Guidelines for anaesthesiologist specialist training in pain medicine

European Journal of Anaesthesiology 2007; 24: 568–570 r 2007 Copyright European Society of Anaesthesiology Guidelines for anaesthesiologist specialist training in pain medicineSECTION AND BOARD OF ANAESTHESIOLOGY1, European Union of Medical Specialists Working party on Pain Medicine: A. J. Cunningham*, J. T. A. Knapey, H. Adriaensenz, W. P. Blunniez,E. Buchsery, Z. GoldikJ, W. Ilias**, V. Paver-Erzenyy *Beaumont Hospital, Department of Anaesthesia, Beamont Road, Dublin, Ireland; yUniversity Medical CenterUtrecht, Division of Perioperative Care and Emergency Care, Department of Anaesthesiology, Utrecht, TheNetherlands; zUniversitair Ziekenhuis Antwerpen, Department of Anaesthesiology, Wilrijkstraat, Edegem, Belgium; z Mater Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Ireland; yHoˆpital de Zone, Service d’Anesthesiologie, Morges, Switzerland; JCarmel Medical Center, Department of Anesthesiology, Haifa, Israel; **Krankenhaus der Barmherzige Bruder, Department of Anaesthesiology, Grosse Mohrengasse, Vienna, Austria; y y University Medical Centre, Clinical Department of Anaesthesiology, Zaloska, Ljubljana, Slovenia SummaryThe Section and Board of Anaesthesiology of the European Union of Medical Specialists aims (EUMS/UEMS)at harmonization of training of anaesthesiologists and at improvement of patient care throughout Europe. Painmedicine is considered to be an area of expertise in anaesthesiology although exclusivity is not claimed. TheSection and Board has approved both a core syllabus for pain medicine to be part of the specialist training inanaesthesiology and an additional qualification in pain medicine following the completion of a 5 yr basicspecialty training in anaesthesiology. These proposals were prepared by the Working Party on Pain Medicineof the Section and Board. It considers a multidisciplinary approach to pain to contribute to quality in care andhas taken the initiative to set up a Multidisciplinary Joint Committee on Pain Medicine within the EUMS/UEMS, for which these guidelines define the area of expertise of anaesthesiology.
This document is divided into two sections and Interest in postoperative pain management during the incorporated in the European Union of Medical 1980s prompted the establishment of a new compo- Specialists (EUMS/UEMS) Section and Board of nent of anaesthesiology practice. A postoperative analgesia or acute pain service may feature severalmodalities to combat postoperative pain. The basic > Pain medicine in anaesthesia specialist training.
objectives of such services include administering and > Additional qualification in pain medicine.
monitoring postoperative analgesia and identifying/managing complications or side-effects of postoperativeanalgesic techniques. Implicit in these objectives is the inclusion of an active quality assurance programme The areas of expertise of Anaesthesiology are: Perioperative Anaesthesia Care, Emergency Medicine, Intensive Care Medicine, Pain Medicine and Reanimation directed at maintaining high quality patient care.
Correspondence to: Johannes T. A. Knape, Department of Anaesthesiology,Division of Perioperative Care and Emergency Care, University Medical Center Utrecht, P. O. Box 85500, 3508 GA Utrecht, The Netherlands. E-mail:[email protected]; Tel: 131302506716; Fax: 131302541828 Differentiation between acute and chronic pain is Accepted for publication 23 December 2006 important in clinical practice because pathophysiology and therapy may differ significantly. Pain persisting Neuromodification techniques – central axial longer than 6 months can be viewed as chronic pain.
Many departments of anaesthesia and individual practitioners have organized pain clinics whosefunction is based on the use of nerve blocks for the management of patients with difficult painproblems. The addition of psychological services, Neurosurgical pain relieving procedures (basic knowledge, indications, contra-indications and detoxification) and physical therapy can markedly increase the range of patients who can be success- Psychological, psychiatric and behavioural inter- fully managed in a nerve block clinic. The concept of an interdisciplinary approach to cancer pain management has recently been applied in manyinstitutions.
Postoperative pain (mechanisms, psychological Section 1 – Guidelines for specialist training effects, treatment modalities, acute pain service).
