Living with Chronic Pain
Requirements for a Pain Specialist in Canada
A standard training program designed for physicians wishing to specialize in pain management did not exist in Canada until 2014. This meant anyone receiving care at a pain clinic, prior to this time, would see a physician who may be specialized in, for example, anesthesiology or neurology, or a general practitioner who had taken a short course on pain management.
Pain Medicine subspecialty formed
In March 2014, after more than seven years of lobbying, Pain Medicine became an officially designated subspecialty recognized by the Royal College of Physicians and Surgeons of Canada. The first residency program opened the University of Western Ontario; two residents were accepted in July 2014. Currently, the University of Calgary, University of British Columbia, University of Toronto, University of Ottawa, Universite de Montreal, McMaster University, and University of Manitoba also have Pain Medicine residency programs.
In order to be eligible for the Pain Medicine subspecialty program, a candidate must be accredited or enrolled in a specialty, including Anesthesiology, Emergency Medicine, Internal Medicine, Neurology, Pediatrics, Physical Medicine and Rehabilitation, Psychiatry, or Rheumatology. In acceptable cases and with special approval from a committee, entry is possible from other accreditations, such as Medical Oncology, Neurosurgery, Orthopedic Surgery, or Palliative Care.
Course of study
The program trains and directs candidates on how to prevent, evaluate, diagnose, treat and rehabilitate pain-related conditions, including acute and chronic pain. Individuals must attend training for a period of two years (26 four-week blocks).
Out of the 26 blocks, 13 involve clinical experience in a multidisciplinary pain clinic. Additionally, candidates must complete seven blocks, which include the following:
- Addiction medicine (Psychiatry)
- Musculoskeletal system in Physical Medicine and Rehabilitation or Rheumatology
- Acute pain service
- Cancer pain and symptom management
- Pediatric pain services
Six additional blocks must be chosen from the following:
- Adolescent Medicine
- Community-based experience in Pain Medicine
- Diagnostic imaging
- Education/curriculum development
- Interventional Pain Medicine/neuromodulation
- Obstetrics and Gynecology
- Orthopedic/spine surgery
- Palliative care service
- Public Health and Preventive Medicine
- Research methodology/biostatistics
- Sleep medicine
- Other rotations relevant to training in Pain Medicine as approved by the Program Director
To obtain Pain Medicine certification, the Royal College of Physicians and Surgeons also requires the following:
- Certification in one of the acceptable entry disciplines
- Successful completion of a 2-year Royal College accredited program in Pain Medicine
- Successful completion of the certification examination in Pain Medicine
- Completion of a scholarly project related to Pain Medicine
What does that mean for Canadians attending pain clinics?
Currently, most Canadians will not find someone who has the Royal College of Physicians and Surgeons of Canada Pain Medicine certification at their local pain clinic. This is due to the Pain Medicine residency program being very new and only accepting a handful of candidates. If an individual goes to a pain clinic associated with a university having a Pain Medicine subspecialty program, they may find a physician that is in the training program.
Additional sources: The Royal College of Physicians and Surgeons of Canada and Schulich School of Medicine and Dentistry: Western University