Clinical training

The Pain Clinic at Mayo Clinic in Rochester, Minnesota, is the base location of the fellowship. Pain medicine trainees always work under the direct supervision of the pain medicine program director and pain clinic faculty.

Trainees participate in the evaluation and treatment of patients with a wide variety of pain problems, including cancer pain, spine pain, sympathetically mediated pain, head and facial pain, neuropathic pain, visceral pain, and myofascial pain.

Most patients are seen as direct referrals from other Mayo Clinic physicians or from physicians at Mayo-affiliated facilities. Trainees are expected to completely evaluate their patients and present their findings and treatment plans to pain medicine faculty.

Typical treatment plans may involve behavioral modification, psychological testing and treatment, interventional pain procedures, medications, and physical modalities.

Fluoroscopically guided interventional pain procedures are performed either at the Gonda Outpatient Procedure Center or in an operating room at Mayo Clinic Hospital, Methodist Campus. Services not physically located in the Pain Clinic, such as diagnostic radiology and the autonomic nervous system laboratory, are readily available elsewhere at Mayo Clinic.

Rotation schedule

Rotation	Length
Anatomy dissection laboratory	1 week required
Anesthesia skills training	1-2 weeks required (non-anesthesia-based fellows)
Continuity clinic	60 half days required
Palliative care	1 week required
Pain Rehabilitation Center	Up to 1 week required
Spine Center	1 week required* (all anesthesia-based fellows); 2 more weeks available as an elective
Electromyography (EMG)	Up to 1 week elective
Headache Clinic	1 week elective
Inpatient cancer-associated pain	2 weeks required
Pediatrics	Up to 1 week elective
Diagnostic radiology	1 week elective
Neuroscience course	Conferences year-round (elective)
Gonda 15 procedures	7-8 weeks required
Methodist Campus Inpatient Pain Service (MIPS)	13 weeks required (on call for all fellows)
Saint Marys Campus Inpatient Pain Service (SIPS)	2 weeks required (non-anesthesia-based fellows)
Pain psychiatry	2 weeks required
Pain medicine ultrasound	1 week required
Simulation Center	1 day required

*Not required for physical medicine and rehabilitation-based fellows.

Rotation descriptions

Anatomy dissection laboratory

An anatomy course is organized specifically for pain medicine trainees and conducted on an annual basis. Trainees gain an increased understanding of anatomical structures pertinent to common pain syndromes.

In addition, they gain expert instruction in discography, disc treatments, vertebroplasty, peripheral nerve stimulation and ultrasound, allowing them to better understand the anatomical implications of common interventional pain procedures.

Anesthesia skills training

Trainees will be able to prevent, recognize and treat immediate and potentially life-threatening complications that can occur following interventional pain management techniques.

Hospital-based pain services

At the Saint Marys Campus and Methodist Campus of Mayo Clinic Hospital, trainees learn how to evaluate postoperative pain patients, manage complications and, most importantly, how to organize and safely manage a hospital-based pain service. All hospital-based pain service activities are directly supervised by pain medicine faculty.

Palliative care

Trainees gain experience in managing palliative care patients and understand how to identify and manage imminently dying patients. They will also appropriately assess and treat pain, employing excellent, evidence-based pain management techniques, including differentiating type, severity, etiology and approach to pain.

Pain Rehabilitation Center

Trainees learn to identify patients who may benefit from a behavioral rehabilitation approach to chronic pain. They are also exposed to various psychometric testing procedures, rehabilitative approaches to therapy, and gain experience in identifying and treating patients with substance abuse and dependence issues. Trainees work under the supervision of the medical director of the Pain Rehabilitation Center during this rotation.

Spine Center

Trainees improve musculoskeletal examination skills; improve skills in interpreting radiographs, CT, MRI and other imaging studies of the spine; and learn to order and interpret nerve conduction and electromyographic studies.

The Spine Center is a multidisciplinary facility. Trainees work under the direct supervision of spine center faculty, which includes neurologists, orthopedic surgeons, neurosurgeons, physiatrists and others.

Electromyography (EMG)

Trainees perform routine and complex nerve conduction studies (NCS), needle EMG and evoked potentials independently and become capable of practice within an academic clinical neurophysiology laboratory.

Headache Clinic

Trainees develop the necessary knowledge, attitudes and skills required to diagnose, manage and appropriately refer patients with head and/or face pain.

Hospice

Trainees learn basic concepts of hospice care, including eligibility and certification, cancer pain and symptom management in terminal patients, and ethical issues related to death and dying. Information about palliative sedation, depression and anxiety are taught during this rotation. Trainees are supervised by faculty specialists in palliative care.

Pediatrics

Trainees gain experience in managing pediatric patients.

Center for Pain and Supportive Care

Trainees gain exposure to additional pain faculty and are exposed to a somewhat different case mix during this rotation in Scottsdale, Ariz. All activities are directly supervised by pain medicine faculty.

Neuroscience course

Pain medicine trainees with interests in basic neuroscience are encouraged to participate in the Mayo Clinic Graduate School of Biomedical Sciences Neuroscience Course. This course includes more than 40 conferences a year. Presentations are made by basic science and clinical faculty with interests and expertise in this field.

Mayo Clinic School of Graduate Medical Education and Mayo Clinic Graduate School of Biomedical Sciences also conduct courses in the conduct of human and basic scientific research. Interested pain medicine trainees have the opportunity to participate in these courses on an elective basis.