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The Pain Management Center of the Department of Anesthesia at BWH is a rapidly expanding subspecialty section. The Center integrates the management of acute (including post-operative) and chronic pain. For physicians with an interest in the study of pain, the division provides an exceptional educational opportunity, recognized by the ABA for subspecialty certification. The Department of Anesthesia has a long tradition of innovation and excellence in regional anesthesia. The Division of Pain Management is based on this foundation. The senior resident or fellow can expect to become proficient in the evaluation, diagnosis and treatment of such diverse conditions as low back pain, reflex sympathetic dystrophy, acute and post-herpetic neuralgia and other neuropathic pain syndromes, chronic pelvic pain, and the rapidly expanding field of oncologic pain management, to name only a few. Comprehensive consultative evaluations are performed in the Pain Management Center or at the bedside prior to decision to perform neural blockade. Patients are then referred for procedures at the discretion of the fellow or attending. Auxiliary services and modalities include psychological testing, psychotherapy, physical and occupational therapy, biofeedback and hypnosis. The division possesses one of the finest and most diverse acute pain services in the United States. Typically, the CA-3 or fellow becomes expert in the implementation and use of intrathecal and epidural opioids with or without local anesthetics by bolus or continuous infusion, axillary and infraclavicular brachial plexus catheter infusions and intrapleural catheters, paravertebral catheter infusion techniques and patient-controlled intravenous, subcutaneous andepidural analgesia. Abundant opportunity exists to master the neural blockade techniques of caudal, lumbar, thoracic and cervical epidurals (including placement of continuous delivery systems for opioids), stellate ganglion block, celiac plexus block, lumbar sympathetic block, IV regional techniques with antisympathetic agents, IV infusion techniques with local anesthetic, intrapleural and paravertebral catheter placement, as well as a variety of peripheral nerve block techniques. The center also performs implantation of drug delivery systems, spinal cord stimulation, and a wide variety of neurolytic procedures. Most procedures are performed in the outpatient clinic. In addition, on-site facilities are available for fluoroscopic visualization of technically difficult patients. All fellows participate in one of our several ongoing research protocols. A high premium is placed upon patient evaluation and differential diagnosis via a thorough knowledge of pathophysiology. Effectively, the philosophy of the division is to bridge the gap between internal medicine and the anesthesiologist. The service is of large volume. Approximately 2,200 neural blockade procedures are performed annually. New referrals for acute and chronic pain care are in the range of 150-200, and 120-140 patients, respectively per month. The pain residents and fellows take night and weekend call on the service, but may rotate days into the OR, an opportunity to keep other anesthesia skills current. Because of the volume and diversity of the pain problems seen, this subspecialty rotation is quite rigorous. However, if you are seriously interested in pain as the academic discipline, or as a career, there are few places where one could obtain such training.