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    Old 05-26-2004, 04:25 PM   #1
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    Physiatrists ?

    I was wondering if anyone has had any experiences with Physiatrists & pain
    management.I just recently had an MRI done that showed a " moderate,
    diffuse disk protrusion at C5,6 " I have been having severe pain at the base
    of my neck in back and across my shoulder left hand,fingers
    sometimes are numb/tingly and I have started losing dexterity and strength
    in this hand as I sometimes just drop things with my left hand. My PCP has me
    on Neurontin,Flexeril,Bextra & Vicodin and has referred me to a Physiatrist
    for an EMG test and pain management. Does anyone have experience with
    this type of doctor?? What exactly do they do ??


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    Old 05-27-2004, 09:24 AM   #2
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    Re: Physiatrists ?

    Hi Chris,

    I am in the same situation as you, my pain mgmt doctor is a phsyiatrist. He does injections, he really does not like to perscribe opiates but does for me 2 vicodin every 6 hours as needed. My pcp perscribes the rest of my meds, soma, neurontrin, motirn.
    My phsyiatriast's card says pain management/minimally invasive treatment of the spine. The injections that he did caused me increased pain and then had no effect.

    He now wants me to have surgery because he is not sure that he can help me any further and does not want me on "narcotic's" becasue I am too young...

    basically, I am getting passed to another doctor because he feels he cant help me..

    So, PM doctors are many different things, some are anasteologists some are phsyiatrists, some taek a class and then call themselfs pm doc's.

    Not all (like mine) perscribe meds...

    Hope this helps...


    Old 05-28-2004, 09:06 AM   #3
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    Re: Physiatrists ?

    I had the same thing with this type of doctor. He prescribed Lortab and then when I told him I was afraid of addiction he cancilled the Lortab and wanted to inject me. I said NO WAY! My husbands coworker was a great runner and was injured and recieved an injection and became paralyzed!!! There was no way I would get an injection so I am going to a new doctor as soon as I get my referall. Most of these doctors will prescribe to you some medication but if they see no releif and increased need for medication they will discontinue and suggest injections or surgury! I am 28 I dont want this - if the pill works why go under the knife or needle and expecially if the knife or needle don't work or may worsen your pain!!!

    Last edited by cya; 05-28-2004 at 09:06 AM.

    Old 05-28-2004, 09:41 AM   #4
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    Re: Physiatrists ?

    Hey Guys, A physiatrist is a doctor of Physical mnedicine, they usually specialze in rahbiltation and recovery although many also practice PM.

    When it comes to needles, Trigger point injections are pretty bengn, But if you get near the spine you definetly want someone that's been there a thousand times alread, an Anesthesiologist.

    I've seen folks lump physiatrist all together and say they don't treat pain with opiates but they are not all like that. The first doc that was the director of the PM clinic I went to that prescribed a LA med a a Physiatrist. She didn't prescribe opaiates to patients that were n the process of recovering, I guess because they expected a full recovery and there wasn't the need to prescribe LA meds and makesomeone dependent that could get better on their own or with whatever modality that physiatrst thinks is more effective.

    I've also read that neurologist make terible PM docs. Perhaps because they treat Migraines and they are so hard to treat they have develop this reputation. But my chief doc is a nuro soI won't lump all Neuro tohgether. What you want is a group of docs tha all have somethng different in their bag of pain relievng modalities but have the same ission and position about the use of meds. A doc that only has one modality like TP injections and a script pad can't possibly treat every painful condition. Not everyone willbenefit from a trigger point injection or an ESI or BOtox or acupuncture.

    You want a group of docs that offer a full range of modalities that no conditon needs tobe turned away.

    There are docs out there that will only treat spineys with opiates but not fibro, Or that specialize in Migraines but don't mess with other conditions. I'm not saying one condition is any worse than the other, It's matchng your problem up to the right practice that has something to offer people with your same condition.

    I wouldn't want to be the only migraine patient at a PM docs office who specializes in back pain. What can he do other than right a script? But if you have a group of docs, yo know you can always reach one of them, they usually put together a team of docs to cover the bases. Like Neurology, Pshychiatry, Osteopaths, Physiatrists, Anesthesiologists and have on sight Psychologists to help deal with the emotional aspects of CP.

    But a physiatrist that orders a MRI or CT really doesn't have the training to read one, then can't do anything otherthan refer you to a surgeon if they see something catastrophic, even then if they make a recomendation like Micro disscectomy, The surgeon will make his own DX by looking at the films and then decide which is the best procedure if you need surgery.

