What is an Interventional Physiatrist?

An interventional physiatrist is a doctor specializing in physical medicine and rehabilitation. It is their job to diagnose, treat, and manage patients with pain (both acute and chronic) and musculoskeletal conditions, especially the spine. What separates them from the majority of other specialists is that they focus on minimally invasive procedures to treat pain and improve the mobility (and quality of life) of their patients.

Still, when they ask what is an interventional physiatrist, most people don’t want a straightforward (textbook) definition. What they want is a breakdown of the difference between interventional physiatry and related fields (of which there are many since interventional physiatrists often work in multidisciplinary teams).

With that in mind, here’s a bit longer answer to this question.

What does a physiatrist treat?

The simplest answer to this question would be - conditions related to pain, the musculoskeletal system, and especially the spine (often referred to as pain management). Here are some examples of these conditions to help you develop a better understanding of the subject:

• Chronic pain (like neck or back pain)

• Spinal disorders (such as herniated disc)

• Nerve pain (like sciatica)

• Musculoskeletal injuries (like muscle strains)

• Arthritis (both osteoarthritis and rheumatoid arthritis)

• Postoperative pain
• Headaches (like migraines and tension headaches)

Keep in mind that these are just some of the injuries and conditions that an interventional physiatrist will treat. Also, we tried to limit ourselves to just one or two examples in each of these categories. In reality, the list is a lot longer than that. 

What are some interventional physiatry procedures?

Now that you have an idea of what an interventional physiatrist treats, here are a few procedures as examples of what this is supposed to look like in practice.

• Epidural steroid injections: This is the way interventional physiatrists may try to reduce inflammation and alleviate pain - by injecting an anti-inflammatory steroid around the irritated nerve.
• Nerve block: With an injection of anesthetic or anti-inflammatory medication, a physiatrist may try to block out the pain.
• Spinal cord stimulation: A physiatrist will send electrical impulses to the spinal cord in order to interfere with pain signals.
• Radiofrequency ablation: A physiatrist may use heat generated by radio waves to destroy nerve tissue, thus reducing the pain signal from a specific area.
• Stem cell therapy: With the help of stem cells, a physiatrist may attempt to regenerate and repair damaged tissue.

Again, these are just some of the potential treatment methods, with others being sacroiliac joint injections, intrathecal pump implants, vertebroplasty, and more.

All in all, the number of potential treatment options is vast, and, as we’ve already mentioned, this is a type of specialist who often works in multidisciplinary teams. With that in mind, they will probably not be administering this treatment on their own.

Is physiatry the same as pain management?

While physiatry (especially interventional physiatry) and pain management are related, there are a few important distinctions to make. While both specialize in helping patients handle pain, interventional physiatry focuses on interventional procedures that will lead to pain alleviation, while pain management (as a broader concept) will include other methods, as well. In addition, other medical doctors as well as anesthesiologists can specialize in pain management.

To put it even more bluntly, pain management specialists will often emphasize pharmacological treatments and non-interventional methods, with some even resorting to psychological approaches.

Interventional physiatrists, as their name suggests, will put an emphasis on interventional procedures, like injections for back pain.

What is an interventional physiatrist doing most of the time?

Any list of conditions that are treated by an interventional physiatrist is bound to be quite lengthy, but what are the conditions that interventional physiatrists are treating most of the time? In order to get this out of the way, we’ll split it into four separate categories:

Spinal conditions

The most common spinal conditions that an interventional physiatrist will deal with are:

• Herniated discs

• Spinal stenosis

• Degenerative disc disease
• Facet joint arthritis

Chances are that if you’re dealing with an interventional physiatrist, you have one of these four spine conditions.

Musculoskeletal conditions

The next major category is musculoskeletal conditions. We’re talking about conditions like:

• Osteoarthritis

• Rheumatoid arthritis

• Tendonitis
• Bursitis

These individual conditions are incredibly painful if left unchecked and untreated.

Nerve-related conditions

These conditions cause weakness, numbness, and pain. They limit motion and destroy one’s quality of life. The most common such conditions treated by interventional physiatrists are:

• Sciatica

• Peripheral neuropathy
• Complex regional pain syndrome (CRPS)

In these conditions, an interventional physiatrist is someone who can provide the most help.

Chronic pain condition

When it comes to neck and back pain, some people go decades experiencing them on a regular basis before ever talking to a specialist. What interventional physiatrists treat most commonly (in this category) are:

• Chronic back pain

• Chronic neck pain
• Myofascial pain syndrome

The difference between experiencing pain on a regular basis and doing something about it is life-changing.

Of course, interventional methods are not the only option, and you should probably reread our segment about physiatry vs. pain management.

What is an interventional physiatrist doing to facilitate postoperative recovery?

Earlier, we mentioned the role of a physiatrist in postoperative recovery, and they can do a few things to change the treatment's outcome dramatically.

Shortly after the surgery, an interventional physiatrist will perform the initial evaluation and potentially devise a personalized rehabilitation plan.

After the surgery, during the healing process, there will be some pain present, and it might be the job of a physiatrist to prescribe and manage medications in order to control the postoperative pain. If needed, they might use techniques like nerve blocks and epidural injections in order to help with pain management.

Physiatrists will often supervise physical therapy and prescribe assistive devices.

Their most important role is functional recovery and ultimate goal is to keep you from needing spinal surgery. Lastly, they’ll offer assistance in terms of education and support. If their assistance ultimately does not resolve your issue, only then will you need to refer to an expert on a surgical discussion.

Wrap up

So, what is an interventional physiatrist?

The simplest answer is that it’s someone who’s there to help you manage pain, restore functionality, and recover after an injury or surgery. As such, their role in modern medicine and the lives of individual patients is simply indispensable. More importantly, they’re there to work with other medical professionals and provide patients with a more holistic approach to medical treatment.