patient care conferences and develop a rehabilitation plan for chronic pain patients
- Document longitudinal patient care experiences and new patient evaluations in case logs
Chronic Pain Service, Department of Anesthesiology, Lurie Children’s
During the consecutive four-week rotation (a half-day each week), the fellow will:
- Describe the approach to evaluation and treatment of pediatric patients with pain complaints
- Understand the reasons pain is viewed as difficult to evaluate in children, is often not recognized by the healthcare personnel and, consequently, is poorly treated
- Identify the difficulties in the evaluation of the pediatric patient with pain and learn how to utilize the available tools for the assessment of pain in this age group
- Discuss the need for a multidisciplinary team approach to meet the needs of children and adolescents with chronic pain syndromes
- Recognize the importance of treating pain in infants, children and adolescents to enhance their quality of life and to reduce the adverse impact of chronic pain and stress on the course of their illness
- Identify how complimentary medicine techniques like acupuncture, massage and counseling are integrated into the care plan of the pediatric pain patient
The fellow is expected to participate in the clinical activities of the section. These include making rounds on the postoperative pain patients, seeing inpatient consults, performing neuraxial and peripheral nerve blocks, seeing patients in the outpatient pain clinic and performing interventional procedures therein. The fellow is expected to:
- Demonstrate improvement in manual skills with less need for attending procedure “rescue” as training progresses.
- Demonstrate improved accuracy in assessing history and physical examination findings as training progresses, as validated by supervising attendings who directly observes the fellow’s history taking and examination skills.
- Be involved in the research activities of the division.
- Supervise residents and medical students rotating through the service.
- Have no operating room call responsibilities.
- Rotate in taking out-of-hospital calls to answer questions, pages, etc., related to the management of inpatient consults, patients on epidural opioid infusions and continuous peripheral nerve blocks, as well as pain clinic patients. The fellows will cooperatively create and manage a pain call schedule amongst themselves, in conjunction with the APNs on the Acute Pain Service.
- See emergency consults such as postdural puncture headache in the emergency room, acute vasospasm conducive to sympathetic blockade or patients with impending ventilatory failure secondary to fractured ribs. These emergency consults are rare. The fellow will communicate with the covering pain attending and discuss/plan management of these patients.
- Rotate in making Acute Pain Service rounds on weekends with the attending on call. In most cases, the attending makes rounds alone on Sundays when the number of inpatients on the service is small.
- Regularly tabulate his experience logs as required by the Accreditation Council for Graduate Medical Education and the American Board of Anesthesiology. These logs should be kept on electronic data base. They will be checked regularly by the program director to ensure that program requirements are appropriately met. Failure to complete these logs in a timely manner may result in probation or suspension.
Lectures are given to the fellows and residents rotating through the Anesthesiology Pain Medicine Clinic four days a week, Monday through Thursday. The schedule of lectures is made monthly. The lectures are given either by an attending covering the clinic for the day, by one of the fellows, by one of the residents rotating on the service or by an invited visiting lecturer. There will be monthly Radiology Rounds for the pain fellows whereupon a pain attending reviews interesting, unique or exceptional radiographic images of the spine or appendicular joints in the context of pain management.
The lectures given by the pain fellows are expected to be in-depth and sophisticated than that given by the residents rotating on the service. These lectures should be based on the latest original studies or reviews that have been recently published.
Lectures and presentations will be submitted by the fellow in PowerPoint format to the program director or their designee. These will be uploaded onto New Innovations after the presentation is made and will be integrated into each fellow’s Educational Portfolio. The presentations will be reviewed by a pain clinic attending to prevent plagiarism with regard to prior archived presentations. Failure to transmit this information in a timely manner may result in probation or suspension.
There are multidisciplinary lectures and conferences offered throughout the academic year, including monthly Interdisciplinary Spine Conferences and bimonthly Neurosurgery/Pain Conferences. There may be case conferences at the Shirley Ryan AbilityLab and lectures given to fellows by the Shirley Ryan Ability Lab attendings during the AbilityLab rotations.
Fellows will be relieved of clinic duties to attend lectures and participate in multidisciplinary conferences unless there are extenuating circumstances.
