A fellow’s clinical experience is divided among clinics, procedure rooms, and specialty clinics.
Fellows spend two-and-a-half days per week evaluating patients in clinic and two days per week in the procedure room at the Madison Surgery Center, where thousands of spinal interventional pain procedures are performed each year.
Pain fellows gain experience in various spinal and peripheral nerve block techniques employed in workup and management of acute, chronic, benign, and cancer pain.
Under the direct supervision of an attending faculty member, fellows learn 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, fellows 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, and nerve injections are taught using state-of-the-art ultrasound equipment with expert instruction.
Fellows spend up to one full day per week in the Spine Clinic, Pain Management Clinic, Headache Clinic, and/or Cancer Pain Clinic to gain 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 visit the Spine Clinic each year. The Spine Clinic rotation helps fellows gain competence in musculoskeletal system examination techniques, diagnosis and management of musculoskeletal injuries and pain states, evaluation and treatment of injured workers and athletes, and impairment rating.
The Chronic Pain and Headache Clinic serves 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 non-opioid analgesics, multimodal therapy, managing patients with implantable drug delivery systems, and adjusting intrathecal analgesics. Fellows gain experience in evaluation and treatment of primary and secondary headache disorders. Fellows also spend time with psychology faculty to:
The half-day per week in the Cancer Pain Clinic allows fellows to assess and manage patients with cancer pain, including pain at end of life and among cancer survivors.
Each fellow completes five weeks of inpatient rotations in two-week blocks on:
Inpatient rotations are at American Family Children’s Hospital, University Hospital, and UW Health at The American Center. On inpatient services, fellows 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. Fellows are required to perform a minimum number of anesthesia techniques, such as mask ventilation, endotracheal intubation, and IV sedation.