Pain Medicine Division

Best Medical Schools for Anesthesiology #5 in the nation.The Pain Medicine Division delivers care across the health system using the skills of multiple specialists, including physicians, nurse practitioners, physician assistants, psychologists, physical therapists, acupuncturists, and massage therapists. Its breadth of six clinical pain practices treats patients along the continuum of health care needs utilizing state-of-the-art interventions. The division’s comprehensive approach is interwoven with the research mission to develop novel, non-opioid therapies for the prevention and treatment of chronic pain.

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In 1974, Dr. Bruno Urban became the first dedicated pain management specialist within Duke Anesthesiology. He was quickly joined by a multidisciplinary team, including Dr. Blaine Nashold in neurosurgery, Dr. Francis Keefe in psychology and other future leaders in the field of pain medicine. Dr. Urban set the stage and expectations that pain management needed to be a multidisciplinary approach that crossed specialty barriers. Patients were frequently evaluated by several members of the team prior to development of a multidisciplinary treatment plan, including neurosurgical and neurostimulation techniques. When the Pain Medicine Division was established in 1999, Dr. Urban served as its first chief, prior to retiring from clinical practice in 2000.

In the early 2000s, Dr. Winston Parris was recruited, and interventional and neurostimulation techniques were expanded, adding novel treatments, such as epidural lysis of adhesions. The Pain Medicine Fellowship expanded from one to three fellows and academic growth continued with program representation at multiple national meetings. A formalized educational process both within and outside of the division was solidified.

In 2014, with the growing needs for population health management, in addition to interventional-based pain therapies, the outpatient clinic relocated from Morreene Road to a dedicated clinical space (Medical Park Clinic) and several new physicians were recruited. Dr. Steve Prakken was brought in to lead the Medical Pain Service (MPS) and Dr. Richard Boortz-Marx was recruited for the interventional/Implant program. The MPS was designed for care of the complex patient with chronic pain and co-existing disease, utilizing an APP team approach. Dr. Boortz-Marx continued the growth of the neurostimulation and implant program, solidified under Dr. Parris.

In 2017, the Duke Innovative Pain Therapies (DIPT) clinic opened as one of the only clinics in the nation to offer simultaneous services by specialists for orofacial pain, musculoskeletal and spine conditions. The clinic takes a patient-centered approach, incorporating additional therapies in acupuncture, massage and physical therapy. DIPT is the home for Duke’s Regenerative Pain Therapies Program.

In the same year, Duke Pain Medicine further expanded its collaboration with Duke Neurosurgery. Dr. Scott Runyon became the medical director of Duke Spine and Pain Management of Raleigh, where he has had a presence since 2015. This clinic, integrated with Neurosurgery, serves vital diagnostic and interventional needs for spine patients in the Raleigh area.

Also in 2017, Duke Anesthesiology opened the Duke Perioperative Pain Care clinic, one of the few in the country to optimize patients with chronic pain before surgery and to facilitate their recovery. Patients are evaluated early, identifying and eliminating barriers to successful surgical recovery.

In 2018, the Duke Raleigh Hospital Pain Clinic opened its doors, offering comprehensive spine and pain management under the direction of Dr. Kevin Vorenkamp. This clinic provides comprehensive evaluation, treatment and procedural care for patients across Raleigh.

Pain Medicine Division

From Left to Right, Front to Back: Joel Goldberg, MD; Richard Boortz-Marx, MD; Thomas Buchheit, MD; Steve Prakken, MD; Tamara Buthuis, RN; Srini Pyati, MD; Jennifer Parsons, NP; Scott Runyon, MD; Marianne Paul, PA; Lisa Peoples, PA; Dianne Scott, MD; Thomas Hopkins, MD; Lance Roy, MD; David Lindsay, MD; Anne Marie Fras, MD. Not pictured: Brian Ginsberg, MB BCh; Ru-Rong Ji, PhD

In addition to pain preventive strategies, conscientious clinical care and risk reduction protocols, Duke Pain Medicine is actively working to shape the future of pain medicine in the United States. This team believes that the ideal solution to the co-existing chronic pain and opioid crisis is the development of novel non-opioid analgesics and the delivery of scientific discoveries to the bedside. Their mission is “to provide extraordinary care for the patient in pain through precision diagnosis, innovative interventions and refined medical therapies” while simultaneously seeking translational scientific discovery to reduce the future burden of chronic pain.

Neurostimulation Implant Program (multiple sites)

In recent years, the clinical and translational scientific programs have grown dramatically. Specific areas of targeted for growth include the Neurostimulation Service, which performed 257 neurostimulation cases in 2018, including cutting-edge techniques, such as dorsal root ganglion stimulation. Trials and implants take place across multiple clinical sites.

