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In the last decade, management of acute and chronic pain has
attracted significant attention on both the patient and professional
level. The need of qualified personnel to supply services for the patients
who have pain has increased. Pain medicine as a subspecialty has
been well recognized by the public. Therefore, several organizations
offer credentialing and certification.
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Pain syndromes often involve exceedingly complex issues and no
single, traditional, established specialty can simply and effectively
cover all aspects of pain-related problems. Pain management is truly
a multidisciplinary medical practice that involves application of
a wide variety of techniques to which no single currently existing
specialty can lay sole claim. Pain management still exists as a
division of a larger department throughout most parts of the country—and
not as a department of its own. Pain medicine has not been established
as a generally accepted teaching course in medical schools even
though some pioneer medical schools offer elective introduction courses
to medical students. Medical school education in pain is usually
minimal. In the first 2 years of formal lectures, it is common for
coverage of this field to be limited to 1 to 2 hours. During the
second 2 years of clinical rotations, students often receive additional
informal education; however, little if any of this education is
provided by experts in the field. Some medical schools (including
Harvard Medical School) have started to offer didactic sessions
as well as elective rotations in pain centers for senior students.
These rotations can vary from 1 day to 1 month. Overall, however,
medical school education in pain medicine remains minimal. Postgraduate training
is mainly affiliated with other pain-related subspecialties or as
part of training in such subspecialties. A distinct residency program
in pain management has not been accepted. Additionally, the overwhelming
majority of pain fellowship programs are affiliated with various
primary specialty programs: mostly anesthesiology. The number of
anesthesiology pain management fellowship programs, however, has
increased significantly in the past 10 years. The Accreditation
Council for Graduate Medical Education (ACGME) also expects the
anesthesiology residency programs to provide some pain management
training in a pain clinic setting.
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There are several different pain management certifications offered
currently. The American Board of Anesthesiology (ABA) took the first
step. The ABA, founded in 1941, first notified the American Board
of Medical Specialties (ABMS) of their intention to subcertify physicians
in pain management in 1989, and then held discussions with other
ABMS member boards interested in certifying physician in pain management.
On September 26, 1991, the ABMS agreed with the ABA to issue a pain
management certificate. The first subspecialty pain certificate
to the qualified ABA diplomates was issued in 1993.1 Five
years later, with the support of the American Board of Anesthesiology,
the American Board of Physical Medicine and Rehabilitation (ABPM&R),
and the American Board of Psychiatry and Neurology (ABPN) submitted
a joint proposal to offer subspecialty certification in pain management.
The first certification of subspecialty in pain management was ...