For pain that won't end...you need care that won't quit

PLEASE NOTE:

The following information is provided for general patient education purposes only.  This should not be substituted for the professional evaluation and treatment of a licensed physician.  Action PM&R assumes no liability for the information contained on this page.  If you have any questions or concerns about the information provided, we encourage you to contact our office.  

Patient Education Articles

Physiatrist (Physical Medicine & Rehabilitation Physician)

Education:
4 years of College, 4 years of Medical School, 4 or 5 years of Residency Training

Course Work:
Generally a basic science degree is recommended. This will include either a Biology Major, or Minor. The Medical School experience will include Biochemistry, Anatomy, Physiology, Neuroanatomy, Pharmacology, Psychology, Nutritional Studies, as well as clinical rotations for medicine, pain management, orthopedics, rheumatology, as well as caring for patients with brain injuries, strokes amputations, spinal cord injuries, arthritis, speech and language disorders, post surgical conditions, cancers, and cardiopulmonary diseases. There is also specialized training in the use of different electrical and physical devices to treat pain, dysfunction, and disability.

What we do:
The physiatrist can function as a primary care physician for those people with chronic disabilities, or as a specialist for those people with bone or muscle injuries, sports injuries, people who were injured in car accidents, or at work, and are also experts in exercise prescription for recovery from surgical conditions.
We also help people who have had severe traumatic injuries and lead the rehabilitation team composed of physical, occupational, and speech therapists, nurses, dieticians, recreational therapists, psychologists and pharmacologists.
We work in hospitals, in our own offices, in nursing homes, and at sporting events. Some Physiatrists perform injections using specialized x-ray devices called fluoroscopes. These physicians perform injections in and around the spine, into small joints, and near nerves. These procedures are useful to treat chronic pain and to help with muscle spasms. These procedures can allow the patient to improve their activity and decrease pain enough to prevent other spine surgeries. We also treat patients who have joint pains, and do not want surgery. Oftentimes the patient can continue and even improve their activity and reduce their pain with a carefully prescribed program including medication, exercises, physical modalities, and limited injections. Some physiatrists work as team physicians for professional teams like the Seattle Seahawks, the Arizona Cardinals, and the Indiana Pacers. Basketball players like Reggie Miller, and Scottie Pippin have treated with Physiatrists. You can think of us as non-operative orthopedic medicine doctors.

Many Physiatrists work with the elderly. We see patients after knee and hip replacement surgeries, to improve their balance, to increase their activity after a prolonged illness, and sometimes to assist with care of their wounds. We even work with those people who have foot pains and prescribe orthotics (devices that assist and provide proper alignment of the foot) to allow better walking and prevent foot and leg pains.

Remember the Physiatrist when you need help walking, talking, performing your self-care activities, when you want to do better in sports, and if you are in pain. We may have a difficult name to remember, but if you have any of the above problems and you don’t want to have surgery you should remember to see a Physiatrist.

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Fibromyalgia & Chronic Fatigue Syndrome

Fibromyalgia, chronic fatigue syndrome, sleep deprivation, mental haziness, and mood swings; these conditions may be a direct result of imbalanced and improperly functioning immune and/or neurological systems. These symptoms have been proven to be much more prevalent in our society than originally believed. The impact on those suffering from a vast array of symptoms can be quite devastating. It may render a previously healthy, pain free and fully functioning individual to become totally incapacitated and to suffer severe unrelenting pain and disease. 


The actual symptoms may include severe headaches/migraines, chronic muscle and joint pains, chronic fatigue, sleep disorders, mental fogginess, mood swings and irritability. Other symptoms such as depression, digestive disturbances, urinary symptoms, skin disorders, immunological compromise, chronic infections, neurological disorders, and allergic reactions are also possible.


Unfortunately many individuals who suffer from these symptoms have had extensive medical workups that show no definitive conditions. These individuals are then told by many medical professionals that they have no disorder and all of their symptoms are in their head. 


Why can't our sophisticated technology determine the cause for the individual's symptoms? Most of the time the tests performed are not the correct ones necessary or the results are in the low or high normal ranges. The ordering physician is then very hesitant to give a specific diagnosis without a clearly positive test result. Many health practitioners are guided by the specific medical conditions that are relevant to their sub-specialty. Frequently, this narrow interpretation misses the true cause of the individual's disease.


What may be the root factors contributing to an individual's chronic and debilitating symptoms? The physicians at Action PM & R have observed through comprehensive medical and complimentary health care research and from our own experience, that these progressively incapacitating symptoms (conditions) may be caused by one or more of a multitude of factors. They may include an individual's genetics, injury, infectious microbes, environmental toxins, improper nutrition, food allergies, sedentary lifestyle, mental and emotional stressors and even medications. 
What treatments have been found to be helpful for these conditions? The most appropriate approach is an encompassing, holistic evaluation of the individual's physical, psychological, emotional, and social status. This is done through a comprehensive examination and specific diagnostic tools that will best determine the true factors influencing the individual's health. Then, the ideal treatment regimen is individualized to the patient. This regimen may include physical therapeutics, nutritional, and lifestyle modifications, stress relief, management and imagery techniques. The goal of the treatment regimen is to attempt not to just manage the disease but to maximize the individual's complete health potential. For more information about Action's treatment programs for these conditions or to make an appointment to be evaluated by one of our physicians, call our office at 815-725-4918. Action PM & R strives to provide each patient with a comfortable, caring environment, superb service, and excellent and effective care.