    A physiatrist can't make anyone perform a surgery the surgeon doesn't see fit. So I don't really understand physiatrist doing some of the test they do which arer clearly pre surgical mapping tests. If the EMG comes back all screwed up, can she make a surgeon operate or suggest a procedure. NO. If it comes back screwy, she can either work on it with what she/he has in their bag of tools or refer you to a surgeon that will make his own DX and treatment plan based on his interpretation of the films. All the surgerries I have had, I don't think I have ever seen a surgeon read a radologist report. They want to make their own decions and don't want someone elses conclusion influencing what they see.A radiologist knows anatomy, but he doesn't know what a disc bulge looks like to the naked eye once you cut someone open and how that flm actually shows the bulhe. But after years of experience they can pretty much tell what's going on under the skin by examining films or Diagnostcs themselves.

    Obviously I'm not big on PM docs doing diagnostcs. Personally it would seem like, by the time yo get to PM you should have an idea of wehat your DX is and shold have had several diagnostics tests done to fnd out why you need PM. The GP can order the test, a surgeon can interpret them and if there isn't a clear surgical solution the surgeon should refer you to PM, Or contact the GP and have the GP do it if you have an HMO and every referral comes from the GP. It's really not the GP's job to figure out why you hurt unles no other doc can figure it out. Diagnosing the condition isn't part of the PM job, He handles the symptoms of the diagnosis.

    If you show up at PM with a non descript DX of say back pain but you have never had a MRI, Why are you at the PM docs office, You may need a surgeon. It's the GP's job to send you in the right direction, not jus pass you off like a hot potato because the GP isn't comfortable prescribing pain meds.

    It's certainly OK to prescribe without a firm DX, But I would be leary to start a lifelong course of opiate management if you haven't even had the diagnostics done to see what's wrong and what the best aproach to fixing or dealing with it is. I guess because Physiatrist do deal with physical medicine and rehab they could certainly come up with a treatment plan and be able to tell what needs to be treated.

    The whole HMO thing has our healthcare system so screwed up, GP's are discouraged from doing the expensive diagniostics, If you get referrred to a surgeon and say no matter what you find I'm not having back surgery, Then he isn't going to feel to obliged to try to pinpoint the problem with an MRI or any other test . No point in buying the map if your not taking a trip.

    Personally I want to know whats wrong before I start masking the symptoms, but that's just me. Some folks will never find out the why question and all they have is treating the symptoms. They can't expalin why some folks get Neuralgia or Migraines or cluster headaches, there isn't a why answer for everyone but that doesn't mean you can't be treated.
    Just my opnion. Dave

    Old 05-28-2004, 10:51 AM   #5
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    Re: Physiatrists ?


    I agree w/ Shore (like always). I have a Dx and my psyiaistrist ( i always spell that wrong) is trying to help me, although since the ESI's did not work I feel that he has knid of given up on me. He keeps pressuing me to have surgery. I don't want to right now with all the other medical problems that I am facing. he has scheduled me for a EMI or nerve test in hope that I will decided to have surgery.

    I have not heard great out comes from people my age having a discectomy...

    Anyway, I have tried MANY ways to treat my pain and numbness with out meds, Acupuncter, TENS, PT, Injections. All with very minimual sucsess. Geesh....cant type or spell today....

    What do you think shore? I am being closed minded about having surgery?

    your experience was not good..

    DDD, DJD, Nerve inpinchment from bone spurs,disk buldges, forminal narrowing all at c 5/6 c6/7.

    Old 05-28-2004, 04:36 PM   #6
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    Re: Physiatrists ?

    Hey Heady, I hope you don't agree with my spelling, I swear I'm getting a new keyboard, too much greasy kid stuff on it.LOL

    Old 05-28-2004, 05:09 PM   #7
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    Re: Physiatrists ?

    My surgeon is setting me up with a Neuropsychiatrist. He says this type of doc can take care of my pain meds and any antidepressants I may need. My last PM was an Anesthesologist (sp?). He mainly just liked injections. Facet and Nerve blocks. Once my insurance denied the IDET procedure, he didn't have anything left to offer me. Finding the right PM can be a pain. Pun intended. My surgeon told me this new PM he is sending me to is one that uses meds and develops a life long plan. He said he sends all of his back surgery patients to him if they need long term pain management.

    I hope we all find a PM we like and that can help us because we are all in the same boat here. I think my little skiff has a hole in it. Oh well, thats life.

    God Bless,
    Spinal Fusion with cages, Cluster Headaches, Depression, Arthritis, Adhesions, Alt. Digestive Tract

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