Forgot your password?

Not Registered?

Previous Discussions

Recap of the June 25 PainEDU Webinar: Standardizing the Assessment of Patients with Chronic Pain
Kevin L. Zacharoff, MD
Preview of PAINWeek 2014 – The National Conference on Pain for Frontline Practitioners
Debra Weiner
The Importance of Responsible Medication Storage
Doug Hebert and Shelly Mowrey
The PainEDU REMS Education Program
Kevin L. Zacharoff, MD

Click for More...

Make a Suggestion

Is there a topic for this section you want PainEDU to cover? Send us an email!

Click for More

Spotlight Interview

Physiatry And Pain

An Interview with Mitchell Freedman, D.O.


Each month, Dr. Lynette Menefee tackles pressing issues in pain management with one of the nation's leading practitioners. This month, Dr. Menefee speaks with Mitchell Freedman, D.O., a physiatrist who serves as Medical Director at McGee Interdisciplinary Pain Management Center and Medical Director of Physical Medicine and Rehabilitation at the Rothman Institute in Philadelphia.

--------------------------------------------------------------------------------------------------------------

Questions

1: What is physiatry’s role in the treatment of pain?


2: And now physiatrists are becoming more interested in pain management?


3: How would you describe your approach to patients?


4: What is the role of opiates in your practice?


5: What types of pain do you see in your practice?


6: How do you treat phantom limb pain?


7: Are there any concerns you have about pain treatment?


8: And the second concern about pain treatment?


9: Any final thoughts or suggestions for practitioners?


--------------------------------------------------------------------------------------------------------------


Dr. Lynette Menefee:
Thank you for speaking with us today, Dr. Freedman. We want to talk about the role of physiatrists in pain management.

What is physiatry’s role in the treatment of pain?


Mitchell Freedman, D.O.: Well, in the past, physiatry has been split into two artificial camps – physical medicine and physical rehabilitation. Training is geared toward the generalist, and much of the time, programs have an emphasis on one end or the other. Some people become hybrids and can care for traditional rehabilitation patients (like those with strokes or spinal cord injury) as well as individuals with musculoskeletal problems.

Back to Top



LM:
And now physiatrists are becoming more interested in pain management?


MF: Yes. Physiatrists have moved into the interventional area and fellowships are offered for interventional pain procedures. More rehabilitation physiatrists are becoming pain specialists, which makes sense because the focus in training is interdisciplinary. This interdisciplinary focus during training is different from that of most other specialties, which is definitely a strength we bring to the pain management field. Additionally, a rehabilitative focus is about making the best of a problem, versus “fixing it,” which is the focus of some other medical specialties.

Back to Top



LM:
How would you describe your approach to patients?


MF: I believe that each person in pain needs to be treated as an individual. I usually tell patients that they have 5 basic options for pain management - surgery, injections, medications, physical therapy and lifestyle changes. I work with patients to establish their goals, incorporating their preferences for treatment, as long as it is in their best interest, medically speaking.

Back to Top



LM:
What is the role of opiates in your practice?


MF: Well, first, you have to understand that I want to minimize drugs as much as possible. My concerns about prescribing opiates have to do with the stigma the patient sometimes encounters and the side effects, especially in elderly patients. If a patient and I agree that opiates are an important part of treatment, I am careful to educate that patient. An agreement is signed so that the patient knows and agrees to the expectations I have with respect to opioid use. I also require the patient to be in a functional program and to have any psychological problems addressed. In order for me to continue opioid usage over the long term, the medication must contribute to reduced pain and enable functioning at an enhanced level.

Back to Top



LM:
What types of pain do you see in your practice?


MF: Many kinds, really. Physiatrists treat patients with musculoskeletal pain, post- surgical pain, post-stroke, phantom limb pain, neuropathic pain and complex regional pain syndrome.

Back to Top



LM:
How do you treat phantom limb pain?


MF: I quite often prescribe the Lidoderm patch. I also prescribe it for neuropathic foot pain, post-herpetic neuralgia, and neuropathic hypersensitivity in the foot, shoulders and knees. Musculoskeletal pain can also benefit from Lidoderm. There is really little downside to this medicine. Patients use it in a 12 hours on and 12 hours off fashion.

Back to Top



LM:
Are there any concerns you have about pain treatment?


MF: I can think of two concerns. First, my greatest concern is relying too heavily on any one modality - it’s the “If you only have a hammer, all you see is a nail” syndrome. Good practice, in my opinion, means working with patients, asking about their goals and expectations. Treatment then becomes a collaborative process and teamwork can be built into the relationship.

Back to Top



LM:
And the second concern about pain treatment?


MF: Patients in pain are real people. Sometimes I see practitioners so frustrated to help a patient in pain that they try any new treatment. Just because something is new, doesn’t mean that it’s great. The more I practice, the more interested I am in the downsides versus the upsides of a treatment.

Back to Top



LM:
Any final thoughts or suggestions for practitioners?


MF: Look at the patient. Listen to the patient. Help patients create goals and figure out where they want to go. Understand that patients don’t live in a vacuum – they have families, careers, and lives. Look at every aspect of what you do. Use your sympathy as well as all your tools.

Back to Top


 

 
HONcode accreditation seal.
Last Update
7/23/2014
  ©2003 - 2014Inflexxion, Inc.®All rights reserved.
PainEDU.org is supported byZogenix, Inc.