Question: What is Physiatry?
Answer: Physiatry, or PM&R, started in earnest after World War II, when many soldiers returned from the war with serious musculoskeletal disabilities. Recognizing the benefits of physiatry, the Advisory Board of Medical Specialties approved PM&R as a specialty of medicine in 1947.
Physiatrists specialize in using a team approach to manage severe impairments such as stroke, paraplegia and amputation and in the non-surgical management of painful conditions including those that affect the spine, joints and other aspects of the musculoskeletal system. The specialty of physical medicine and rehabilitation (PM&R) physicians is known as physiatry.
As specialists, we focus on the body’s musculoskeletal system, which includes bones, muscles, ligaments, nerves, and tendons. Physiatrists treat patients of all ages with diverse problems ranging from simple sprains to complex disorders, such as spinal cord injury. Our comprehensive care includes treating the entire patient, not just symptoms.
For more information about Physical Medicine and Rehabilitation, visit the American Academy of Physical Medicine and Rehabilitation website.
Question: What’s the difference between seeing a Physiatrist and going to a pain clinic?
Answer: Before being treated for pain, it is vital to understand the root-cause of pain. Physiatrists dedicate their entire training learning to diagnose the cause of pain, and the many minimally invasive and nonsurgical treatment options available. Under a physiatrist’s care, the goal of treatment is for life-long relief of pain through a comprehensive and minimally-invasive treatment plan.
Pain clinics are usually staffed by doctors who are not trained to diagnose the cause of pain. The focus of these doctors treatments are injections and medications and often they will make surgical referrals without consideration of the full range of non-surgical treatment options. They are not trained to diagnose the cause of pain, or in all of the other treatment options available. The treatment options at pain clinics usually only help pain temporarily, resulting in frequent visits for more medication or injections. They will often treat patients for many years with repeated injections and narcotic medications. The results of treatment in these clinics for the important things in life, getting back to family activities, socializing with friends, return to recreation, exercise and work activities (i.e. return to function) is poor.
Question: Do Physiatrists offer specialized treatments to reduce pain or improve mobility?
Answer: Yes, there are many specialized treatments, which include medication, therapy, local injection, fluoroscopic or ultrasound-guided injection, osteopathic manipulation, acupuncture, yoga, education, and more.
Physiatrists perform joint, bursa and trigger point injections. These procedures in expert hands can be performed easily in the office and often will quickly and completely resolve problems such as acute bursitis, tennis elbow, carpal tunnel syndrome and many others. Many of these injections are now performed in our practice using ultrasound guidance, which allows us to directly visualize the structures being injected. This results in less painful injections and assuring the medication reaches the precise area where it is needed.
Special injection procedures are performed under fluoroscopic guidance to assure proper placement of the medication. Special training is required. These injections include epidural, sacroiliac and facet injection procedures.
BOTOX® injections are another procedure performed by physiatrists, not for cosmetic reasons but for patients who have had strokes, traumatic brain injuries, cerebral palsy or spinal cord injuries. These specialized injections help control spasticity, allowing the patients to function better or their caregivers to manage their care more effectively.
Manipulation, particularly spinal, is performed by a number of our physiatrists. Many are osteopathically trained and have had extensive teaching in osteopathic manipulation techniques. These techniques, when combined with injection and therapy, can be very beneficial in relieving some patients’ spinal pain problems.
Question: What specifically do you treat?
Answer: Our treatments include injections, medication management, osteopathic manipulation, acupuncture, physical therapy program management, and patient education in the following areas that include, but are not limited to:
-Stroke and Brain Injury
-Neck and Back Pain
-Pain in joints and limbs
-Auto, Personal and Work Injuries
-Acute and Chronic Pain
-Failed Back Syndrome
-Numbness, Tingling & Weakness
Question: I was told I have a disc abnormality on my MRI. Do I have to have surgery?
Answer: No. It is rare to need surgery for disc abnormalities. There are many non-surgical options available. The first step is to determine if the MRI abnormalities are related to your pain. Many people are surprised to learn a large number of disc anomalies on MRIs are meaningless. In fact, in individuals 60 years of age and older, more than 90% will have some disc abnormality on their MRI and many won’t even have symptoms.
There are many non- or minimally invasive treatments have been shown to be very effective, if not more, than surgery, which can cause infection and serious complications.
Question: How do rehabilitation physicians diagnose?
Answer: Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They will take a complete medical history, conduct a thorough physical exam, review current and/or request additional imaging studies. They will also use special techniques in electrodiagnostic medicine like electromyography (EMG) and nerve conduction studies. These techniques help the rehabilitation physician to diagnose conditions that cause loss of function, pain, weakness, and numbness.