DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

CLINICAL ACTIVITIES
PAIN MANAGEMENT
Thomas E. Buchheit, M.D.
Co-Chief, Division of Pain
Management
Clinical Associate in the
Department of Anesthesiology
PAIN MANAGEMENT
Anne Marie Fras, M.D.
Co-Chief, Division of Pain
Management
Associate in the Department of
Anesthesiology
64 CLINICAL ACTIVITIES
Members
Billy K. Huh, M.D., Ph.D.
Dianne L. Scott, M.D.
Brain Ginsberg, M.B., Ch.B., Acute Pain
Service
Joel S. Goldberg, M.D., Director Pain
Management, Durham VAMC
David Lindsey, M.D., VAMC
Allison Taylor. P.A.-C
Fellow:
Adil S. Kamal, M.D.
The year 2000 brought many changes to
the Division of Pain Management in the
Department of Anesthesiology. After 28
years of distinguished service at Duke
University Medical Center, Bruno J.
Urban, M.D, Dr.med stepped down
from clinical practice. It was also the
year that the leadership in the division
was passed to co-directors, Anne Marie
Fras, M.D. and Thomas E. Buchheit,
M.D. In November of 2000 the completion
of the Morreene Road Clinic
allowed the move of the Anesthesiology
pain clinic to a newly constructed
multidisciplinary clinic facility.
In 1974, Dr. Bruno J. Urban, along
with Dr. Blaine Nashold of Neurosurgery
and Dr. Bill Wilson of Psychiatry,
founded the Duke Pain Clinic to provide
treatment to patients with chronic
pain using a multidisciplinary approach.
This was one of the first clinics established
in the United States to offer this
approach to the evaluation and treatment
of patients with chronic pain
syndromes. Unfortunately, economic
pressures led to the separation of these
specialists into parallel clinics in 1998.
During the 26 years that Dr. Urban practiced
pain management, he stressed
a comprehensive approach to patient
evaluation and treatment to the residents
and fellows who learned pain
management under his tutelage.
One of these former fellows, Dr.
Fras, succeeded Dr. Urban in a leadership
position within the Division. The
future of the division was assured with
naming of Co-Division Chiefs, Dr. Fras
and Dr. Buchheit. Dr. Fras will supervise
clinical matters and Dr. Buchheit
will supervise resident and fellow education
and research. The year 2000 saw
the Anesthesiology Pain Clinic move
from its home of 26 years in Duke South
to join the multidisciplinary clinic
housed in the Morreene Road Clinic
Building. The participation of the
Anesthesiology Pain Management
Division as part of this multi-specialty
clinic will facilitate the cooperation of
clinicians from the specialties of
Anesthesiology, Psychiatry, Psychology,
Neurology, and Neurosurgery. One of
innovative ideas for the new clinic is a
single point of telephone access for
patients and referring physicians. The
proximity of the clinicians from varying
backgrounds with a common interest in
pain management will encourage collaboration
in clinical care, research,
and teaching.
Anesthesiologists in the pain clinic
evaluate and treat all types of chronic
pain syndromes including neuropathic
pain, musculoskeletal pain, headaches,
cancer pain, as well as sympathetic and
visceral pain syndromes. The comprehensive
evaluation in the clinic includes
a detailed pain history, physical
examination, and laboratory assessments
as indicated. Patients seen in
the multidisciplinary clinic complete a
comprehensive Pain Perception Profile
to evaluate the multiple factors involved
in the generation of chronic
pain syndromes. The emphasis on the
multi-dimensional aspect of pain evaluation
and treatment is in accordance
with the original mission of the pain
clinic. The patients may receive a
variety of interventions in the clinic including
standardization of medications,
diagnostic and therapeutic injections,
including discography, neurostimulatory
and infusion procedures, and
neuro-ablative procedures. The location
of the Anesthesiology pain clinic
within multidisciplinary clinic facilitates
referral for physical therapy interventions
as well as instruction in biofeedback
and relaxation techniques.
The outpatient clinic meets five
days per week at Morreene Road. The
expansion of clinic staff in March of