When you get injured, your first thought may be to make an appointment directly with an orthopedic surgeon, chiropractor or sports medicine physician. However, a physiatrist helps a wide range of patients, including those suffering from injury, disease or musculoskeletal pain.

Physiatrists prefer to take a non-surgical approach to rehabilitation and are dedicated to problems of the musculoskeletal system. Consulting with a physiatrist before seeking surgical treatment can be a valuable decision. Physiatrists offer big-picture insight to help patients understand their full spectrum of treatment options.

The Big Picture

Physiatrists study the big picture and, because their training is broad, it allows them to look at the total body rather than just one organ. By considering other areas of the body, physiatrists can be helpful for pinpointing difficult-to-diagnose pain by examining the relationships of all the moving parts of the body. A physiatrist’s goal is to restore functionality in patients living with injuries, diseases and disorders.

Physiatrists often act in concert with a patient’s other physicians, such as primary care doctors and neurologists — or even spearhead a team of medical professionals to optimize a patient’s treatment.

By having a physiatrist assume a central role in your recovery, they will create your step-by-step plan for rehabilitation, orchestrating the entire therapeutic team. Physiatrists enlist the support of many experts, including physical therapists, occupational therapists, psychologists, care managers, and other needed physicians and professionals.

Physiatrists can use non-surgical procedures to treat injury and illness, and manage pain. This can involve a range of therapies, including prescribing adjuvant and analgesic medications to help with function recovery, strength and flexibility exercises; aids such as braces and wheelchairs are often employed. For those needing surgical procedures, consulting a physiatrist before and after surgery can be can be very helpful in speeding up recovery and maintain functionality. (See last week’s blog.)

Because a physiatrist focuses on functional wellness, they tailor your treatment to your needs. If you simply want to climb the stairs or be able to play on the floor with your children, your treatment program may be different than an injured Olympic athlete hoping to compete professionally again. Whatever your needs, a physiatrist can help get you there.

What Procedures do Physiatrists Perform?

• Electromyography (EMG): Inserting fine needle electrodes into muscles to measure the performance of muscles and nerves. This helps physiatrists discern if weakness is due to dysfunction of the muscles or nerves.
• Nerve conduction studies (NCS): Using electrodes to establish the location of a nervous system injury.
• Peripheral joint injections: Injecting bone and soft tissues to help diagnose and treat disorders.
• Trigger point injections: Using lidocaine or dry needling on trigger points to ease soft tissue pain.
• Musculoskeletal ultrasound: Using internal imagery through an ultrasound to evaluate soft tissue abnormalities, and to guide injections.
• Spasticity management: Using oral antispasticity agents to treat spasticity after CNS injury (stroke, cerebral palsy, etc.), and to help relieve pain.

Physiatrists may also provide treatments such as image-guided spinal diagnostics and injections, epidural injections, radiofrequency ablation; and other procedures like acupuncture and stem cell treatments.

If you or someone you know is suffering from musculoskeletal pain, injury, or disease, talk to your physician about being referred to a Michigan Spine and Pain physiatrist. We strive to be a model physiatrist practice through continual education and dedication to providing quality care.

Study Shows Net Benefits Physiatrist Consultation on Surgery Rates for Back Pain

Results of a 2013 study published in the medical journal Spine demonstrated a dramatic correlation between patients referred to a physiatrist and a significant decrease in spinal surgery.

The study, developed to determine whether an insurer rule requiring physiatrist consultation before non-urgent surgical consultation would affect surgery referrals and surgery rates, was dramatic, according to the study’s authors, Dr. John Fox; Dr. Andrew J. Haig; Brian Todey; and Sastish Challa.

While spine surgery rates vary, efforts to curb excessive reliance on surgery versus alternate treatments have been spotty, according to the authors. As nonsurgical spine experts, the study posits that physiatrists often are effective in providing patients with a different perspective on treatment options.

The study, conducted in 2007, included the requirement by insurers that patients with non-urgent spine surgical consultations in a specific geographic region first had to consult with a physiatrist (who received extra compensation for the assessment).

Both surgical consultations and surgical rates results were then compared between 2006–07 and 2008–10. A survey of patients evaluated by physiatrists was subsequently performed to assess patient satisfaction and the results were telling.

The study concluded that physiatry referrals increased 70 percent while surgical referrals decreased 48 percent, and the total number of spine operations dropped 25 percent, with an incidental decrease in overall costs as an added benefit to both patient and insurer. (Although spinal fusion rates dropped, the percentage of fusion operations increased from 55 percent to 63 percent of all surgical procedures.)

Of 740 patients surveyed (a 48 percent response rate), 74 percent were “satisfied” or “very satisfied” with the physiatry consultation. However, only 40 percent of patients who underwent previous spine surgery were satisfied. Although surgical rates decreased at all regional hospitals and throughout all surgical groups, there were substantial shifts in market share.

The study concluded that a physiatrist consultation prior to surgical consultation resulted in decreased surgical rates and continued patient satisfaction across large segments of the public.

To read more about this study, click here.

For more information on how a physiatrist can benefit your diagnosis and treatment options, contact the professionals at Michigan Spine and Pain at online or call (800) 586-7992 to schedule a consultation.

Is there anyone in the world who has never had a headache? In some cases, we can solve this pesky problem by ourselves, yet sometimes we should see a doctor immediately.

With this in mind, the experts at Michigan Spine and Pain have put together a quick reference guide to help you identify the type of headache you have and the best strategy for pain relief.

TENSION HEADACHE

This is the most frequent type of headache in the world: everyone has experienced it at least once in their life.

Symptoms: Usually, this is a mild non-throbbing pain. Tension headaches often cause a pressure sensation that feels like you’re wearing a tight band around your forehead. Most often, the intensity of the pain increases from morning to evening.