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Research Articles:

Pharmacologic treatment of fibromyalgia.

Barkhuizen A.

Department of Medicine (L329A), Oregon Health Sciences University and Portland VA Medical Center, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.

Fibromyalgia is a chronic syndrome characterized by widespread pain, unrefreshed sleep, disturbed mood, and fatigue. Until such time as we have a clearer understanding of the trigger and/or pathophysiologic mechanisms producing these symptoms, pharmacologic treatment should be aimed at individual symptoms. Such treatment should ideally be offered as part of a multidisciplinary treatment program using both pharmacologic and nonpharmacologic treatment modalities. Critical components of any successful fibromyalgia treatment program include addressing physical fitness, work and other functional activities, and mental health, in addition to symptom-specific therapies. The main symptoms that should be addressed include pain, sleep disturbances including restless leg syndrome, mood disturbances, and fatigue. Pharmacologic therapy should also be considered for syndromes commonly associated with fibromyalgia including irritable bowel syndrome, interstitial cystitis, migraine headaches, temporomandibular joint dysfunction, dysequilibrium including neurally mediated hypotension, sicca syndrome, and growth hormone deficiency. This article provides general guidelines in initiating a successful pharmacologic treatment program for fibromyalgia.

PMID: 11403739 [PubMed - in process] 

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Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins.

Smith JD, Terpening CM, Schmidt SO, Gums JG.

Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA.

BACKGROUND: Fibromyalgia is a common rheumatologic disorder that is often difficult to treat effectively. CASE SUMMARY: Four patients diagnosed with fibromyalgia syndrome for two to 17 years are described. All had undergone multiple treatment modalities with limited success. All had complete, or nearly complete, resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. All patients were women with multiple comorbidities prior to elimination of MSG. All have had recurrence of symptoms whenever MSG is ingested. DISCUSSION: Excitotoxins are molecules, such as MSG and aspartate, that act as excitatory neurotransmitters, and can lead to neurotoxicity when used in excess. We propose that these four patients may represent a subset of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or, alternatively, may comprise an excitotoxin syndrome that is similar to fibromyalgia. We suggest that identification of similar patients and research with larger numbers of patients must be performed before definitive conclusions can be made. CONCLUSIONS: The elimination of MSG and other excitotoxins from the diets of patients with fibromyalgia offers a benign treatment option that has the potential for dramatic results in a subset of patients.

PMID: 11408989 [PubMed - in process]

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Efficacy of knee tape in the management of osteoarthritis of the knee: randomized controlled trial - Article Summary

Bennell, K., Crossley, K., Hinman, R., McConnell, J.  

Osteoarthritis is a type of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae. Risk factors include aging, obesity, overuse, or abuse of joints as in sports or strenuous occupations and trauma. One place osteoarthritis is commonly found is in the knee joint. Many people worldwide suffer from osteoarthritis of the knee joint. Osteoarthritis causes pain and disability and accounts for a large proportion of visits to health professionals each year.
One treatment for osteoarthritis of the knee that has been proven effective is therapeutic taping of the knee. A recent research study examined the efficacy of knee taping in the management of osteoarthritis of the knee. The study was comprised of 87 participants that were over the age of 50, had a presence of osteophytes in the knee, and had knee pain. Participants who had an allergy to tape, a history of joint replacement,a previous history of knee surgery, rheumatoid arthritis or steroid injections were excluded from the study. All participants did not significantly differ in personal characteristics such as age, sex, and body mass index. In this study, the tape was worn for three weeks and reapplied weekly. Participants were assessed before treatment, after the three week treatment, and at a follow-up visit at six weeks. There were three groups divided into 29 participants. One group had therapeutic taping, one had non-therapeutic taping, and one had no taping. 
After intervention, the group who had therapeutic taping showed a significantly greater reduction in pain than the control and no tape group. Twenty-one out of the 29 participants with therapeutic taping reported pain scores of 4 or 5.This was using a perceived rating of change in pain scale from 1(being much worse) to 5 (being much better). The finding in this study showed that therapeutic knee tape reapplied weekly and worn continuously for three weeks significantly improved pain and disability I patients with osteoarthritis of the knee. Furthermore, benefits may be maintained three weeks after stopping treatment. This study provides the first evidence of the prolonged effects of knee taping in the short-term once treatment has stopped.
Taping may cause subtle changes in patellar position that may alter the magnitude or distribution of patellofemoral joint pressures or stress on joint structures. In addition, unloading the fat pad may reduce strain on this often inflamed tissue. Changes in proprioceptive acuity, quadriceps strength and neuromotor control of the knee with taping have been described as well in other populations.

*Therapeutic knee taping is one of several treatments Action PM&R utilizes in the management of knee pain due to osteoarthritis or other causes of knee pain.

British Medical Journal 2003; 327:135-138.

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