CURRICULUM FOR THE DIPLOMA IN PAIN
MANAGEMENT
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Trainees should be proficient in the following topics:
1. Neurobiology of pain
1.1 Neuroanatomy of the pathways at the peripheral, visceral and central nervous systems involved in pain perception and modulation 1.2 Neurophysiology of nociception, sensitisation and other pathological states such as phantom phenomenon or neuropathic pain 1.3 Regional and neuro-anatomy relevant to the practice of interventional pain management 1.4 Principles of pharmacology for pain related chemicals including anaesthetic agents, analgesics, sedatives and psychomimetic substances. 1.5 Physiological variations of age, pregnancy and sex on pain physiology, and pharmacology, as well as the psychological and social implications. 1.6 Principles of genetics and its relations with pain physiology, clinical presentation, response to therapies and implications on research 1.7 Contributions and limitations of animal studies in the understanding of pain
2. Clinical pharmacology of analgesics
2.1 Principles of pharmacokinetics and pharmacodynamics 2.2 Opioids 2.3 Paracetamol 2.4 Non-steroidal anti-inflammatory drugs (NSAID) 2.5 Antidepressants 2.6 Anticonvulsants and ion channel blockers 2.7 Local anaesthetics and membrane stabilizing agents 2.8 NMDA antagonists 2.9 Muscle relaxants and GABA agonists 2.10 Serotonin or catecholamine receptor agonists and antagonists 2.11 Steroids 2.12 Other agents including Capsaicin, Botulinium toxin, Nitrous Oxide 2.13 Management of side effects and overdoses
3. Sociobiology of pain
3.1 Taxonomy of pain according to IASP definitions 3.2 Local and global epidemiology of painful conditions 3.3 Medical-legal issues of pain conditions, including traffic accident and injury on duty cases, and their impact on clinical outcome 3.4 Financial and other social resources for pain patients and their effect on clinical outcome 3.5 Substance abuse, its relation with pain conditions and management, and legal implications 3.6 Ethnic, gender and cultural aspects of pain and pain management 3.7 End of life issues, and the current legal or professional guidance 3.8 Principles of evidence based medicine 3.9 Consent, professional misconduct and other forms of negligence 3.10 Medical research, its ethnics, conduct and reporting 3.11 Biostatistics
4. Assessment of pain and disability
4.1 Measurement of pain and other outcomes of pain treatment in human and animals, including extremes of age and mentally incompetent patients 4.2 Multi-dimensional pain history taking and examination of relevant body parts 4.3 Clinical assessment of non-organic signs, their interpretation and limitations 4.4 Investigations and their clinical uses and limitations 4.4.1 Imaging including plain X-rays, radioisotope scans, Computerised Tomography and Magnetic Resonance Imaging 4.4.2 Other investigations including blood tests and nerve conduction studies 4.5 Psychometric and quality of life assessment tools, their uses and their limitations 4.6 Assessment of mood disorders and suicidal risk
5. Indications, contraindications and outcome of interventional pain management
5.1. Somatic and autonomic nerve blocks related to acute and chronic pain management 5.2. Physical and chemical methods of neurolytic procedures 5.3. Muscle and joint injections 5.4. Neurostimulation techniques 5.5. Drug delivery implants and wound management 5.6. Neuroablative and corrective surgical techniques 5.7. Role of steroids in interventional pain management 5.8. Principle, uses and safety of imaging during pain intervention
6. Physical therapy in pain management
6.1. Analgesic modalities including Transcutaneous Electrical Nerve Stimulation, temperature treatment, ultrasound, inferential therapy, manipulation, traction and massage 6.2. Other modalities including stretching, strengthening and aerobic exercises
7. Psychological and Psychiatric therapy in pain management
7.1. Principles, technique and outcome of Cognitive-Behavioural Therapy, including its application in the clinic setting 7.2. Role and limitations of biofeedback, relaxation, hypnosis or other forms of psychotherapy 7.3. Psychiatric clinical pharmacology 7.4. Management of sleep disorders 7.5. Placebo phenomenon, theories and its application in pain management