CAUSES: Factors that seem to contribute to tension headaches are severe stress, fatigue, poor posture, and holding the head in an improper position for a long time. Chronic tension headaches are rare and are often associated with head or neck injuries.

TREATMENT: There are many over the counter medications that effectively mitigate a tension headache. However, this should only be used occasionally. If headaches occur frequently and last for a long time, consult your doctor. Also, try to be physically active, stretch your shoulders and neck regularly, and spend more time outdoors.

SINUS HEADACHE

This type of headache is caused by sinusitis. It is often accompanied by fever, facial swelling, and tension in the forehead and cheekbones.

SYMPTOMS: Typically, you’ll feel a deep pressure, and pain in your forehead in the area of the eyebrows and under the eyes. The pain usually gets stronger when you move your head sharply. You may also have a running or blocked nose and feel tired.

CAUSES: Sinus headaches are caused by sinusitis. They are also a common complication after having a cold or are the result of a seasonal allergy.

TREATMENT: Sinus headaches rarely go away on their own. If you have an allergy, antihistamines may help. In other cases it’s best to see a doctor who will most probably prescribe antibiotics, if you have a sinus infection.

MIGRAINE

All symptoms of this severe headache occur during a migraine attack that progresses through four main stages. Different people report various symptoms of these headaches.  Not all migraines are experienced identically.

CAUSES: A migraine is often associated with a violation of the metabolic processes and dilation of blood vessels in the brain. A person also may inherit a genetic predisposition for developing migraines.

TREATMENT: There’s currently no cure for migraines, although a number of treatments are available to help ease the symptoms. You need to see your doctor to choose the right medication. Moreover, regular exercise will help you improve your health significantly.

CLUSTER HEADACHE

Cluster headaches are rare, affecting less than 1 percent of the population. They are five times more common in males than females.

SYMPTOMS: A cluster headache may cause a stabbing pain behind or around your eyes, usually on one side of your head. It frequently develops during sleep. Symptoms may also include redness of the eyes, sensitivity to light and eye tearing. The pain usually lasts from 15 minutes to 1 hour.

CAUSES: Scientists don’t know exactly what causes cluster headaches. They are most often linked to disruptions in the body’s biological clock.

TREATMENT: Treating a cluster headache can be tricky because the pain appears and disappears spontaneously and at a moment’s notice. Only a doctor can help you solve this problem.

HANGOVER

CAUSES: We hear many different versions about why people often have a headache after drinking alcohol. One of them suggests that alcohol causes blood vessel dilation and affects serotonin levels in the body. Moreover, alcohol promotes water loss and dehydration — major migraine triggers.

TREATMENT: The best remedy is to take an over the counter headache medication, drink plenty of water and get some good sleep. You should take a hangover seriously. If you have a headache after consuming even a small amount of alcohol it may indicate that you’re suffering from a mild form of migraine.

A new study will seek to determine whether access to acupuncture as a pain management tool for chronic pain could help prevent patients from becoming addicted to opioids.

The state of Vermont is seeking to answer that question by funding a study to see if making acupuncture accessibly to Medicaid patients could be useful in treating chronic pain, as a way to avoid or reduce reliance on opioid medicines and is both feasible — and useful.

Since acupuncture is increasingly considered a viable option for pain relief, Vermont legislators have made clear that they want to explore how it could impact the lives of others — particularly those living below the poverty line.

Robert Davis, a neuroscience professor at the University of Vermont Larner School of Medicine, is running the study. During the three-month study, different acupuncturists in three different Vermont cities will offer free sessions to qualifying Medicaid patients with chronic pain.

Davis acknowledged in an interview with Vermont’s National Public Radio that people who often seek out acupuncture are those who can afford it, but he says it often doesn’t mesh with the larger trend toward including non-pharmaceutical options for treating pain and other illnesses.

“For example, the Joint Commission, which is a nonprofit organization that credentials hospitals and health organizations, they made it clear that you can’t just rely on pharmacologic treatments for pain,” Davis said in the radio interview. “You should also consider non-pharmacologic treatments, and they specifically mentioned things like acupuncture, massage, mindfulness.”

While not without controversy, there is growing evidence that acupuncture can be effective for some types of pain relief. In 2010, 93 percent of deaths from opioids in Vermont involved overdosing on prescription medicine, according to the state’s Department of Health. That percent has since decreased as use of heroine has risen. But misuse of prescription opioids continues to be a problem. Addiction issues stemming from prescription medicines are still a significant part of the opioid epidemic.

The Legislature-funded study is looking to see if acupuncture could provide an alternative, or a complement, to prescription opioids. It isn’t evaluating the science of acupuncture; there won’t be any comparing its effectiveness to a placebo — and there’s already evidence it can provide pain relief.

Instead, the research project is set up to see just how feasible it would be for Medicaid patients to use acupuncture. And what impact it might make on their lives.

“One of the things that we’ll learn from this study is: Will these people utilize acupuncture if offered?” Davis asked in the interview.

The study will also measure if people’s pain was reduced, and will look at a whole range of health measures, from the ability to do daily activities to the patient’s psychological status to whether his or her use of painkillers decreases.

The study is even measuring how acupuncture might impact the patient’s use of other health services.

“In other words, we’re interested to see: Did it affect the amount of times that people went to the emergency room? Did it affect how often they went to doctor, or filled prescriptions, or things like that?” Davis asked.

If early indications hold any weight, there’s certainly interest in acupuncture among people suffering chronic pain. The trial just began soliciting volunteers a few weeks ago, and already 75 people have been processed and enrolled, according to Vermont NPR.

The study will continue through April 2017 and the results will be submitted to the Vermont legislature later this spring.