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What is Physical Medicine? How PM&R Goes Beyond Pain Management

Physical medicine and rehabilitation are the primary care for patients with painful or debilitating conditions. The goal is to avoid surgical intervention when possible. Listen as Dr. Sean Stevenson discusses how PM&R works.
What is Physical Medicine? How PM&R Goes Beyond Pain Management
Sean Stevenson, DO
Dr. Stevenson completed his residency at Mercy Medical Center in Rockville Center, New York, where he served as Chief Resident. He received his medical degree from the University of New England College of Osteopathic Medicine and B.S. in Exercise Science from UMASS Amherst. He is a member of several professional affiliations, including the American Academy of Physical Medicine & Rehabilitation, American Osteopathic College of Physical Medicine & Rehabilitation, and the American Osteopathic Association.

Prakash Chandran (Host): When we suffer injuries, don't we all want to heal in the most natural way possible? Not all western medicine involves prescription drug and surgery-based treatments, and today we'll learn about the practice of physical medicine and rehabilitation, otherwise known as PMNR, and how it goes beyond just pain management. I'm pleased to welcome Dr. Sean Stevenson; a doctor of osteopathic medicine at Harrington Healthcare. Dr. Stevenson, it's a pleasure to have you. So how would you describe the field of physical medicine and rehabilitation? And how is it different than regular pain management?

Dr. Sean Stevenson, DO (Guest): Well first of all, thanks for having me. The way I like to describe the field in one line is really it's sort of the primary care for patients who have painful or disabling conditions. So what we try to do is sort of coordinate care for these patients and develop a comprehensive treatment plan, and that can include a wide range of things. But in general, we're focusing on functional status and quality of life, and hopefully avoiding interventional procedures such as surgery and other invasive treatments if possible.

Host: Yeah, that sounds good. So I'm curious about how it's different from the everyday pain management we hear. Like I think normally what happens is when we injure ourselves, we're told to take some medication, and maybe potentially consider those surgery options, which I think this kind of tries to steer away from. So maybe talk a little bit about the main differences between the two.

Dr. Stevenson: Sure. So pain management really is just a sub-specialty within physical medicine rehab. So it's certainly an aspect there, but we're interested in things beyond just pain control. And while that's an important thing, it's really just a small factor in our patients' overall health and their overall functional status. So we may prescribe pain medicines, we may do injections, but that's just a small piece of the overall plan, where we're really focusing on patient's quality of life and getting them back into the things they want to do or need to do on a day-to-day basis.

Host: Yeah, when I was doing a little bit of research, one of the things that I liked about this so much was it really seems like it's focused on the overall wellness of the person, and not just the fact that- there's the pain in the knee, but then there's the overall quality of life. So tell me a little bit about your philosophy on that, and what your approach is like when you work with patients that come to you with an injury.

Dr. Stevenson: Yeah, so taking that knee pain example, it's actually a pretty good one. I see a lot of patients that come in with knee pain, and they've seen multiple doctors or providers who really focus just on the knee, and maybe that's the right approach in some patients, but oftentimes you see other factors that are really contributing to it, such as maybe there's something slightly wrong with the foot or the ankle or they're walking a bit funny because they have some back pain. All of these things sort of go hand-in-hand, and contribute to the knee. So you can treat the knee all you want, but if you're not fixing some of the underlying issues on top of that, you're really not getting anywhere. And a person's everyday job is a big part of that as well; so what you do for work is really a huge factor. You spend eight or ten hours a day doing the same thing over and over again, and often that's not doing you any favors.

Host: Yeah, that makes sense. So I'm curious about- let's focus still here on this knee example. So if I came in with a knee injury, and you're focused on my overall wellness and what I'm doing day-to-day, would you then give me advice on the way I should be sitting or not sitting at work? What are some of the types of things that you will help your patients do day-to-day to recover?

Dr. Stevenson: Yeah, that's certainly one thing is posture, and other things certainly involving the ankle is probably the biggest one that I see, or small differences in leg length. So maybe a foot insert would be helpful for you, or a shoe orthotic. Maybe you have some back issues that we need to address with physical therapy or with some of your biomechanics at work, or maybe you're doing some repetitive things at work that need to be adjusted in a way that you're not putting so much strain on the lower part of your body.

