Our multi-faceted, one-year program is designed to prepare a consultant for a rewarding career in pain management. Washington University Medical Center is a tertiary referral center and Level-1 trauma center. This broad clinical base gives pain management fellowship trainees an excellent opportunity to participate in managing a wide spectrum of pain problems. The trainees will have opportunities to care for patients from diverse backgrounds, different social economic statuses, and wide range of pain complexities.  

Participation of pain management fellowship trainees in research is included. In addition, the pain medicine fellowship program is excited to expand our fellowship training program to include a 24-month, combined research, and clinical fellowship track. The goal of this distinctive track is to help develop and explant the field of academic pain management by focusing on training clinician-scientists. 

Our pain management clinical practice is largely divided into two areas: acute and chronic pain management. The acute pain management service facilitates the exposure and training of fellows in managing postoperative and post-trauma pain, using various nerve blocks, and complex pharmacological management. This experience also assists fellows in the development of relationships with patients and colleagues, skills that are vital to becoming leaders in Pain Medicine in the community. 

Our fellowship is a rounded training program—the trainees will have ample interventional experiences and great exposure to multidisciplinary pain training, while at the same time enjoying a balanced work-life. There are built-in none clinical days for the fellows to participate in scholarly activities and wellness.  

The chronic pain management practice is primarily based at the Pain Management Center, Barnes-Jewish Hospital, with additional rotations at Missouri Baptist Hospital and Barnes-Jewish Hospital West County. Anesthetic, medical, and interventional techniques are used within the context of multidisciplinary pain management. In addition to the evaluation of patients, fellows gain expertise in fluoroscopic and ultrasound-guided interventional pain techniques, such as various nerve blocks, neuraxial blocks, joint injections, neurolytic procedures, and radiofrequency lesioning. The fellows will have opportunities to develop surgical skills including, trial and permanent placement of dorsal column SCS, DRG and peripheral stimulator, MILD, VTP, Vertiflex, and intrathecal pump  

A multidisciplinary approach is widely used and encouraged, through the regular and active participation of a pain psychologist, physical therapists, palliative care medicine, and neurologists. Various treatment modalities include acupuncture, biofeedback, physical therapy, psychotherapy, and interventional techniques such as local anesthetic and neurolytic nerve blocks, implantable pumps, and spinal cord stimulators. 

The importance of didactics is emphasized through weekly multidisciplinary pain conferences, didactic lectures, problem-based learning cases, and journal clubs. Weekly anesthesiology grand rounds and clinical conferences help fellows to remain updated with anesthesiology. Fellows are regular presenters at weekly didactic lectures. There will be one month of didactic that is devoted to practice building, contract negotiation, and billing. Monthly “hands-on” cadaver lab sessions provide excellent opportunities for practicing techniques of interventional pain management. Fellows will participate in patient safety training through Department Case Review Committee and Division M&M.  

Curriculum

Fellowship training may include rotations in psychology, toxicology, neurology, physical therapy, physiatry, palliative care, and/or other rotations. We currently have 17 faculty members with proficiency in a wide variety of skills. This high faculty-to-trainee ratio allows us to provide intensive, individualized training to maximize each fellow’s experience. 

Inpatient Acute Pain Service (APS)
 
Location: Barnes and Jewish Hospital
Inpatient Chronic/Cancer Pain Service (CCPS)

AM: Outpatient Chronic Pain
PM: Rounding with Inpatient CCPS

Location: Barnes and Jewish Hospital
Outpatient Chronic Pain
 
Location: Barnes and Jewish Center for
Advanced Medicine, Barnes and Jewish West County, and Missouri Baptist Hospital
External Rotations:

Physiatry: 8 days with PM&R faculty
Neurology: 6 half days with Neurology faculty
Toxicology: 1-2 days with EM toxicology faculty
Anesthesiology: 2 weeks with OR anesthesiologist
Palliative Care: 1 week with Palliative Care Medicine Faculty
Pediatric Pain: 2-3 days with Pediatric Pain faculty
 
Location: Barnes and Jewish Hospital and Saint Louis Children Hospital
Didactics

Our didactic is designed for pain board preparation and to enhance clinical learning. The didactic is structured as a monthly theme, topics include:

  • Foundation of Pain Medicine
  • Basics of Diagnosis and Image Guidance in Pain Medicine
  • Acute Pain Management
  • Business of Pain Medicine
  • Cancer Pain Management
  • Musculoskeletal and Joint Pain
  • Neuromodulation, and Minimal Invasive Treatment of Neurogenic Claudication
  • Peripheral Nerve Blocks for the treatment of pain
  • End of Life Pain, Migraine Headache
  • Small Fiber Neuropathy

Lectures are on Tuesday nights from 5-6 p.m.

Sample didactic page

Board Review Night: We host a Board Review Night where fellows get a chance to practice board questions with the faculties in a relaxed environment.

