Chronic Low Back Pain

 

Curriculum

 

PGY-1         PGY-2         PGY-3

 

Patients with chronic pain often pose significant challenges to health care providers. In addition to their pain, which may be sub-optimally managed, many of these patients have under-recognized and under-treated co-morbid conditions, including mental illness, substance use and disorders, and abusive personal relationships. Additionally, when caring for patients with chronic pain, physicians are less likely to seek the patients’ active involvement in care and are less likely to address health maintenance issues.

The three workshops address the following:

PGY1 – Residents will learn to evaluate and develop a treatment plan for a patient with no major co-morbidities who presents with low back pain. This will include how to take a comprehensive history and physical exam, identifying “red flag” signs and symptoms, medications and therapies, principles of the WHO Analgesic Ladder, and generating a differential diagnosis.

PGY2 – Residents will learn to evaluate and develop a treatment plan for a geriatric patient with several co-morbidities who presents with low back pain. This will include how to take a comprehensive history and physical exam on a geriatric patient with low back pain, identifying “red flag” signs and symptoms in a geriatric patient, medications and therapies to be used and avoided in geriatric patients with chronic back pain as well as in patients with co-morbidities such as liver or kidney failure, and generating a differential diagnosis specific to an older or medically complicated patient.

PGY3 – Residents will learn to evaluate and develop a treatment plan for a patient with a history of addiction or medication misuse who presents with low back pain. This will include demonstration of previous knowledge and skills developed as PGY1 and PGY2 residents, as well as developing a treatment plan which incorporates regular monitoring/ screening for substance abuse and diversion, discussion of the epidemiology of substance abuse and diversion, setting boundaries with patients, and troubleshooting.