Host: Yeah, playing basketball so much, I actually suffer from quite a few injuries in the ankle and the knee, and one of the things that I really like about what you're saying is that you kind of look at the body as this support system. Right? That everything has to work properly in the back and the ankle in order for you to prevent yourself from injuring that knee again. And I love that holistic approach. That's really great that you do that. Right?

Dr. Stevenson: Yeah. You know, it's really- it all comes down to biomechanics, how the forces at each joint play together, and they really affect the joints above and below. You know, it's a pretty common thing that we're taught in training, is that if you're somebody that has pain in a certain joint, look at the joint above, look at the joint below at the minimum, because oftentimes you'll find dysfunction there as well.

Host: So we talked about knee pain, but I want to learn a little bit more about who you typically see day in and day out. What kinds of injuries are you seeing from patients?

Dr. Stevenson: So we see a whole- a large range of patients. Anywhere from patients who've had severe neurological dysfunction such as strokes, or brain injuries, even spinal cord injuries, all the way to your common orthopedic injuries; knee pain, ankle pain. Obviously the spine is a big part of our patient population. Chronic back pain is probably the most common thing out there, and we certainly see our share of that. But neck pain, problems with the shoulder. We really fit in between a lot of different specialties, sort of in the mix of orthopedics, neurology, and rheumatology, which is a specialty that treats autoimmune conditions as well.

Host: So I heard that beyond just working with a patient and looking at the body as a whole machine that needs to function well together, I heard that you also work with the family a little bit. Right? So for example, if a patient went through an accident and is looking at a very long road to recovery, do you also work with the family to set expectations and let them know how they can help?

Dr. Stevenson: Yeah, that is a huge part of our field as well, specifically on the inpatient side of this field. So patients who have had strokes, or who had major trauma, they tend to be in the hospital doing recovery for quite a long time, and before they're discharged, that's where we really try to focus on coordinating their care for once they get home, and that involves meeting with the family, meeting with perhaps nurses or therapists that are going to come to the home, and help with their care. So it's a pretty unique part of medicine that a lot of other specialties don't get involved with.

Host: That's very unique, and what an amazing service because it kind of takes a tribe or a village to help us recover sometimes. I'm really curious about some of the specific things that you tell family or friends to help that person recover. Like give us some examples about some of the things that the family can help do during a time of recovery.

Dr. Stevenson: Sure, so obviously it'll vary tremendously depending on the condition that a patient has. But the prime example is probably the patient who suffered a significant brain injury. That tends to be the most challenging for family members to deal with because the personality itself can change. So it's really educating the family about the fact that that is a possibility, that they need to have a lot of patience, and really realize that this patient is going through a significant change to their life, and almost reverting to a childlike state. So it's quite challenging, not only for us educating, but of course for the family to deal with that.

Host: You know, you mentioned a brain injury, and I was just thinking about the fact that for many of your patients, they might never be cured, so I imagine that you kind of form a long or a lifelong relationship with some of your patients and their families. So I'd love for you to talk a little bit about what that's like to have that kind of connection with people.

Dr. Stevenson: Yeah, that's one of the more rewarding parts of the field, in my opinion. In the same way that a primary care physician has a similar rewarding aspect to their field, dealing with a patient chronically throughout their life, you really get to see the ups and downs and almost become a part of their family in a sense. So it's quite rewarding.

Host: So let's say the next time I have a basketball injury, and they're like, "Well, you need to go see an orthopedic surgeon," and now with this newfound knowledge, I want to request for a doctor like you, what can I do? Let's say I go to Harrington, who can I ask for?

Dr. Stevenson: Well, the first person to deal with it anytime you have any medical condition is your primary care physician because they'll be able to direct you to the right specialty. Me specifically, I'm accepting patients from really anywhere, so you can call- you can usually call our doctor's office directly, depending on your insurance needs, and ask for a consultation. But I usually recommend you go through your family physician with any condition.

Host: Okay, great. So go to your family physician first and then they'll point you in the right direction. But it's just really good to know about this comprehensive side of medicine that looks at. So Dr. Stevenson, is there anything that we didn't cover today that you'd like the audience to know?

Dr. Stevenson: No, I think we hit a good range of topics on this field.

Host: Well, fantastic. Thank you so much for being here. For more information, please visit Our guest today has been Dr. Sean Stevenson. This is Healthy Takeout from Harrington Healthcare. I'm Prakash Chandran, thank you so much for listening.