Korean Memorial, Washington DC

The practice of physiatry is approximately 50 years old.  So how is it many pain and immobility challenged patients have never heard of this medical specialty?

    Good question, I guess it’s possible this specialty could be considered the gold standard of rehabilitative medical treatment.  And available to pain and immobility suffers once other medical treatment has been exhausted.

    If you don’t already know about the discipline of physiatry, I will now fill you in on what this specialization can offer a chronic pain and immobility challenged patient that requires rehabilitative services.

   A physiatrist is a medical doctor that deals with muscular-skeletal, neurological, acute and chronic pain and rehabilitative therapy.  They are also referred to as a doctor of osteopathy who specializes in Physical Medicine and Rehabilitation (PM&R); using noninvasive diagnosis, treatment and management of disease through “physical” means (Physical therapy and medications).

    They can perform all types of specialized tests that range from nerve and spine imaging to determine severity of nerve damage (e.g. electromyography, nerve conduction) to evaluate various nerve disease/disorders, etc.  They also specialize and work with patients that have a history in degenerative back and neck disease problems.  To include, but not limited to:  Rehabilitative treatment with sports and work injuries; and those diagnosed with arthritis, tendonitis, osteoarthritis, rheumatoid arthritis, myofascial pain and spinal cord injuries.

    There are approximately 6000 physiatrists to date that specialize and focus on bad backs and the relationship to other parts of the body that also become affected.  For many patients that suffer from back pain and distal radiating pain to other body parts a direct connection to the pain origin can be substantiated and treated.  Radiating or distal pain from the origin pain source can take years to diagnose correctly and can be very challenging for many physicians.  In other words, so challenging primary physicians may take a subjective “shot in the dark” in referring a patient to a medical specialist that may, or may not be of immediate help.

    Sometimes these “shot in the dark” referrals may not pan out.  For me this was the case.  And I suspect there are many of you like me that had the same experience of visiting a lot of specialists and the end result was temporary physical therapy sessions, shots and more pills.  And only until a significant amount of time passed while working through a medical “status quo” policy driven health maintenance organization, did I finally get the treatment I needed.  And this occurred after I learned how to properly advocate and self refer to specialists that could treat me relative to my unique pain issues.

    It is my personal experience many of my medical referrals throughout the years to determine my pain origins were a waste of resources and time that lacked relative treatment.  I believe in my case, I should have been first referred to a physiatrist to determine the best rehabilitative course.  And it is also my belief that if this would have been the case, much of my pain and suffering would have been alleviated five years ago.  And to be honest, I’m not sure what the long-term impact will be on my health as a result of untimely and irrelevant treatment.

    Let’s now take a look at what the physiatrist’s educational requirements are so you can better understand their specialty background and how they as a “direct” referral source to other specialists may help you.

    Physiatrists go through 4 years of medical school and 4 years of residency training (1^st year – internal medicine/general practice; next 3 years emphasize specialty training; fellowships for additional specialization in sports medicine, brain injury (stroke), spinal cord, pain management and pediatric medicine.

    Their patient goal is also to treat the whole person’s physical, emotional, psychosocial and vocational goals.  This discipline also falls in line with Mirror Athlete’s principled fit-healthy concepts.  Mirror Athlete is about “ill-health prevention for the encompassing being (mind, body and “soul-spirit”) and is our principled fitness life philosophy.

    For many pain sufferers with chronic pain that have not responded to previous pain management and rehabilitative treatments, access to highly trained physiatrist resources can make a significant difference in increasing mobility and/or alleviating pain. 

    It is true; most of us have access to highly trained medical specialists through our referring physicians.  And it is also true a primary care physician will “usually” not refer you first to a physiatrist “for pain and mobility challenges. 

    You ask why this is.  My answer to you, I honestly don’t know.  The only thing I can think… Maybe it has to do with higher costs of services.  And maybe if you are stabilized and appear to be tolerating your disability, and/or don’t understand, or know you can self refer to see a physiatrist, the HMO policy advices primary physicians to follow a cost effective services protocol otherwise.

    However, I can share with you, if you can get a referral to a neurologist; you’re really in line to get a referral to see a physiatrist from that point if your pain is substantiated and will help with your disability rehabilitative objectives.

    It is surprising to me in the last 7 years; I’ve been referred to at least a half dozen neurologists, none of which led me to a physiatrist for my chronic back/leg pain until recent.  And what is most perplexing, my pain-medical story had not changed significantly through the years.  If I had known about physiatry resources 5 years ago, I would have known to self-refer from a neurologist to a physiatrist knowing what I now know.  Why not 7 years ago?  In my case, I understand now it took two years to determine and substantiate my pain origins.  And I now realize I could have self referred to a physiatrist after I had my second neurologist visit.

    My lesson learned and now passed onto you:  The medical policy and practice “status quo” when dealing with “substantiated” pain and/or immobility, coupled with depression will include pharmaceuticals and other treatment until (a) you reach a certain age.  (b) The pills are now creating other medical health issues.  (c) The risk of other complications is high if continuing the same pain and/or depression management course.  (d) Something substantiated and significant has changed, or has been found through CAT, MRI, x-Ray results and/or lab work and is complicating your pain, or mobility story.  (e) You self refer to see a neurologist from your physician, and then ask for a referral to see a physiatrist from your neurologist.   The later sequence is the best course toward rehabilitative pain alleviation of chronic pain, including range-of-motion and rehabilitative, limited mobility challenges [My experience].

    To treat a patient without considering the entire being is to allow a part of the component being to become ill.  When relative and timely treatment is not balanced, part of our “being” becomes depressed.  And it is also a fact as one will age; without relative and timely treatment, quality living experiences are negatively impacted.

    With the assistance of a physiatrist the patient has access to a team of specialists to assist in customizing a rehabilitative treatment program that incorporates healing for the encompassing being.

    The team of specialist the physiatrist may access to assist your ill-health conditions are: Speech-language pathologists, social workers, nurses, and psychologists, neurologic (brain injury, stroke, and spinal cord injury), physical therapy, occupational and recreation therapists etc.  Other disabling conditions include amputations, complicated multiple trauma and pain, including burns rehabilitative therapy.

    Physiatrists also work with a whole team of specialists to restore independence in mobility, eating, dressing, and hygiene. The physiatrist also provides long-term continuity of care for functional problems that often persist after stroke.  Note: This is not simply a physical therapy program.

     In my opinion, a physiatrist is an encompassing-being, rehabilitative care provider.  And if you have not seen a physiatrist and if you’ve been suffering from chronic pain and/or are mobility challenged, also you have reached the end of your referral solutions; be sure to ask your primary care physician, or neurologist to see a physiatrist.

     A physiatrist referral sooner than later will provide most chronic pain and immobility sufferers pain relief and better quality care and living activity experiences.

 Internet Reference

http://www.spine-health.com/glossary/p/physiatrist

http://www.physiatry.org/Field_Section.cfm

http://www.umassmemorial.org/medicalcenterIP.cfm?id=3081

Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2011 Copyright, All rights reserved, Mirror Athlete Publishing @: www.mirrorathlete.org,  Sign up for your Free eNewsletter.