Primus inter pares

The first swallows over another row to hoe

The Rector's School of Excellence project has been launched three years ago, and it works. Henceforth, surgery, therapeutics, obstetrics and gynaecology directions are reinforced with the School of Pain Management, which is acknowledged as an independent branch of clinical practice.
Almost every second patient complains of pain suffering. One out of five might get nothing for his pains: chronic pain of uncertain genesis as opposed to acute pain may become for a specialist or general practitioner a kind of insoluble problem. The School of Pain Management Excellence is conceived to equip the medical staff with insight and practical skills enabling them to cope with such missions.
Associate Professor of Nervous Diseases and Neurosurgery Chair Maxim Churyukanov was not sure if the rector would approve piloting of his initiative. “I outlined the goals to pursue, and the issues to solve”, admits Mr. Churukanov, "adjusted the draft with the head of my department, and submitted it to the Rector’s Office, presuming that the Schools on classic disciplines would be the first to get started up. When I was notified that "pain management" had been approved, it was a great surprise”.
Pain Management is much extensive multidisciplinary sphere dealing with practical methods of treating the patients suffering from pain syndromes using clinical, diagnostic and treatment techniques appropriate for various types of pain not only of neurological nature, but also that dealt with by rheumatologists, urologists, gynaecologists, surgeons, traumatologists, oncologists and physicians of other specialties.
Such studies have been in the focus of international medical research community since the 50s. Currently, the extensive data, proving that chronic pain is rather a disease itself than a symptom of some other diagnosable disease, is being cumulated and processed. The pain is identified as chronic if it persists longer than 3-6 months after normal tissue healing period. According to statistics, over 20% of European population, say, 75 million people at least, need special pain relieving medical aid. Russian statistic papers feature comparable values. 
In Russia, the problem of chronic pain is often the subject just for neurologists, whilst abroad there are some specialized clinics with pretty numerous staff, including anesthesiologist, psychologist, psychiatrist and expert in motor rehabilitation. This is a team that works synergetically to be capable of coping with pain of almost any kind.
We practice field classes, for example, in Petrovsky Surgery Center running the first Russian outpatient pain management department since the 70s, which is now reestablished as a pain management clinic headed by Oleg Zagorulko MD. But the bulk of our time we spend with the patients of our department in case studying of back pain, headaches (primary, secondary) and facial pain, peripheral and central neuropathic pain, fibromyalgia, visceral and rheumatic pain, pain in oncology in cooperation with Prof. G. Abuzarova of Herzen Institute and so forth.
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Dealing with such patients, it is crucial to collect medical history the way making you sure that you are encountering with true chronic pain case, which determines the treatment strategy. The history taking lasts for about an hour examining all the features of the history and pain specificity helping us to detect the genesis and lay down the treatment programme. 
The neuroorthopaedic survey skills, as well as additional methods of inspection: quantitative sensory testing, when the estimated pain and temperature sensitivity; electroneuromyography; evoked potentials; neuroimaging (MRI, CT), which are not taught within the general course are also touched upon within the School of Excellence curriculum. Students have an option to learn the relevant techniques and the ways of error-free results interpreting. 
Moreover, we overview the issues of cognitive-behavioral pain treatment, pointed-injection therapy, reflexology and acupuncture to encourage broad-mindedness on the subj in terms of drug and non-drug treatment. Some sessions are dedicated to the exercise and reciprocal therapy applicable for pain treatment. Our mission is not just to deliver in-depth training for neurologists, but also to upgrade the specialists who would have enough expertise in related disciplines appropriate for working with chronic pains. The “joint meetings” are another type of training sessions we practice together with the other Schools of Excellence. So, for example, future therapists are now well aware of what to do with the patients suffering of pain in the back or in the chest. 
The problem of chronic pain treatment is complex so, that it requires much concentrated professional dedication to translate the patient's complaints from the perception level into pathophysiological mechanisms analysis terms, eliminating any emotional component. To become prompt in acquiring clinical expertise, some students spend in the department of pain management all their spare time monitoring the patients, examining their histories and discussing upon these with their senior colleagues. Many of them has already got involved in the research process. Thanks to the University management, they have unlimited access to the ClinicalKey system containing full-text articles published in hi-rated global scientific periodicals. Our students are also welcome at national industrial conferences. 
The School of Pain Management Excellence head M. Churyukanov AP confirms the view of the leaders of the other Schools that the “pain managers” are exceptionally highly motivated. They know exactly, why they have gone in for medicine and soak up knowledge like blotting paper. 
So far, not only students, but most of certified doctors are deprived of the very opportunity to obtain such knowledge within postgraduate medical education. Our students are the first swallows of national analgesic care service initiation. The experience of our School of Excellence can form the basis of some national multidisciplinary interuniversity center specializing in pain management.
13.04.2016

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