Believe the Patient, Treat the Cause (Not the Symptom), Re-Educate the Muscles
Diagnosis is a large part of the practice of physiatry, and a good history and physical exam are crucial to the diagnosis. Brian Kahan, D.O., a physiatrist and medical director of The Kahan Center for Pain Management, relates this example: A gentleman complaining of right-sided pain was found on MRI to have a herniated disc. After surgical intervention to remove the disc, his pain was still there, exactly as it had been before surgery. Thinking he needed help with his “post surgery pain,” the surgeon referred him to The Kahan Center for Pain Management. “At first glance, it was easy to attribute his condition to normal postoperative pain,” Dr. Kahan says, “but in this case, the pain pattern didn’t fit. What would produce pain on the right side?”
Upon questioning the patient further, Dr. Kahan learned that the gentleman also experienced headaches, numbness and tingling along with the right-sided pain. “The only way to get that kind of pain is to have something wrong in the brain,”
Dr. Kahan says. “We began to think in terms of a disease such as multiple sclerosis and the whole picture changed. There had been, in fact, a herniated disc in this patient’s back, but it was not the cause of his pain. This is why we, as physiatrists, take more of a whole-body approach to pain. If we focus on a single organ system, we may miss the diagnosis completely.”
Physiatrists work in various subspecialties from traumatic brain injury to pediatrics. Two of these — pain subspecialists and musculoskeletal subspecialists — are experts in how the body works with respect to muscles, nerves and joints. “Although we can’t put things back together if they’re broken, we understand how things work,” Dr. Kahan says. “We use a finely tuned process that includes examination, exercises and spinal injections to appropriately diagnose and help treat the impairment. And we ask a lot of questions.” Orthopedic surgeons often rely on physiatrists to confirm a diagnosis and to exhaust every nonsurgical means of intervention.
“If a patient does not respond to conservative treatment within six to 12 weeks, we usually know where the problem is coming from and we begin to consider surgery,” Dr. Kahan says.
We use a finely tuned process that includes examination, exercises and spinal injections to appropriately diagnose and help treat the Impairment. And we ask a lot of questions.
Brian Kahan, D.O., FAAPMR, DABIPP, DABPM, DAOCPMR
The Kahan Center for Pain Management
2002 Medical Parkway Suite 150
Annapolis, MD 21401