Voices in Pain Medicine: Established Pathways Into Pain Medicine: A Multidisciplinary Foundation for the Future

Pain Medicine has entered a period of meaningful evolution. Historically viewed as a subspecialty dominated by anesthesiology and later joined by physiatry, the field is now undergoing a clear transformation in who is applying, training, and ultimately practicing as pain physicians. As applications from traditional pipelines such as anesthesiology decline from their historical peaks, fellowship programs are witnessing a marked rise in applicants from fully eligible but previously underrepresented specialties, including family medicine, emergency medicine, psychiatry, neurology, and radiology. This shift has made the specialty’s multidisciplinary identity not only conceptual, but visible.

The Shifting Landscape of Pain Medicine Training:

Multiple recent analyses of the fellowship application environment reveal an unmistakable trend: the traditional dominance of anesthesiology applicants is declining, while interest from other specialties continues to rise. Program-director survey data show that nearly all programs report a decrease in anesthesiology applications over the past several years, coupled with notable increases from physical medicine and rehabilitation (PM&R), neurology, psychiatry, emergency medicine, and primary care disciplines.¹–³

The reasons are multifactorial. Program directors commonly cite factors such as increased compensation and demand for general anesthesiology, perceived declines in reimbursement for interventional pain procedures, and ongoing regulatory pressures related to opioid stewardship.¹ At the same time, trainees from non-traditional backgrounds increasingly view Pain Medicine as a natural extension of their foundational training, particularly as the field expands into neuromodulation, headache and neuropathic pain, behavioral pain interventions, rehabilitative approaches, transitional pain services, and integrative care models.

Regardless of the drivers, the outcome is clear: Pain Medicine is becoming more multidisciplinary in both philosophy and practice. Fellowship cohorts increasingly reflect this diversity, and the specialty is growing stronger as a result.

Established Board-Recognized Pathways Into Pain Medicine:

The American Board of Medical Specialties (ABMS) and the ACGME recognize multiple primary specialties as eligible to pursue a Pain Medicine fellowship and subsequent board certification or a Certificate of Added Qualification (CAQ). These include:

• Physical Medicine & Rehabilitation (PM&R) — A function- and biomechanics-centered specialty grounded in musculoskeletal medicine, spine evaluation, and rehabilitation-based approaches.
• Neurology — Specialists in neuropathic pain, headache disorders, central sensitization, and neuromodulation candidacy.
• Psychiatry — Experts in the psychological and behavioral dimensions of pain, including mood disorders, trauma, substance use, and cognitive pain processing.
• Family Medicine — Bringing continuity of care, multimorbidity management, population health, and whole-person care—each highly relevant to chronic pain’s complexity.
• Emergency Medicine — Skilled in acute pain management, procedural care, and transitions from acute to chronic pain.
• Radiology (including Interventional Radiology) — Offering unparalleled expertise in anatomy, imaging interpretation, and image-guided interventions.

Each of these disciplines contributes a unique lens to Pain Medicine. Together, they form the multidisciplinary backbone of modern pain care.

Why a Multidisciplinary Workforce Matters:

Chronic pain remains one of the most prevalent, disabling, and costly conditions in healthcare, yet its causes and expressions are highly heterogeneous. For this reason, Pain Medicine has long conceptualized itself as multidisciplinary. What has changed is that the training pipeline now embodies that philosophy more authentically.

Research reinforces the benefits of integrated and interdisciplinary models. Such frameworks improve outcomes, support safer opioid stewardship, and enhance functional restoration through collaboration among physicians, psychologists, physical therapists, and rehabilitation specialists.⁴ Emerging educational models similarly demonstrate that interdisciplinary training increases provider confidence, enhances patient-centered care, and better prepares clinicians to address the biopsychosocial nature of pain.⁵

When fellowship cohorts include anesthesiologists, physiatrists, neurologists, psychiatrists, family physicians, emergency physicians, and radiologists, the result is a richer clinical environment—one where diverse perspectives improve diagnostics, procedural decision-making, behavioral interventions, rehabilitative planning, and long-term management.

Pain Medicine does not belong to a single specialty. Its strength lies in integration.

What This Means for Residents From Non-Traditional Backgrounds:

As a Resident Ambassador for AAPM from a non-traditional pathway, I am frequently asked: “Do I really have a pathway into Pain Medicine?”

For residents in family medicine, emergency medicine, psychiatry, neurology, or radiology, the answer is unequivocally yes. Not only is there a legitimate pathway, you are increasingly part of the specialty’s future.

Trainees from non-traditional backgrounds bring essential strengths derived from their respective specialties. Pain Medicine thrives when these strengths converge—not merely adding physicians from different disciplines at the end of training, but enriching the field throughout the fellowship journey itself.

As differing primary specialties train side-by-side, new perspectives emerge; procedural and cognitive skills are exchanged; and each trainee graduates not only as a pain medicine physician, but as a clinician shaped by the cross-pollination of ideas from multiple specialties. This process expands and strengthens the field as a whole, advancing the specialty’s long-standing multidisciplinary aim.

The expanding applicant pool highlights the need for residents across disciplines to see themselves as essential members of the pain-care workforce.

Preparing for a Career in Pain Medicine and Practical Advice:

For residents considering Pain Medicine, especially those from non-traditional pathways, here are actionable steps to strengthen your candidacy:

• Secure mentorship early.
• Identify a Pain Medicine mentor who understands your background and can advocate for you.
• Pursue relevant clinical exposure.
• Rotate through pain clinics, interventional suites, multidisciplinary pain programs, or spine services when possible.
• Engage in scholarly work.
• Quality improvement projects, case reports, literature reviews, and research all demonstrate commitment regardless of specialty.
• Highlight the strengths of your discipline.
• Programs increasingly value applicants who clearly articulate what their primary specialty contributes to pain care.
• Demonstrate multidisciplinary thinking.
• Emphasize whole-person care, teamwork, and openness to learning from other specialties, core principles of Pain Medicine.

Pain Medicine is changing, and its training pathways are changing with it. As applications shift away from traditional sources and toward a wider range of fully eligible specialties, the field becomes better equipped to meet the complex and evolving needs of patients. Understanding the established pathways into Pain Medicine empowers residents, regardless of background, to envision themselves as future pain specialists.

The message is simple: your background is not a barrier; it is an asset.

If you feel called to this field, there is a place for you here.

Dalton House MD
AAPM Resident Ambassador

Resident Physician, PGY-2
Family and Community Medicine
University of Kentucky

References

1. Jueng J, Pritzlaff SG, Mehta N, et al. Analyzing trends in the pain fellowship match: a survey of program directors. J Pain Res. 2025.

2. Pritzlaff SG, et al. Declining pain medicine fellowship applications from 2019 to 2023: a review of contributing factors and workforce implications. Pain Pract. 2025.
3. Christiansen S. A sudden shift for pain medicine fellowships: understanding the changing applicant landscape. Pain Rep. 2024. Hooten WM. Integrated pain care models and the importance of aligning multidisciplinary approaches for chronic pain. Pain Rep. 2024;9(6).
4. Munneke W, et al. Development of an interdisciplinary training program for chronic pain management: a comprehensive curriculum model. BMC Med Educ. 2024;24:5308.