Diagnostic characteristics and treatment modal- ities of musculoskeletal, visceral, ischaemic and > Other systematic analgesics including adjuvants.
Headaches (migraine, tension headache, headache from cervical origin, cluster headache, atypical facial pain and trigemenial neuralgia).
Low back pain (anterior and posterior compart- ment syndrome, radicular and pseudo-radicularsyndrome).
Neuropathic pain and pain syndromes (deaf- > Central mechanisms for pain transmission.
ferentiation pain, phantom pain, sympathetic reflex dystrophy, causalgia, neuromata, post- herpetic neuralgia and central thalamic pain).
General principles of pain evaluation and manage- Pharmacological treatment with opioids, NSAIDs, drugs and other mixed agents (co-analgesics).
Indications and treatment possibilities using > History taking and physical examination in perispinal opioid administration systems.
patients suffering from postoperative, cancer and Transcutaneous nerve simulation; indications and > Pain measurement in man, basic concepts and Indications and treatment modalities using bias, scoring systems (visual analogue scales, specific radiofrequency and neurolytic blockade > Psychological aspects of pain (individual differ- ences, socio-cultural influence, situational andenvironmental factors, the family and pain).
Case management and communication skills> Show a relevant attitude towards patients suffer-ing from chronic pain.
Establish an acceptable contact with the patient > Transcutaneous nerve simulation (indications and Set up and maintain an acceptable contact with > Perispinal opioid administration systems.
nurses, social workers, medical psychologists, > Frequently used analgesic nerve blocks (diagnostic psychiatrists, other consulting specialists and r 2007 Copyright European Society of Anaesthesiology, European Journal of Anaesthesiology 24: 568–570 > Show abilities of self-confidence, knowledge of Individual department heads should use the his/her functioning and self criticism.
Inspectors’ report to strengthen their case with management to ensure that acute and chronicpain facilities are provided.
Duration of pain medicine in anaestheticbasic specialist training Section 2 – Additional qualification in painmedicine specialist training should be on a continual basis Refers to the concept of an add-on extra expertise throughout the 5 yr of specialist training in qualification following the completion of a 5 yr basic specialty training in anaesthesia.
> The chronic pain medicine component could be This concept relates to multidisciplinary practice including neurology, neurosurgery, rehabilitation medicine, orthopaedics, psychiatry and others.
mended and simulators, where available, would Committee on Pain Medicine will develop thecurriculum/training/assessment and recognition criteria for this add-on qualification.
> The role of log books or a portfolio in assessing To determine the quality of additional training, pain medicine, including chronic pain, in basic consideration will be given to the content and specialist training is confined to the trainee’s duration of pain medicine experience in basic ability to undertake practical procedures.
> The board recommends that a minimum 10% of To acquire an add-on specialty qualification, an the multiple-choice questions in the Diploma of additional 2 yr pain medicine training may be the European Academy of Anaesthesia (DEAA) examination should relate to acute/chronic painmedicine and that these issues be systematicallyevaluated in the oral examinations.
The Multidisciplinary Joint Committee on Pain Medicine will assess the curriculum to quantify the time and the number of modules needed forspecialists to acquire the relevant knowledge, In the Joint European Board of Anaesthesiology clinical exposure and practical skills.
(EBA) EUMS–UEMS/European Society of Anaes- The Multidisciplinary Joint Committee on Pain thesiology (ESA) Hospital Visiting Programme, Medicine will assess the role of log books and the current assessment of acute and chronic pain is role of an exit examination, including assessment limited to the presence or absence of this exposure of technical/communication skills and theoretical The sub-committee recommendations included: > The Joint EBA/ESA Hospital Inspection Team should recommend that the Board’s Pain Medi-cine Training Guidelines be adhered to.
The Multidisciplinary Joint Committee on Pain > Where these minimum training opportunities are Medicine will determine how institutions can be not available in certain institutions, trainees should inspected to ensure they are suitable for training be directed to acquire this training elsewhere.
specialists who aspire to this add-on qualification.
r 2007 Copyright European Society of Anaesthesiology, European Journal of Anaesthesiology 24: 568–570


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