IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:115
Conference: TACON  2014 The Anaesthetist Conference [Click here for details]

Authors: Anurag Agarwal

Authors Affiliations: Associate Professor& Pain Specialist, Dept. of Anesthesiology, GSVM Medical College, KANPUR, UTTAR PRADESH, India

Address of correspondence: dranurag11@gmail.com


Introduction- Pain Medicine aka Algology is new, exciting specialty of medicine. This new specialty deals primarily with patients of chronic, unrelenting painful conditions. Though this specialty was pioneered by anesthesiologists initially, gradually other branches of medicine also started to pour in, which actually helped the specialty to grow. Minimally invasive pain interventions are integral part of Pain Medicine. This presentation at TACON is an attempt to find some answers about the ownership of the branch, resources to learn Pain Medicine, and to distinguish between Pain Medicine and Peri-operative pain management.

Article– There is a big misconception about the Pain Medicine, a new super-specialty of modern medicine, whether it deals with the acute or peri-operative pain conditions or whether it deals with chronic, difficult pain conditions. Actually management of acute and peri-operative pain is the prerogative of Peri-operative physician; an anesthesiologist in peri-operative scenarios and of Primary Care Physician in acute pain scenarios. Pain Medicine aka Algology primarily dealt with chronic, unrelenting and difficult pain conditions, when the cure is usually not possible. This chronic pain can be either malignant or non-malignant origin such as chronic low back pain, different neuralgias, failed back surgery syndromes etc. Various neuropathic pain conditions also warrant specialized care for successful management .  in Pain Medicine the major thrust is not on the etiology correction, rather to increase functionality of the patient with optimization of pain, which is interfering in the daily life. The physical, social, economic, psychological and spiritual rehabilitation are the major goals of a Pain Specialist aka Algologist, who uses his knowledge and training to decide the realistic treatment goals as per patients condition and then decide the best treatment plan to achieve these goals. This is the reason there is no blanket therapy in Pain Medicine which can be applied to a large number of chronic pain patients, every case is a new challenge.

Now who can be a Pain Specialist? Is an Anesthesiologist automatically become a Pain Specialist! The answer is no. Anesthesiologists do have a natural edge over other specialties of medicine in handing fine, minimally invasive techniques in and near to the delicate bodily structures such as spine, but they are poor in examination and over all evaluation part of chronic pain syndromes. To learn the missing link in their training, additional, hands-on training is a must for any anesthesiologist to become a Pain Specialist. Across the world, the optimum training period for Pain Medicine is One year, full time and in-house. Same standard applies to our country.  But in this time of instant coffee and 2 minutes noodles, many weekend courses in Interventional Pain Management/ Pain Medicine have been started. These courses are good to update one’s knowledge who is already a Pain Specialist and practicing it, but for someone who is new and novice, these short term courses are actually detrimental as they give very superficial knowledge that too mainly about the interventional part of whole pain Medicine. Once a person comes out in the field with false confidence grown after poking needles in cadavers and mannequins during a weekend course of Pain Medicine, he finds himself deficient in almost every aspect of Pain Medicine, even in interventional part. These short term courses are being grossly misused in our country  and primarily driven by the greed in lieu of increasing demand for more & more pain specialists. The proponents of theses short term ‘2-minute noodle’ courses should understand that they are dealing with human lives rather than noodles.

As it is a new and still emerging specialty, not many standard courses are available in our country, but they are increasing in number  and strength. As of date, B.H.U. Varanasi and SGPGI, Lucknow are providing one year, full time, in-house training in Pain Medicine with their P.D.C.C. (Post Doctoral Certificate Course) after an entrance examination. Similarly, K.G.M.U. Lucknow is also starting same training this year only. Apart from these government institutions, many good and able teachers are available in private sector offering training in Pain Medicine, but my advice would be to go for long term training.

In other senses also Pain Medicine is strikingly different from mainstream anesthesia practice. As mainstream anesthesia practice is mostly no investment, early settlement and steady but constant income type of practice; practice of Pain Medicine demands a good investment in terms of money and time, takes some time to take off but after that sky is the limit. Anesthesia is mostly ‘behind the curtain’ job, but pain practice demands a lot of interaction with patients, their relatives and society; remember in pain practice- Bouquets are yours-but- so are the Brick-bats!

Conclusion- Pain Medicine is a very exciting and gratifying field, but requires additional training and dedication to deal with very complex subset of patients. A quest of learning, desire to sail in unchartered territories and utmost dedication towards the patients is the key of success.


How to Cite this Abstract
Agarwal A. Pain Medicine aka Algology. International Journal of Conference Proceedings 2015;(2015):115