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The academics of pain management

Published: July 25, 2017 By: Jesef Williams
David A. Caro, M.D.
Phyllis L. Hendry, M.D., FAAP, FACEP
Matthew D. Warrick, M.D.

UF COMJ training programs continue to emphasize pain education

Though widespread opioid abuse has placed a brighter spotlight on pain management lately, it’s been a heavy focus among educators at the University of Florida College of Medicine – Jacksonville for decades.

David Caro, MD, an associate professor of emergency medicine and director of the emergency medicine residency program, said the program has increasingly included education on pain management over the past 20 years. As new treatments and strategies emerge, they’ve been reviewed and incorporated into the curriculum.

“A high percentage of emergency patients will have painful conditions. Differentiating which patients require which specific therapy is critical to proper emergency care,” Caro said. “That emphasis has shifted to incorporate recent information on opioid abuse and the recognition that differing strategies exist to approach the management of painful conditions.”

It’s also emphasized in the pediatric emergency medicine fellowship program, and Caro said medical students who rotate through the department receive on-the-job training on how to use opioid and non-opioid techniques and therapies.

Anesthesiology education

The department of anesthesiology started its regional anesthesia and acute pain division in 2013, which has placed a greater emphasis on pain management. Services provided include peripheral nerve blocks, epidural catheter placement and care, and opiate consultation.

Perioperative care is also a focus, and the department’s training programs reflect that.

“As the control of pain is central to patient recovery after surgical procedures, we have placed an emphasis on teaching the physiology and treatment of pain within the acute pain service,” said Matthew Warrick, MD, an assistant professor of anesthesiology and director of the regional anesthesiology and acute pain management fellowship program, which began in 2015.

The department uses a “flipped classroom” teaching method that features assigned readings and questions, along with technical workshops, early in the academic year.

“This means our trainees are very familiar with the principles of ultrasound and acute pain management prior to any patient contact,” Warrick said. “We encourage residents to review the literature and develop evidence-based techniques and protocols that alleviate pain, are cost-effective and speed discharge from the hospital, allowing patients to return to normal activities.”

PAMI resources

In addition to the various residency and training programs, a wealth of information is shared through the Pain Assessment and Management Initiative, or PAMI — a free-access, online-based platform that includes videos, learning modules, pain-related news, dosing guides and links to other pain education websites. It’s geared toward physicians, nurses, advanced practitioners and others who can benefit from not having to pay the costs often associated with conventional, in-person courses.

Phyllis Hendry, MD, principal investigator for the PAMI project and a professor of emergency medicine and pediatrics at UF COMJ, said PAMI has been a success since fully launching in 2015. For instance, there are now seven learning modules and a discharge planning toolkit. The website has received more than 27,000 page views.

“We revise and add new materials often because there’s so much new information coming out,” Hendry said of the program. “Pain management has grown as a specialty, and our patients need safe options.”

All medical students on emergency medicine rotations receive information about PAMI and are encouraged to familiarize themselves with the site. A goal is to incorporate podcasts and case scenarios, which Hendry said are popular among students and residents.

“The PAMI project has come a long way and received input from the UF College of Pharmacy,” Hendry said. “We hope PAMI materials continue to help in the efforts to educate because pain is multidisciplinary. It really touches everyone.”

For more information about PAMI, click here.


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