8. Roles of nurses in pain management, including clinical, educational, administrative and research.
9. Uses and limitations of complementary alternative medicine, including acupuncture, in pain management
10. Principles of Rehabilitative Medicine
10.1. Assessment of function, impairment, disability and handicap 10.2. Use of aids, orthotics and prosthesis 10.3. Principles of ergonomics 10.4. Vocational and recreational training resources
11. Acute pain management
11.1. Pathophysiology and epidemiology of un-relieved acute pain 11.2. Management of non-surgical acute pain such as burns, trauma, angina pectoris, acute zoster 11.3. Management of pain during pregnancy, labour and at the post-partum period 11.4. Relationship between acute and chronic pain states, role and limitations of pre-emptive analgesia 11.5. Principles, uses and limitations of patient controlled analgesia, epidural infusions and other nerve blocks in acute pain management 11.6. Organization of the acute pain service
12. Cancer and HIV pain management
12.1. Pathophysiology and epidemiology of pain in cancerous or HIV positive patient 12.2. Principles of Palliative Medicine and hospice care 12.3. Application and limitations of the WHO analgesic ladder 12.4. Effect of oncological treatment on pain management 12.5. Management of incident pain and other somatic symptoms for the terminal patient
13. Musculoskeletal pain management
13.1. Principles of Rheumatology, including clinical diagnosis, investigations and controversies such as myofascial pain syndrome, chronic fatigue syndrome and fibromyalgia 13.2. Pain management for metabolic bone diseases including osteoporosis and osteoporotic fractures 13.3. Spine pain and sciatica management 13.3.1. Pathophysiology and epidemiology 13.3.2. Acute low back pain assessment and management 13.3.3. Uses of the Red and Yellow flag signs in clinical management 13.3.4. Surgical treatment options and outcome 13.3.5. Multi-disciplinary approach for back pain management 13.3.6. Controversies with the diagnosis and management of neck pain with whiplash injuries
14. Neuropathic pain management
14.1. Diagnosis and clinical features of neuropathies 14.2. Pathophysiology of painful neuropathies, including the autonomic system in neuropathic pain 14.3. Stump pain, phantom pain and sensation management 14.4. Painful peripheral neuropathies including Diabetes, post-herpetic, alcohol and trauma 14.5. Trigeminal and other cranial neuralgias 14.6. Complex Regional Pain Syndrome (CRPS) types I and II 14.7. Central pain management
15. Other pain states management
15.1. Management of common visceral pain states including irritable bowel syndrome, chronic pelvic pain, and their differences with somatic pain 15.2. Management of headache including migraine, tension-type headache, cluster headache, headaches associated with analgesic abuse, and their classification according to the International Headache Society 15.3. Temporomandibular joint disorders and oro-facial pain
16. Special patient groups
16.1. Patients with substance use disorders 16.1.1 Acute and chronic pain management, including use of opioids 16.1.2 Patients on maintenance therapy 16.1.3 Patients with co-morbidities including tuberculosis and AIDS 16.1.4 Diagnosis of substance abuse in pain patients 16.1.5 Management of substance use disorders, including withdrawals and overdoses 16.2. Pain in children 16.2.1 Developmental neurology, analgesic pharmacology and psychology 16.2.2 Pain assessment in children 16.2.3 Management of procedural pain and acute pain in children 16.2.5 Common chronic pain states including recurrent abdominal pain, headache, cancer and musculoskeletal pain 16.2.6 Effect of family, schooling, peers and social influences on pain behaviour and management 16.3. Pain in elderly 16.3.1 Epidemiology of pain in the elderly 16.3.2 Differences in pain pathophysiology, behaviour, beliefs, psychosocial factors and treatment compared with the non-geriatric population 16.3.3 Pain management with concurrent illnesses, including depression, dementia, cerebrovascular events and organ failure
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