Goals and objectives of CA-2 Resident Pain Rotation:

1. Two month rotation in pain management. The rotation will provide basic experience in acute, chronic and cancer pain.
2. The residents are fully committed to pain management during this rotation without any operating room coverage.
3. The residents are responsible along with their CA-3 colleagues, to operate and provide 24 hour pain coverage under the supervision of the Pain Management Specialist.

1. Understand the anatomy, physiology and patho-physiology of pain, e.g., nociceptors, pathways, mechanisms and spinal or central modulations.
2. Understand the pharmacology and pharmacodynamics of oral, I.V., cutaneous and spinal opiates.
3. Understand the importance of post-operative and post-trauma pain management.
4. Understand the multiple acute pain management modalities, e.g., I.V. PCA, peripheral nerve blocks, neuro-axial blocks, the role of NSAID�s and neurolytic drugs, TENS units, and psychotherapies.
5. Understand the complex pathways and mechanisms in chronic pain patients.
6. Understand the nature of neuropathic pain and the mechanisms, e.g., CRPS type I & II, post-herpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia.
7. Understand the complex mechanisms involved in back and neck pain.
8. Understand the role of nerve blocks and the neuro-axial implants in the treatment of chronic pain e.g., dorsal column stimulators and intra-thecal drug delivery systems
9. Understand the principles of diagnostic testing.
10. Understand the human aspect of pain and suffering and the possibility of failure to relieve the pain of some chronic pain sufferers.

1. Order and manage PCA pumps and provide the necessary documentation.
2. Perform peripheral or neuro-axial nerve blocks in accordance with their level of training.
3. Recognize and treat the side effects of these treatments.
4. Conduct a full history taking and physical examination including neuro-muscular exam.
5. Assist and perform some chronic pain management therapies.
6. Conduct Acute and Chronic Pain Management service rounds and respond to in-house consults.
7. Assist in all intrathecal pump refills and drug refill orders.

1. Attendance at Anesthesiology Grand Rounds.
2. Attendance at Wednesday lectures series.
3. Attendance at the Journal Clubs.
4. Prepare and read about the procedures prior to performing them. Discuss cases with the attending.
5. Read the entire pain management handout prior to the rotation. Make use of the pain reference textbooks and journals during the rotation.

Goals and Objectives for CA-3 Resident Pain Rotation:

1. A two to six month rotation in pain management. The rotation will enhance their knowledge and skills in acute and chronic pain management.
2. The CA-3 resident has the same commitments and the responsibilities of the CA-2 resident, in addition the responsibility to be a leader and a teacher for CA-2 resident.

1. Demonstrate mastery of all cognitive objectives expected of CA-2 resident.
2. Discuss in depth the acute pain management modalities and their complications.
3. List the indication and contraindications for each acute pain management modality.
4. Describe the effect of centrally acting drugs.
5. Understand the difference between tolerance and addiction to narcotics.
6. Demonstrate mastery in evaluating pain patients and formulating a plan of treatment.
7. Describe the benefit of additional testing and consults.
8. Discuss the measurement and assessment of pain and function.
9. Discuss the role of nerve blocks in pain management.
10. Discuss the indications and contraindications of advanced implantable therapies.
11. Discuss the indications and contraindications for radio-frequency therapy.
12. Discuss the importance of a multidisciplinary approach to pain management, and the contributions of other specialties to the success of the treatment.

1. Demonstrate mastery of all skill objectives of CA-2 residents.
2. Perform thoracic epidurals and neuro-axial blocks.
3. Perform peripheral continuous nerve blocks.
4. Perform a full history and physical examination.
5. Perform a wide range of chronic pain blocks.
6. Assist in the insertion of implantable therapies.
7. Refill and manage the pumps.

1. Attendance at Anesthesiology Grand Rounds.
2. Attendance at Wednesday lectures series.
3. Attendance at the Journal Clubs.
4. Current Review of Pain, by P. Raj
5. The Pain Clinic Manual, by S. Abraham
6. Cancer Pain, by R. Patt
7. The Clinical Journal of Pain.
8. The Journal of Regional Anesthesia.

Case Western Reserve University, MetroHealth Medical Center
Department of Anesthesiology
CA-3 Resident Advanced Rotation Curriculum

1. Two to six months rotation in pain management. The rotation will enhance their knowledge and skills in acute and chronic pain management.
2. CA-3 resident has the commitment and the responsibility of a CA-2 resident, in addition to the responsibility to be a leader and a teacher for CA-2 resident.

1. Demonstrate mastery of all cognitive objectives expected of CA-2resident.
2. Discuss in depth the acute pain management modalities and their complications.
3. List the indication and contra-indications to each acute pain management modalities.
4. Describe the effect of centrally acting drugs.
5. Understand the difference between tolerance and addiction to narcotics.
6. Demonstrate mastery in evaluating pain patients and formulating a plan of treatment.
7. Describe the benefit of additional testing and consults.
8. Discuss the measurement of and assessment of pain and function.
9. Discuss the role of nerve blocks in pain management.
10. Discuss the indications and contraindications of advanced implantable therapies.
11. Discuss the indications and contraindications for Radio-frequency therapy.
12. Discuss the importance of a multidisciplinary approach to pain management, and the contributions of other specialties to the success of the treatment.

1. Demonstrate mastery of all skill objectives of the CA-2 resident.
2. Perform thoracic epidurals and neuro-axial blocks.
3. Perform peripheral continuous nerve blocks.
4. Perform a full history and physical examination.
5. Perform a wide range of chronic pain blocks.
6. Assist in the insertion of implantable therapies.
7. Refill and manage pumps.

1. Attendance of Anesthesiology Grand Rounds.
2. Attendance of Wednesday lectures series.
3. Attendance of the Journal Clubs.
4. Current Review of Pain, by P. Raj
5. The Pain Clinic Manual, by S. Abraham
6. Cancer Pain, by R. Patt
7. The Clinical Journal of Pain
8. The Journal of Regional Anesthesia