Monthly Cadaver Session: Monthly “hands-on” cadaver lab sessions provide excellent opportunities for practicing techniques of interventional pain management.

Weekly Seminar: Every Thursday morning from 6:30-7:30 a.m. we have our weekly seminar. Invited guest speakers will give lectures on various topics to enhance fellow’s education.

Multidisciplinary Pain Meeting: Every Thursday morning from 7:30-8:30 a.m. we have our weekly multidisciplinary meeting. During this meeting, there will be pain psychologists, physical therapists, clinical pharmacologists, palliative care physicians, and our interventional pain physicians; together we will discuss complex patient cases. Fellows will have opportunities to learn multidisciplinary care approaches to chronic pain management.

Journal Club: Every Friday morning from 6:30-7:30 a.m. we have our journal club which is presented by our anesthesiology residents. Once a month we will have a joint journal club between clinical pain and pain research which is co-presented by our pain fellow and pain research post-doctoral. Journal club is designed to dive deeper and from multiple angles into current pain research and evidence-based pain treatments.

Quality Improvement Project: All fellows participate in a mentored quality improvement project. The trainees will work together with a faculty mentor to come up with a question, develop a study plan, and collect data to answer the question. This is a year-long project.

Surgical Skills and Suture Lab: All fellows will have a group surgical skills lab with a senior surgery resident, and then each fellow will have a one-on-one additional suture lab. Of course, all trainees will be trained in surgical techniques during their surgical cases with our interventional pain faculty. In addition, fellows are encouraged to attend industry sponsor cadaver trainings.

Interventional Skills Experience
Neuromodulation:
Peripheral Nerve Stimulation: trial and permanent implantation
DRG Stimulation: trial and permanent implantation
Dorsal Column SCS: trial and permanent implantation
Minimal Spine Surgery:
Vertiflex
MILD
Vertebroplasty and bone biopsy
Neuraxial Procedures:
Epidural steroid injection: caudal, lumbar, thoracic, and cervical
Selective nerve root blocks: lumbar, thoracic, and cervical
Epidural blood patches
Medial Branch Nerves Blocks
 
Sympathetic nerve block
Ganglion Impar
Superior hypogastric nerve plexus block
Lumbar Sympathetic nerve block
Celiac plexus block
Stellate ganglion nerve block
Sphenopalatine Ganglion block
Gasserian Block
 
Joint Procedure
Bursa Injection
Minor and Major Joints injection: Anatomical landmark, ultrasound, and fluoroscopy guidance
Radiofrequency ablation of shoulder, knee, and hip
 
Spine Joint Procedure
Facet Joint injection
Radiofrequency Ablation: medial branches of cervical, thoracic, lumbar, and lateral branches of the SI joint.
 
Targeted Drug Delivery Therapy
Intrathecal pump trial
Intrathecal pump implant
 
Nerve blocks
Occipital nerve block
Trigeminal nerve block
Medial branch nerve block
Suprascapular nerve block
Intercostal nerve block
PEC I/II block
TAP Block
Erector Spinae Plane Block
Ilioinguinal/iliohypogastric nerve block
Genitofemoral nerve block
Lateral femoral cutaneous nerve block
 
Infusion and Other medication Therapy
Lidocaine infusion
Topical 8% capsaicin (Qutenza)
Benefits

Discretionary Fund: $2,000 – for books and educational expenses

Benefits:

  • Medical, dental, vision, and pharmacy insurance benefits
  • Life, accident, and disability insurance
  • Access to WUCare and Employee Assistance Program
  • Monthly parking reimbursement
  • White coat and departmental jacket
  • ASRA membership
  • 15 vacation days
  • 5 meeting days
  • iPhone provided for professional use during fellowship
  • Non-clinical days
  • Wellness resources and subscriptions
Social Life

David Lam, MD

Pain Medicine Fellow 2022-23

Residency: Yale New Haven Hospital

Medical School: University of Connecticut School of Medicine

“The Pain Fellowship Program strongly stood out as a program that would allow me to develop my skills as a pain physician. The practice of pain management is so diverse and comprehensive—as such, it was crucial to me that I optimize my learning and training experience to prepare myself for life after training. 

Beyond the standard procedures, the program provides opportunities for fellows to further develop their skills and expose us to new interventions developing in the pain medicine world. The attendings are all motivated to remain at the forefront of these innovations and it is exciting as a trainee to experience and develop these skills firsthand. Moreover, the attendings encourage different thoughts of thinking and methodologies to promote independent clinical thought and judgment which is invaluable as a trainee.

The program has a strong infrastructure that allows the fellows to have a more thorough understanding of the necessary components beyond immediate medical management to ensure good quality care to patients.

Outside of work, I enjoy working out, golfing, and running through Forest Park. During the weekends, it has been great trying out the multitude of restaurants in the city as well as going to concerts and sporting events.”

 Our team enjoys happy hours, dinners, holiday parties, and more throughout the year. We enjoy being together & celebrating each other’s career and personal accomplishments.