Duke Pain Medicine

This clinic, located at Medical Park in Durham, houses both the Interventional and Medical Pain Services. The Interventional Service offers diagnostic and therapeutic interventions, including advanced neurostimulation techniques, fluoroscopically-guided spine procedures, ultrasound-guided musculoskeletal and peripheral nerve interventions, and radiofrequency lesioning techniques. In addition to the neurostimulation program, there is a comprehensive, targeted drug delivery (spinal infusion pumps) in the treatment of cancer-related pain. In 2018, the Duke Pain Medicine clinic had more than 18,000 visits and performed more than 2,000 procedures.

The outpatient Medical Pain Service team evaluates and manages high-risk pain patients, providing patient care, complex care coordination, and education for patients and clinicians throughout the Duke University Health System. With an extensive background in the management of chronic pain and psychiatric disorders, Dr. Prakken manages a team that includes four advanced practice practitioners: Karen McCain, Ashley Underwood, Deborah Stoia and Cher Nicholas.

Duke Innovative Pain Therapies (DIPT)

This multispecialty clinic, located in Raleigh at Brier Creek, opened in 2017 and has seen steady growth, treating patients with orofacial, neuralgic, spine, and musculoskeletal conditions with fluoroscopically- and ultrasound-guided injection techniques, acupuncture and physical therapy. Massage therapy was added to the clinic repertoire in 2019. DIPT is also the home of the Regenerative Pain Therapies Program (RPTP) that offers a full spectrum of non-opioid, biological treatments, with a focus on Duke Autologous Serum (DAS).

Duke Spine and Pain Management of Raleigh

Under the medical direction of Dr. Scott Runyon, this clinic performs approximately 6,500 visits per year, offering a full spectrum of fluoroscopic and ultrasound-guided procedures, medication management, radiofrequency rhizotomy, spinal cord stimulation, dorsal root ganglion stimulation, botox injection for chronic pain conditions, and kyphoplasty. This clinic is integrated with Duke Neurosurgery and serves vital diagnostic and interventional needs for spine patients in the Raleigh area.

Duke Raleigh Hospital Pain Clinic

Under the direction of Dr. Kevin Vorenkamp, this clinic successfully transitioned to Duke Anesthesiology in 2018, offering comprehensive spine and pain management. Dr. Vorenkamp began his role as medical director on August 27 after leaving his role as the director of the Pain Medicine Fellowship at Virginia Mason Medical Center in Seattle. The clinic is now fully staffed with pain medicine (Anesthesiology) physicians, including the addition of Dr. Brian Starr, and nurse practitioners, Emily Davis, Natalie Miller and Sarah Baxt. The clinic provides comprehensive evaluation, treatment and procedural care and is now providing access within 72 hours for all new patient visits. The clinic is also offering services, including perioperative pain management, for the Duke Raleigh medical campus.

Duke Perioperative Pain Care

This clinic, located at Duke Medicine Circle in Durham, is an innovative program that focuses on care of the patient around the time of surgery. Patients are evaluated before surgery to identify and eliminate barriers to optimize pain management. A comprehensive plan is developed for the pre-, intra- and post-operative period by a team of physicians and a licensed clinical social worker. Many of its providers also work in the Inpatient Pain Service, providing continuity and a seamless transition between the clinic’s plan of care and inpatient management.

Inpatient Pain Service

The Inpatient Pain Service is a comprehensive, multidisciplinary consult service focused on providing specialized care for acute postoperative pain, acute-on-chronic pain, and cancer-related pain. Led by specialized pain physicians, the Inpatient Pain Service utilizes a variety of advanced medical and interventional therapies, including peripheral nerve catheters, epidural analgesia, non-opioid analgesic medicines, and psychosocial support.  This team provides 24/7 inpatient pain services and conducts daily rounds in close collaboration with the patient’s primary management team. It vigorously supports acute pain medicine research initiatives aimed at maintaining a state-of-the-art capability to provide care for complex acute pain conditions. To ensure a smooth transition at discharge, the Inpatient Pain Service strives to assist primary management teams in the development of continuous pain care pathways.

Pain Medicine Fellowship

Pain Medicine FellowshipDuke University Medical Center is one of the leading medical centers in the nation with a worldwide reputation for excellence in clinical care, teaching and research. Duke Anesthesiology’s Pain Medicine Fellowship is a multidisciplinary ACGME-accredited training program. Fellows who successfully complete the program are eligible for board certification in pain medicine.

Fellows spend time at four clinical sites: the Duke Pain Medicine clinic at Medical Park, Duke University Hospital, Davis Ambulatory Surgical Center, and the Durham Veterans Affairs Medical Center (VAMC). The Duke Pain Medicine Fellowship prides itself on being a multidisciplinary fellowship. Pain management fellows are mentored and taught by faculty from Duke Anesthesiology’s Pain Medicine Division, as well as members of the Departments of Neurology, Psychiatry, Radiology, Palliative Care, and Physical Medicine and Rehabilitation. Dr. Lance Roy serves as the fellowship director. The fellowship reviews applications from all qualified applicants, irrespective of primary specialty. It has trainees and faculty from all ACGME-approved disciplines, including anesthesiology, neurology, psychiatry, and physical medicine and rehabilitation.

