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Interv Pain Med
Interv Pain Med
Interventional Pain Medicine
2772-5944
Elsevier

S2772-5944(24)00036-0
10.1016/j.inpm.2024.100416
100416
Letters to the Editor
Minimally invasive spine surgical procedures and interventional pain medicine: Need for standardization of training
Abrahams Eldhose eldhose-abrahams@ouhsc.edu

Anesthesiology and Pain Medicine, University of Oklahoma, 825 NE 10th St, Suite 2B, Oklahoma City, OK, 73104, United States
27 5 2024
6 2024
27 5 2024
3 2 10041622 4 2024
18 5 2024
18 5 2024
© 2024 The Author
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcDear Editor,

I have read the article “A sudden shift for Pain Medicine Fellowships – A recount of the 2024 match” by Christiansen et al. [1]. I agree with the commentary that the field of pain medicine is currently at a crossroad with the field gravitating towards minimally invasive surgical spine procedures thereby potentially creating turf battles with the orthopedic and neurosurgical spine fields. Due to the multidisciplinary nature of pain medicine fellowship and lack of standardization of training experiences prior to starting fellowship, despite what fellows learn over the course of one year, I have found it takes years of postgraduate experience for the inequality to subside. Variability of clinical exposure to certain techniques even within the same program contributes to this as well as differences in clinical and technical knowledge of fellows [2].

In the article, the authors mention that pain physicians are better suited to explain to patients why they would be better candidates for minimally invasive spine procedures than spine surgeons. This needs to expanded on with specific focus on how the pain fellowship training equips us better than a spine surgeon's training in regards to this. Or is it because we spend more time with the patient and listen more to them when surgery has not helped them? Currently, the ACGME does not list a detailed understanding of spinal biomechanics in its list of competencies for a pain medicine fellowship and nor do the requirements dictate minimum case numbers for spinal instrumentation and arthrodesis cases. I believe the competencies should be revised to include relevant medical knowledge and training requirement for advanced procedures such as interspinous fusion devices and percutaneous lumbar decompressions as well as minimum numbers set if we pain physicians were to claim our credibility with spinal instrumentation procedures. A few device courses with cadaver training would not suffice this requirement. Neurosurgery residency and orthopedic spine fellowship programs have minimum number requirements for spine cases and we should be held to the same standard if we pain physicians were to instrument the spine even if it were via a minimally invasive approach. Attention should also be focused on managing surgical complications with these procedures. I believe rotations with spine surgeons during a pain fellowship would help with these requirements as well as participation with them in multidisciplinary clinics or committees.

Emphasis should also be placed on a surgical intern year, as the article had mentioned, or at least 3–4 months of surgical experience during residency training in a categorical program, which could be requested as elective rotations throughout the aspiring pain fellow's residency training, regardless of their specialty. During fellowship training, there could be rotations with spine surgery providing fellows the opportunity to scrub into laminectomies, fusions etc so they can learn proper dissection techniques, suturing, as well as complication management from surgeons. Multidisciplinary education should be emphasized when teaching fellows the invasive surgical procedures with detailed discussions of preoperative, intraoperative and postoperative concerns [3].

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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References

1 Christiansen Sandy Pritzlaff Scott Escobar Alexander Kohan Lynn A sudden shift for Pain Medicine fellowships – a recount of the 2024 match Interventional Pain Medicine 3 2 2024 100404 10.1016/j.inpm.2024.100404 ISSN 2772-5944
2 Agarwal S. Cicone C. Chang P. Interventional pain procedures in physical medicine and rehabilitation residencies Am J Phys Med Rehabil 97 4 2018 Apr 298 303 10.1097/PHM.0000000000000871 PMID: 29189304 29189304
3 Hagedorn J.M. Deer T. Sayed D. Lamer T. Pain medicine: if we want to be surgeons, we must have surgical training Reg Anesth Pain Med 45 7 2020 Jul 561 562 10.1136/rapm-2019-101105 Epub 2019 Nov 8. PMID: 31704788 31704788
