Course Goals:

From the experience on this rotation, students will be expected to have gained the following skills:

1. understand basic concepts of the physiology of pain,
2. understand and be able to perform a pain oriented evaluation and physical examination,
3. understand the known diagnostic classifications of pain and their treatments,
4. understand the complex interplay of medical, psychological and social issues with pain,
5. understand the basic indications for and practice of analgesic therapy.

Entry Level:

Third or fourth year clerks having completed basic internal medicine and surgery rotations are eligible. The UC Davis Division of Pain Medicine accepts one medical student per month. Extended rotations can be accommodated on a case by case basis.

The staff and fellows will work very closely with the student, meeting on a daily basis. The student will be scheduled to attend all daily didactic teaching sessions as well as be a member of one of our major services (acute pain, cancer/chronic pain, outpatient nerve blocks and clinic) to be rotated weekly.

The student will be given the option to spend two weeks on one of our three services and one week on each of the other two. Thus, one week will be spent on the Acute Pain Service, one week on the Cancer/Chronic Pain Service, one week in the outpatient clinic, and an additional week on one of the three. The rotation is flexible and schedules can be varied to suit individual needs. We will try to accommodate students who wishes to spend more time on a particular service. Medical Students will not take overnight call. Students are accepted as space allows.

Topic Outline:

Because pain is a prevalent feature in treating all patients, this rotation is intended to offer training for students interested in any clinical specialty. Students will be directly involved with the practice of contemporary multidisciplinary pain management including acute, chronic and cancer pain. Students will work with attending staff from disciplines of anesthesiology, internal medicine, psychiatry, and neurology. They will follow staff, fellows and residents on daily rounds on the inpatient and outpatient services as well as in the outpatient clinic.

Students will be part of the team that provides medical management of chronic and cancer pain in both the outpatient continuity care setting and the inpatient consultation setting. Exposure to nerve block techniques such as epidural injections, sympathetic nervous system blocks (stellate ganglion blockade, lumbar sympathetic blockade, intravenous phentolamine), facet joint blockade, as well as bier blocks and intravenous lidocaine infusions are an important part of the rotation. The program offers a daily mix of formal and informal educational experiences. Students are exposed to contemporary thinking in pain treatment from multiple disciplines.

Grading:

Evaluation will be based on the final input from the rotation Director (Dr. Fishman) as assimilated from staff, fellow, and resident input.

Reading:

Borsook D, Lebel AA, McPeek B: MGH Handbook of Pain Management, Little Brown Publishers, Boston. 1995

Wall PD, and Melzack R, eds. Textbook of Pain (3rd ed.). New York, Churchill-Livingstone, 1995.

Explanation of Potential Course Overlap:

No overlap is anticipated and to my knowledge no similar course is offered in the medical school.