Clinical Experience

The fellow’s clinical experience is divided between clinics, procedure rooms, and specialty clinics.

Madison Surgery Center

The fellow spends 2.5 days per week evaluating patients in the clinics and 2 days per week in the procedure room at Madison Surgery Center (MSC), a facility that performs approximately 5,000 spinal interventional pain procedures each year.
 
Pain fellows gain experience in various spinal and peripheral nerve block techniques employed in workup and management of acute and chronic, benign and cancer pain.
 
Under the direct supervision of an attending faculty, a fellow learns to perform all types of lumbar injection procedures in the first six months and cervical injection procedures in the second six months.
 
Injections performed commonly include interlaminar and transforaminal ESI, facet joint injections, medial branch blocks, SIJ and hip joint injections, radiofrequency neurotomy, sympathetic blocks, and discography.
 
In addition to these procedures, the fellow will also gain experience with celiac plexus neurolysis and other neurolytic blocks, IV lidocaine infusion, and neuraxial analgesia with implanted intraspinal catheters and implanted pumps in management of cancer pain.
 
Fellows participate in spinal cord stimulation trials and implant, intrathecal catheter trials and pump implant, and managing patients with implantable devices.
 
Ultrasound-guided peripheral joint, bursa, nerve injections are taught using state-of-the-art ultrasound equipment with expert instruction.

Specialty Clinics

The fellow spends half to 1 day per week day in the spine clinic, pain and headache clinic, and/or cancer/palliative care clinic.
 
The fellow gains competence in assessment, workup and management of patients with various types of pain states. They become familiar with basic neuroimaging studies including CT and MRI of the spine and brain, psychological testing, and electrophysiologic tests including quantitative sensory tests.
 
More than 10,000 patients attend the Spine clinics each year. The spine clinic rotation helps the fellow gain competence in musculoskeletal system examination techniques, diagnosis and management of musculoskeletal injuries and pain states, evaluation and treatment of injured workers/athletes, and impairment rating.
 
The Chronic Pain and Headache Clinics serve approximately 10,000 patients per year. Fellows are trained in neurological assessment techniques, diagnosis and treatment of neuropathic pain, visceral and pelvic pain, use of opioid and nonopioid analgesics, multimodal therapy, managing patients with implantable drug delivery systems, and adjusting intrathecal analgesics. The fellow gains experience in evaluation and treatment of primary and secondary headache disorders. The fellow also spends time with psychology faculty to:
  • Understand the principles of psychological testing and treatments
  • Develop effective interview and communication techniques
  • Learn team training and conflict resolution skills
  • Identify and manage pain patients with psychological co-morbidities.
The half day per week in the cancer clinic allows the fellow to assess and manage patients with cancer pain, including pain at end of life and in cancer survivors.

Inpatient Rotations

Each fellow completes 5 weeks of inpatient rotations in 2-week blocks on:
  • Acute pain service
  • Inpatient pain consult service
  • Psychiatry consult service
  • Palliative care service
Inpatient rotations are at American Family Children's Hospital (AFC), Clinical Science Center (CSC) and The American Center (TAC). On the inpatient services you will gain experience caring for both pediatric and adult patients. Acute pain service rotation provides experience in acute postoperative pain, epidural and regional analgesia and anesthesiology techniques. The fellow is required to perform a minimum number of anesthesia techniques, such as mask ventilation, endotracheal intubation, and IV sedation.
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