This chapter will introduce a different group of clinicians who treat pain with a primary focus of improvement in functional mobility of the patients. One of these disciplines is physical medicine and rehabilitation, also called physiatry. Like any other clinician, a physiatrist follows the established algorithms for the diagnosis and treatment of a variety of medical conditions. The same is true for the evaluation and treatment of pain patients. A physiatrist evaluates the pain patient, orders appropriate diagnostic studies, and then treats the patient with appropriate therapeutic modalities including the medication and interventional procedures. One factor that differentiates the physiatrists from other clinicians is their focus of treating the patient as a whole, looking not only at the area of disability but also the patients' functional capability and the tasks that they are able to accomplish. The ideal model for the treatment of pain is a multidisciplinary approach, meaning that a variety of clinicians from different disciplines address the treatment of complicated pain syndromes. This does not necessarily mean that each individual pain patient will require an elaborate program to receive appropriate care. In fact, many of these patients could and should be able to get adequate treatment at a primary care level. However, when required, a multidisciplinary setting will enable the clinicians to treat pain effectively. This will eventually result in an overall reduction of the number of chronic pain patients in the community. The training curriculum for the physiatrist includes the musculoskeletal system as well as the peripheral nervous system. Combining the findings from a thorough physical examination and appropriate diagnostic studies enables the physiatrist to make the diagnosis and then develop an effective treatment plan. Even though the treatments offered to patients with pain generally follow the similar algorithm, as mentioned earlier the main focus here will be the functional restoration for the patients.
Another group of clinicians who are closely involved in the treatment of patients with pain are physical therapists who are uniquely qualified to provide functional restoration through evaluation, treatment, and disease prevention strategies. Physical therapy intervention by a licensed physical therapist has been shown to be a very effective short- and long-term method of managing pain.
While it is difficult to give a complete listing of the qualifications of physical therapists, it is important to recognize that like many other health-care professionals, not all physical therapists are trained the same or will treat each problem in the same manner. A clinician
N. Vadivelu et al. (eds.), Essentials of Pain Management,
DOI 10.1007/978-0-387-87579-8_14, © Springer Science+Business Media, LLC 2011
ought to develop referral relationships with a variety of physical therapists that specialize in treating a wide range of diagnoses and personalities. Physical therapists are educated at the post-baccalaureate level and must pass a state and national licensing examination. Many physical therapists are Doctors of Physical Therapy (DPT) and many have completed specialized residency training. Board certification is available in orthopedics, neurology, pediatrics, geriatrics, sports, cardiopulmonary, and clinical electrophysiology. Physical therapists are licensed by their respective State Board of Physical Therapy. It should be emphasized that treatment by non-licensed persons should not be considered of high quality and should not be billed as physical therapy. Finally, before it is decided whether a patient has failed physical therapy intervention and requires other treatments, it is important to make a thorough assessment of the type and quality of the treatment the patient has received.
In this chapter, we will discuss the evaluation of a patient with musculoskeletal pain, appropriate diagnostic tools, and then available treatment options including physical therapy. It should be emphasized, however, that this is only an introduction to the field of physiatry and physical therapy, and the interested reader is encouraged to refer to other resources for detailed information.
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