Pain fellows will participate in monthly Anesthesiology Fellow Forum meetings. These meetings are open to all anesthesiology fellows and are directed at improving teaching skills for fellows and to promote academic activity/career development. A syllabus and schedule of meeting topics will be distributed at the beginning of the academic year.
Fellows are mandated to participate in on-site cadaver workshops developed by the program director whereupon interventional procedures including spinal cord stimulators, intrathecal pumps and catheters, upper cervical nerve root injections, intradiscal procedures and vertebral augmentation procedures. Fellows will be relieved of clinical duties to participate in this activity when possible.
The fellows will participate in three mandatory surgical training workshops on site at the Northwestern Center for Advanced Surgical Training in the Olson Pavilion. These are three-to-four-hour sessions proctored by general surgeons and pain attending early in the academic year. Fellows will be relieved of clinical duties to attend these workshops. The subjects of suturing, tissue handling and wound management are covered. Fellows will be given written study materials prior to the workshop and are expected to review these materials before attending the workshops.
The fellows are expected to review assigned reading material pertinent to the care of clinic patients on any given day, including away rotations.
The fellows will present classic and contemporary articles during journal club meetings; the specific journal article to be presented is selected by the fellow and pain attending faculty.
A schedule of lectures for the fellows and residents is made every month and is distributed to the fellows. The schedule is given to the fellow at the end of the previous month. All topics required by the ACGME will be covered.
The topics that are covered throughout the year include, but are not limited to, the following topics of pain assessment and treatment:
- Pathways of pain
- Postoperative pain
- Physical/neurological examination of the pain patient
- Electromyography and Nerve Conduction Studies
- Radiology of the spine
- Low back pain: Nerve root irritation and radiculopathies, Facet arthropathies, Discogenic pain, Sacroiliac joint arthropathy, Piriformis syndrome
- Cancer pain
- Hospice/end of life care issues
- Myofascial pain syndromes
- Complex regional pain syndrome (CRPS)
- Herpes zoster and postherpetic neuralgia
- Neuropathic Pain
- Pelvic Pain/Urogenital Pain
- Obstetric Pain/Pain Syndromes during Pregnancy
- Pain in Special Populations: Elderly, Addicted & Impaired
- Major opioids
- Minor opioids
- Addiction, pseudoaddiction, dependence, tolerance
- Nonsteroidal antiinflammatory drugs/COX-2 inhibitors
- Membrane stabilizers/anticonvulsants
- Local anesthetics
- Pharmacology for the interventional physician (steroids, radioopaque dyes)
- Neuraxial opioid & local anesthetic infusions
- Patient-controlled analgesia: intravenous & epidural
- Neuraxial Drug Delivery Systems for Chronic Pain Syndromes
- Epidural steroid injections
- Facet joint injections
- Facet nerve blocks/rhizotomy (RF)
- Thermal and pulsed RF
- Intradiscal procedures (eg annuloplasty, biacuplasty)
- Percutaneous disc decompression procedures
- Vertebral augmentations (eg Vertebroplasty, Kyphoplasty)
- Spinal cord stimulator trials, permanent implantations
- Modalities for Multidisciplinary Pain Management
- Functional and Disability Assessment
- Billing Issues in Pain Management
- Pain Practice Management
- Benzon HT, Raja S, Molloy RE, Liu SS, Fishman SM. Essentials of Pain Medicine and Regional Anesthesia, 3rd ed. Philadelphia: Elsevier-Churchill Livingstone, 2011.
- Benzon HT, Rathmell J, Wu et al. Practical Management of Pain, 5thed. Philadelphia: Elsevier-Churchill Livingstone, 2015
- Rathmell, J. Atlas of Image Guided Intervention in Regional Anesthesia and Pain Medicine. Philadelphia: Lippincott, Wilkins and Williams, 2011
- Fenton DS, Czervionke LF. Image-Guided Spine Intervention. Philadelphia: Elsevier-Churchill Livingstone, 2002.
- A book on spine imaging e.g., Renfrew DL. Atlas of Spine Imaging.Philadelphia: Elsevier-Churchill Livingstone, 2002.
