April 2, 2020

Pain Management

What is a Physiatrist?
By Rita Boslet, MBA, FACMPE

Physical Medicine and Rehabilitation physicians or “Physiatrists” work to improve the wellbeing of patients experiencing a decrease in quality of life because of a pain limiting condition or disabling disorder, often with amazing results. Physiatrists are experts at diagnosis and treatment of pain, as well as the evaluation of function. They focus on nerve, muscle and bone and their interrelationships that determine function or pain responses. Physiatrists often treat patients with acute work or vehicular injuries, sports injuries, adults suffering from low back pain, headache, neurological disorders and arthritis. The goal is to enable patients to return to full function through non-surgical methods.

Often, interventional procedures, such as epidural injections, can provide long-lasting pain relief. Relief of pain allows the patient to resume some normal activity and begin strengthening exercises which will lead to improved recovery. Treatment always includes specific explanation as to potential causes of the symptoms and a discussion of ways to prevent future injury.

A physical medicine-based practice will not use narcotic pain medication as a front line measure. Often, a patient with chronic pain currently treated with narcotics will be referred. This patient may be denied evaluation, due to obvious narcotic addiction or dependence after chart review. Accurate assessment of a patient’s pain cannot be done while the patient is taking significant doses of narcotic pain medications and studies have shown that narcotic medications can worsen, rather than lessen pain in some cases. A Physical Medicine and Rehabilitation specialist is trained to diagnose and treat pain, not addiction. However, after a patient has been weaned from narcotics, the evaluation and treatment process may begin. When narcotics have been prescribed for a short term, the patient may be accepted for treatment. The patient must realize that the narcotics are temporary and the goal is the discontinuation of medication and the restoration of maximum function.

Pain management does not guarantee complete pain cessation, only progress toward a comfortable, active and optimal lifestyle. Hard work and persistence is required in combination with a team approach by patient, physician and therapist.

Specialized treatment modalities used by a Physiatrist can include: epidural blocks, selective nerve root blocks, prolo therapy and platelet rich plasma injections (PRP), radio frequency denervation, discography and intradiscal injection, spinal cord stimulator trials, diagnostic musculoskeletal ultrasounds, ultrasound guided injections, image guided intra-articular hip injections, electrodiagnostic testing, physical therapy, electrostatic therapy, therapeutic massage and more.

If a problem is in early stages, prompt treatment is essential to prevent the unintended slide into chronic pain. Appropriate diagnosis and treatment leads to correcting the harmful activity, breaking the pain cycle, and hopefully, restoration of normal function and a fulfilling lifestyle.

Rita Boslet, MBA, FACMPE is the Practice Administrator for APM Spine and Sports Physicians. APMSpineAndSports.com