Like many others, I had never heard of a physiatrist or the field of physical medicine and rehabilitation until I was introduced to the field by a friend in the physical therapy field. I’d like to take this opportunity to share a few things I have learned since then about the field of physical medicine and rehabilitation (PM&R).
The specialty of PM&R began in the 1930s to address musculoskeletal and neurological problems, but broadened its scope considerably after World War II. As thousands of veterans came back to the United States with serious disabilities, the task of helping to restore them to productive lives became a new direction for the field. The American Board of Medical Specialties granted PM&R its approval as a specialty of medicine in 1947.
What is a physiatrist? Doctors of PM&R are called physiatrists which can be pronounced 2 ways (fizzy-at-rist or fizz-eye-a-tryst), so if you’d heard it both ways, neither is wrong!
Physiatrists are commonly confused with physical therapists or psychiatrists. We are neither. We are rehabilitation physicians and are specialists in treating nerve, muscle and bone disorders that affect how you move or function. We are not surgeons but can provide non-operative treatments for a variety of complaints.
Another misconception about PM&R is that it is the same thing as pain management. However, physiatrists treat much more than pain. I focus on function because most people are concerned about pain because it limits their ability to perform a task (i.e. working, playing with their children, exercising, etc).
To that end, physiatrists not only treat pain, they investigate to determine and deal with the underlying cause of that pain. I like to think of it as “pain resolution” more than “pain management.”
For instance, when I meet a patient with lower back pain, I take a comprehensive history and physical examination and then try to ascertain whether the pain is related to a mechanical dysfunction, arthritis, an autoimmune disease, pinched nerve from a disc herniation, etc. I then tailor a treatment program based on resolving what I believe to be the cause of that pain.
Physiatrists often focus on patient education and empowering patients to understand and manage their pain or illness. A recent study in The February 1 issue of Spine includes "The Effect of Required Physiatrist Consultation on Surgery Rates for Back Pain,” which determined that PM&R consultation prior to spinal surgery results in more efficient treatment for low back pain and fewer surgeries, which reduced health care costs. Patient satisfaction with treatment for back pain increased with a PM&R consultation because nonsurgical options are pursued.
Constructing a comprehensive rehabilitation program for their patients with a focus on restoring function is a large part of what physiatrists do. We often coordinate a care program for our patients which may involve referral to another specialist (orthopedic surgery, rheumatology, neurology) as well as work with physical therapists, chiropractors, occupational therapists, psychologists, nutritionists, and/or massage therapists. We also help patients navigate the sea of treatment options, which can become daunting, and help tailor the most effective treatment plan for each individual patient.
Dr. Deborah A. Bergfeld is a physiatrist, fellowship trained in sports medicine and spine. She treats a wide range of complaints for patients of all ages and has a special interest in nonsurgical spinal care and women's rehabilitative health. To schedule an appointment with Dr. Bergfeld, please call 210.281.9595.