Patient Education 2017-12-20T15:02:06+00:00

Patient Education

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Frequently Asked Questions

Below are commonly asked questions from patients when dealing with our practice. If you need additional information, please call us at (203) 533-7467.

Dr. Kaplan: A physiatrist is a physician who specializes in physical medicine and rehabilitation. The physician undergoes 4 years of medical school and then 4 years of a specialized residency training program. The goal of physiatry is to get the patient to his or her highest possible functional level.
Dr. Kaplan: A physiatrist looks at the whole person, not just at a specific body part or structure. If someone comes in for a back injury and has a disc herniation on MRI, a physiatrist will evaluate more than just the MRI. It is important to diagnose the source of the pain since two people can have the same MRI findings and have quite different symptoms. One may be incapacitated by pain and the other can have minimal symptoms. A detailed history and physical exam as well as a review of diagnostic tests is critical to determine the source of pain and put an appropriate treatment plan in place.
Dr. Kaplan: The first step is to do a comprehensive history by reviewing the medical records and interviewing the patient. Next a musculoskeletal physical exam is done. Then previous imaging studies and other diagnostic tests are reviewed. Sometimes the diagnosis is clear and treatment can be implemented. Other patients will need further diagnostic tests. Educational training is also provided to the patient using a variety of anatomical diagrams to explain the condition, pathology, proposed treatment and strategies to prevent worsening of the condition. For example, if a patient has a back injury, emphasis is placed on posture, body mechanics, safe lifting techniques, and pacing techniques. We also use various other rehabilitation techniques. The most common is land-based physical therapy. We also use aquatic physical therapy, which is especially helpful for those individuals who might not be able to tolerate a land physical therapy program. The patient can do stretching and gentle strengthening exercises in the water. They can usually improve their condition without exacerbating their symptoms.

Dr. Kaplan: Functional spinal stabilization can often be done even in patients with herniated discs to avoid back surgery. The goal is to get the back as strong as possible using the patient’s own muscles to do what a surgeon would do with bone grafts and rods. The nice thing about this approach is that you have not destroyed any anatomy; you have not put any foreign hardware in and if successful for that individual, they are going to not only improve from this particular pain episode, but hopefully prevent a future injury.

In contrast, if you immediately jump to a surgical intervention, for example, a fusion at the L4-5 level, you are going to put increased force and pressure on the disc level above and below the fusion and the structures on the sides. You may have fixed the problem at L 4-5, but now you have increased irritation and increased pressure at L 3-4 and L5-S1. Guess what happens? For a number of years the person is successful. They get back to work, they do things, but put more force on the adjacent lumbar levels and sacroiliac joints. This can lead to additional problems in these other areas and potentially the need for other interventional procedures. In contrast, with functional spinal stabilization, all the muscles are stronger, not just at the L4-5 level, but above, below and to the sides as well.

Dr. Kaplan: Yes with the goal of using as specific a medication as possible. If the pain is coming from nerve irritation, then a neuropathic medication such as gabapentin, Topamax or Lyrica is used. If pain is coming more from spasms, then a muscle relaxant like tizanidine, metaxalone or cyclobenzaprine is best. For acute inflammation, an anti-inflammatory medication like ibuprofen, naproxen or meloxicam is given. In many cases, it is a combination of several different factors so combinations of medications may be used but normally only one new medication is started at a time so the benefit and any side effects can be determined.
Dr. Kaplan: Some physicians will use a narcotic-based pain management approach to minimize the individual symptoms without having a clear understanding of the source of the pain. I call this a “shotgun” approach. If you give enough narcotic pain medications, you will eventually be able to decrease the pain, but you are not really treating the underlying source of the pain. The patient will then often require higher and higher dosages of narcotics. The narcotics themselves can cause secondary problems, whether there are dependency issues or whether there are physiological problems. A classic example is something as simple as constipation. If you have a patient with a disc herniation and you start a narcotic medication they may become more constipated. This can cause straining which will increase the pressure on the discs and lead to more pain which can potentially result in higher dosages of narcotics and all of a sudden you are getting into a vicious cycle. Higher narcotics lead to more constipation; more straining; more pain; and more narcotics. Unfortunately, we have an opioid crisis in CT and in the country as a whole so narcotics should be avoided whenever possible.
Dr. Kaplan: Nutrition is an important issue related to the patient’s overall health as well as chronic pain. If someone has an injury and has gained 50 pounds, the patient is putting more pressure on multiple body parts. This can cause a marked increase in pain, especially for back pain patients. Nutritional counseling will not only help with weight loss but healthier eating habits can improve energy, sleep and general well being.
Dr. Kaplan: Many individuals with chronic pain develop reactive depression. That is a depression related to changes in their circumstances, because they can’t do what they used to be able to do. Depending upon how severe that reactive depression may be, it can interfere with their ability to participate in their rehabilitation program and impact recovery. Cognitive Behavioral Therapy (CBT) is well proven to help deal with depression related to chronic pain. Kaplan Rehabilitation works with several clinicians who are experts in CBT to help patients manage their chronic pain, depression and anxiety. We can also refer someone to a psychiatrist if they need antidepressant medication management. Fortunately many of the medications used to treat depression also work extremely well for chronic pain.
Dr. Kaplan: At times, an epidural is the best treatment, if done in conjunction with the rehabilitation program. You can do an epidural and give the individual significant pain relief. Epidural injections should be done with fluoroscopic guidance that allows the physician to visualize where the needle is in relation to the rest of the anatomy. This is critical to ensure the medicine is injected into the correct location. Spinal injections can often be diagnostic as well as therapeutic. Not all back pain is related to disc herniations. Other sources may be muscular, sacroiliac, facet joints, spinal stenosis or other causes. Kaplan Rehabilitation works with interventional pain physicians to ensure you are referred for the appropriate interventional procedure.

Dr. Kaplan: The ideal candidate is the patient who is referred shortly after their injury and can tolerate a conservative functionally based program. The individual should not have any acute neurological changes that would require an urgent surgical intervention.

Dr. Kaplan: A successful pain management outcome has to have improvement in function, as well as a lowering of the pain. It may not be the complete elimination of the pain. The pain should be brought to a more manageable level so the person can have the best possible function. If all the pain management program is doing is slightly decreasing pain and not changing the person’s functional ability at all, it is not really a successful outcome.

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