by A. Michael deRosayro, M.D.
As the Multidisciplinary Pain Center enters into its 17th year of operation, there have been many changes since our last report in the Michigan Airway of June, 1989. The name itself has changed from its original title of Coordinated Chronic Pain Program to Multidisciplinary Pain Center in keeping with the International Association for the Study of Pain (IASP) recommendations. This was also done to distinguish it from the Outpatient Chronic Pain Rehabilitation Program and Physical Medicine and Rehabilitation, which is under the direction of Randy Roth, Ph.D.
 |
A. Michael deRosayro, M.D. |
Although our space in the Med Inn Building has not grown as we hoped it would, our activities certainly have increased considerably. We operate five days a week, year-round with only a few days off for the holiday season. Our daily core team consists of a staff anesthesiologist, clinical nurse specialist, staff nurse, clinical psychologist, physical therapist, a social worker and medical assistant. The current attending staff for both chronic and acute pain services are Drs. A. M. de Rosayro, Vildan Mullin, Angela McLoughlin, Carmen Green, and Jack Rosenberg. One of the major developments has been the establishment of a formal fellowship program for which we are accredited by the A.C.G.M.E. Although over the years we have had many fellows from as far afield as Brazil, the twelve-month fellowship was established in 1992-93 with Carmen Green, M.D. and Kim Greenwald, M.D., being our first official fellows. In 1994-95, we increased our numbers to three fellows with the institution of a rotation at Oakwood Hospital under the direction of Steve Wiener, M.D.
Pain management is currently one of the most popular sub-specialities for fellowship training and we have had over 50 applicants for positions during the last two years. We believe our fellows have had a positive and enjoyable experience and some of their current activities are included in this issue. This is also a popular elective for the CA-3s who are allowed to do a three-month mini-fellowship each year. Besides training our own residents, we also provide training experiences for residents from Psychiatry, Internal Medicine and Physical Medicine and Rehabilitation on a regular basis. Several medical students have taken advantage of a four-week pain elective which we also offer.
Over the past few years we have established other interdisciplinary ventures. We now have Randy Roth, Ph.D. and Francine Quail, P.T., staffing in the Thoracic Outlet Clinic with Dr. Lazar Greenfield, Jan Bachman, Ph.D., as consulting psychologist in the Dental School Facial Pain Clinic one day each week. Dr. Roth and Leanne Pominville, P.T., collaborate with Margaret Punch, M.D., from OB/GYN who runs a weekly Chronic Pelvic Pain Service in our clinic. We’ve also established a joint clinic with Physical Medicine and Rehabilitation at the VA Medical Center which is currently staffed by Jack Rosenberg, M.D. Starting in January, we will be working in close collaboration with Oren Sagher, M.D., from Neurosurgery in the evaluation and management of patients who may require spinal cord simulation and indwelling intrathecal morphine or baclofen pumps for managing chronic pain. In January we will also see the establishment of a satellite clinic at the University Center for Speciality Care in Livonia.
Patients referred to us continue to increase in complexity and fully tax our core team. However, our total numbers have increased annually and we are currently seeing nearly 6,000 patient visits a year. We are making a concerted effort to improve our research activity. Over the past few years our clinical staff has presented over 15 abstracts and papers at professional meetings and had several articles published in professional journals. To further these efforts, we are taking on a part-time research nurse and part-time research associate beginning in January. Jack Rosenberg has been designated as Director of Pain Research. Some of the protocols either underway or about to be started are listed in the Research Report (see pg. 3).
The advent of managed care will undoubtedly have its impact on pain services. We are actively involved with Joel Saper and others in the state who have the ear of the Michigan legislatures so that hopefully we will be able to preserve our place in the institution and continue to provide the much needed services for this very difficult group of patients.