- A book on physiatry e.g., Braddom, Physical Medicine and Rehabilitation, 2015
All fellows have access to the Eckenhoff Anesthesiology Library at any time. In addition, an extensive collection of recommended pain medicine textbooks is kept in the Anesthesiology Pain Medicine Center, which fellows have access to at any time. Computer access for journals, reference articles and other texts are available to fellows at any time on site or from a remote location. All fellows have access to the Shirley Ryan AbilityLab virtual library in the Learning Center at the Superior Street location.
Fellows will take the ABA Pain Medicine In-Training Exam in the spring of their training year. The fellow is encouraged to have a mock oral examination, near the end of their training, to help in their preparation for the oral examination portion of the American Board of Anesthesiology (ABA), if applicable.
The fellows are evaluated by attending staff quarterly. In addition, the fellows will be evaluated by supervising faculty during away rotations at the completion of an individual rotation experience. The fellows will be able to access their evaluations through New Innovations. Fellows will electronically sign two semi-annual performance summary evaluations. The program director will meet with each fellow at least twice during the fellowship to review goals and objectives, assess and communicate areas for fellow improvement and to identify any issues or problems with the curriculum, clinical experience or supervising faculty.
The fellows are asked to provide evaluations of the faculty every quarter and the program at the end of their training. In addition, the fellows should complete evaluations of the residents rotating through the outpatient pain center monthly. All evaluations are in New Innovations.
Benefits & Wellness
In addition to McGaw Medical Center of Northwestern University benefits and wellness resources, Pain Medicine Anesthesiology fellows receive:
- Memberships to the American Pain Society (APS) and American Society of Regional Anesthesiology and Pain Medicine (ASRA)
- Funding to attend the ASA, ASRA or an academic/research meeting
- Fellows who present an abstract at an approved national scientific meeting will receive funding for a second meeting, provided the program director approves the absence from training.
- $700 educational fund
Fellows funded through the Shirley Ryan AbilityLab receive:
- Memberships to the APS)and ASRA
- Benefits provided by the Shirley Ryan AbilityLab PM&R Chronic Pain Program: AAP and AAPMR memberships, a $300 book stipend and funding to attend one meeting. Funding to attend additional conferences is available with approval from the Shirley Ryan AbilityLab Medical Education Committee for presentation of scholarly work conducted during the fellowship year.
How to Apply
The fellowship offers five positions for a one-year appointment. All fellow candidates who are selected for interviews will meet with several faculty members and trainees. Historically, four positions are filled with those who completed anesthesiology residency and the remaining position is filled by one who completed a physiatry residency. Exceptional candidates from other disciplines may be considered. Candidates may send their application materials as soon as March 1, and interviewing typically begins in the late spring each year. All positions will be filled through the Match. View the application information below to learn more about the application and selection process.
To be considered for a Pain Medicine fellowship position, candidates must be eligible for certification or fully certified by their respective American Board before fellowship training begins.
Candidates must have taken USMLE Step 3 and obtain a temporary or permanent Illinois Medical License before starting their fellowship training. Licensing information and application can be found at the Illinois Department of Financial & Professional Regulations website. To apply for a permanent license, the applicant must already have taken the USMLE Step 3. Please be aware that it may take up to 60 days to process and grant an Illinois license.
All Pain Medicine fellowship positions are filled through the NRMP Match. To register for the Specialties Matching Service (Fellowship) Matches, an AAMC ID is not required but it is recommended. However, including an AAMC ID in your Fellowship Match registration will make it easier for our program to rank you in the NRMP Registration, Ranking and Results system.
Please complete your fellowship application on ERAS. Instructions on how to register for ERAS can be found here. Note: We do not require any additional information beyond what is in the ERAS application. Please do not email the Program Director scores or supplemental materials.
If there are any questions regarding your application or if you need to update your application, please contact Alison Mah at 312-695-5395 or firstname.lastname@example.org.
Contact Northwestern's Office of Graduate Medical Education at:
McGaw Medical Center of Northwestern University
420 E. Superior St.
Chicago, IL 60611
Housestaff training through McGaw Medical Center of Northwestern University provides diverse and challenging clinical experiences and world-class education located in the heart of the beautiful city of Chicago. Learn more via the links to the McGaw website below.
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