The Pain Medicine Fellowship designs each rotation to expose fellows to a different aspect of pain management. At the Duke Pain Medicine clinic, fellows learn outpatient management under the direction of board certified pain physicians with expertise in procedural intervention and comprehensive management. Special emphasis is given to interventional pain management and procedural competency during the fellowship year. The fellows additionally spend time at Duke University Hospital on inpatient rotations, providing them the opportunity to learn how to manage an Inpatient Pain Service, particularly acute pain management as well as management of chronic pain in the context of acute medical illness. As part of the “perioperative home” movement that is currently reshaping the field of anesthesia, rotating on the Inpatient Pain Service provides our fellows with a superior training background if they wish to continue practicing inpatient medicine. This service receives consults for acute-on-chronic pain, cancer pain and palliative care. During this time, they also round with the Palliative Care Service.

Under the ongoing direction of Dr. Joel Goldberg, the VA pain clinic has been in operation since 1988. It is the third longest-running pain clinic within the Veterans Health Administration. While at the Durham VAMC, fellows learn a variety of interventional and non-interventional pain management techniques in both the inpatient and outpatient setting. Also at the Durham VAMC, fellows have their Physical Medicine and Rehabilitation rotation.

Medical Students

In 2016, Dr. Anne Marie Fras developed the second-year Duke University School of Medicine pain management education course that is 3.5 hours of lecture and problem-based learning to introduce medical students to pain management concepts, pain patient evaluation, and assessment of patients for suitability to receive opioids. Students are introduced to the concepts of problematic medication related behaviors, urine drug screen interpretation, as well as risk assessment of patients before and during opioid management.

Dr. Neil Ray is active in teaching the fourth-year Medical School Capstone Course, an important milestone prior to graduation. Dr. Lance Roy leads both the Second Year Selective in Pain Management and the Fourth Year Elective in Acute and Chronic Pain Management. Drs. Roy and Thomas Buchheit also sponsor third-year medical students for continuity clinical experience and the longitudinal care of patients. Dr. Steven Prakken routinely hosts clinicians from primary care and psychiatry for both didactic and shadowing opportunities.

Residency

Dr. Fras also coordinates the Duke Anesthesiology residency rotation in chronic pain. This includes a robust didactic lecture series, journal club, as well as quarterly M and M Case conferences. The residents and fellows rotating at Duke Pain Medicine experience educational opportunities in the clinical evaluation of chronic pain patients, office-based procedures and thorough participation in advanced interventional pain procedures, such as neurolytic blocks, intrathecal drug delivery and spinal cord stimulation.

The clinical pain service works closely with Dr. William Maixner, vice chair of research and co-director of the Center for Translational Pain Medicine (CTPM), and Dr. Ru-Rong Ji, chief of pain research and co-director of CTPM. This collaboration facilitates both the clinical and research missions, providing a strong clinical arm to facilitate translational research development. The team is defining the mechanisms that are involved in the transition of acute to chronic pain, the development of non-opioid analgesic therapies, and projects to further the mechanistic understanding of drivers of chronic pain after nerve injury. This multi-pronged approach addresses two simultaneous public health challenges: the treatment of 100 million American adults suffering from chronic pain and a devastating opioid epidemic.

View the department’s competitive and non-competitive research grant awards by calendar year.

In 2018, the Regenerative Pain Therapies Program (RPTP) launched at Duke Innovative Pain Therapies, under the direction of Dr. Thomas Buchheit. Duke’s RPTP was built around well-proven and tested clinical interventions with demonstrated records of successful outcomes. This program offers a full spectrum of biologically- and non-biologically-based interventions to treat specific types of musculoskeletal injuries and degenerative conditions of joints, tendons and muscle.  Dr. Buchheit has more than 10 years of experience with ultrasound-guided musculoskeletal (MSK) diagnosis and ultrasound-guided interventions, which he employs for precision therapies. In addition to formal certification in ultrasound-guided MSK intervention, Dr. Buchheit has mentored with Dr. Peter Wehling, an internationally-renowned expert in molecular orthopedics and regenerative medicine from Düsseldorf, Germany. Dr. Wehling, adjunct professor in Duke Anesthesiology, has been instrumental in the development of Duke’s Regenerative Pain Therapies Program, including Duke Autologous Serum, a treatment honed after decades of research and clinical practice by Dr. Peter Wehling for the treatment of patients with degenerative joint disease. Therapy is customized for each patient, and may also include acupuncture, massage and physical therapy. This process has successfully treated thousands of patients across the globe, avoiding the need for surgical intervention.

Division Contact

Lindsay Waters
Program Coordinator
919-681-1924
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Divisional News

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