The education of physicians is a fundamental obligation within medicine that must remain closely aligned with clinical care. And although medical education in pain care is essential, the current state of medical education does not meet the needs of physicians, patients or society. To address this, we convened a committee of pain-specialist medical student educators. Tasked with creating systematically developed and valid recommendations for clinical education, we conducted a survey of pain medicine leadership within the American Academy of Pain Medicine (AAPM). The survey was conducted in two waves. We asked AAPM board members to rate 194 previously published pain medicine learning objectives for medical students, (79%) of those eligible for participation responded. The ‘Top 5’ list included awareness of acute and chronic pain; skillfulness in clinical appraisal; promotion of compassionate practices; displaying empathy towards the patient; and knowledge of terms and definitions for substance abuse. The ‘Top 10’ list included the major pharmacological classes as well as skills in examination, communication, prescribing, and interviewing. The top 20 list included pain care of cognitively impaired populations, those with co-morbid illness, and older adults. With the survey results in consideration, the committee produced a new recommended topic list for curricula in pain medicine. We strongly recommend that adequate resources are devoted to fully integrated medical curricula in pain so that students will learn not only the necessary clinical knowledge but also be prepared to address the professional, personal, and ethical challenges that arise in caring for those with pain. We conclude that improved medical education in pain is essential to prepare providers who manifest both competence and compassion towards their patients.

On September 1, 2005, with only 12 hours notice, various collaborators established a medical facility--the Katrina Clinic--at the Astrodome/Reliant Center Complex in Houston. By the time the facility closed roughly two weeks later, the Katrina Clinic medical staff had seen over 11,000 of the estimated 27,000 Hurricane Katrina evacuees who sought shelter in the Complex. Herein, we describe the scope of this medical response, citing our major challenges, successes, and recommendations for conducting similar efforts in the future.

Qualitative pain scores significantly improved when the patient used TENS-R vs. conventional TENS. Lead placement of any TENS modality over the back vs. over the leg improved all pain scores.

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This study documents the time of clinic presentation and most frequent types of PMR conditions of patients treated in the Astrodome Clinic after a historic hurricane. Most PMR conditions were treated by PMR personnel during the first week. Thus, future disaster planning should include PMR professionals as early responders.

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A B S T R A C TBackground. Neurological deficits after epidural steroid injection (ESI) are rare but occur despite meticulous technique. Some neurologic deficits reverse spontaneously, others reverse only with timely interventions, and some are permanent. Etiologies vary.Objectives. Assess the immediate diagnostic and treatment steps to undertake when a patient experiences a severe neurologic deficit so that the best neurologic recovery can be obtained.Design. The literature was systematically reviewed for case reports and case series describing neurologic deficit after ESI.Outcome Measures. From these reports, the mechanism, temporal onset, permanence or reversibility of the deficit, and assessment and management were recorded and analyzed.Results. Thirty-three cases of neurological deficits were identified: 19 permanent deficits and 14 reversible. Infarction was significantly associated with permanent deficits (P Յ 0.008) and presented just after injection (P Յ 0.03), compared with "noninfarct" groups. Temporal onset of differential diagnoses (subdural and intrathecal injection, hematoma, and vascular punctures) overlap. When deficits did not resolve consistent with inadvertent subdural/intrathecal injection, timely initial magnetic resonance imaging (MRI) should be carried out to diagnose mass lesions, which have an optimal 8-hour window for effective surgical intervention. Mass lesions have an excellent prognosis for recovery (83%) compared with infarctions (9%) (P Յ 0.005).Conclusions. Faced with deficits after ESI that do not resolve, the physician will need access to MRI, or similar radiographic studies, and subsequent neurosurgical consultation and facilities if MRI results indicate a decompressible lesion. Respiratory insufficiency with quadriplegia and loss of consciousness can occur, and in the worst of scenarios, the physician would also need the capability to ventilate the patient.

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