Chronic Pain

The chronic pain clinics at the Ottawa Hospital, generally run three days per week.  To meet the RCPSC training requirements, residents are expected to complete two four-week block rotations in chronic pain during their training at the University of Ottawa.  If more than one week of holidays is scheduled during a chronic pain rotation, the resident will be expected to arrange a subsequent make-up time in chronic pain.  Residents who are scheduled for a chronic pain rotation must provide a minimum of one-week notification to the chronic pain site co-ordinator if they are unable to attend the clinic (e.g., holidays, conference etc).

At the completion of the chronic pain rotation, the resident will be expected to:

1.    Obtain a complete pain history and perform a relevant physical examination.

2.    Formulate a comprehensive differential and provisional diagnosis.

3.    Discuss the pathophysiology, anatomy and mechanisms of chronic pain syndromes.

4.    Work as a multi-disciplinary chronic pain team member, utilizing pharmacologic and non-pharmacologic modalities of treatment.

5.    Communicate effectively with other team members and patients, demonstrating compassion, patience and empathy.

Anesthesia Resident Procedural Skills:

At the completion of the chronic pain rotation the resident will be expected to:

1.    Perform with minimal assistance, as well as know the indications, limitations, and potential complications of:

   Trigger point injections

   Guanethidine bier block

   Stellate Ganglion block

   Lumbar epidural steroid injection

   Intercostal nerve blocks

2.    Know the indications, contra-indications, and potential complications of, as well as observe and assist with performing a:

   Celiac plexus block

   Superior hypogastric nerve block

   Lumbar sympathetic block

   Neurolytic nerve blocks

3.    Utilize various modalities of treating chronic pain including:

   Developing a practical working knowledge of the pharmacological agents useful in treating chronic pain syndromes (including long acting opioids, TCA's, NSAID's, steroids, carbamazepine, tegretol etc).

4.    To gain experience in assessing and managing patients with:

   environmentally influenced pain behavior

   central pain states

   nociceptive pain states (e.g., cancer pain, chronic degenerative disc disease, myofascial pain syndromes)

   opioid dependant chronic pain patients

5.    To gain an appreciation of, and the role of other modalities utilized in the treatment of  chronic pain syndromes including:

   TENS

   Acupuncture

   Biofeedback