My Approach to Care

Helping you recover often starts with one simple act.  Listening.

Q and A with Jay E. Rosenfeld, M.D.

Your specialty is Physical Medicine and Rehabilitation, also known as Physiatry.  What is unique about this specialty?
Physical Medicine and Rehabilitation (PM and R) is a small specialty. The best word to describe a physiatrist is “diverse”. In residency, we are trained to evaluate and treat a wide variety of conditions, from brain and spinal cord injuries to neurological and orthopedic conditions. Many of us tend to concentrate our interests after residency. My interests are the non-operative treatment of musculoskeletal and neurological conditions with particular emphasis on acute and chronic pain conditions.

 What are some of the conditions you treat?

I treat a variety of spinal conditions. The most common is the treatment of lower back and neck arthritis that may affect 20 million people in this country. I see older people with fractures from osteoporosis, people with “slipped discs,” people with spinal stenosis. My practice is restricted to ages 16 and up. I also treat patients who have an acute or chronic injury from a sports event or from a car accident. I occasionally see people who need pain management due to cancer.

What are the aspects of your initial evaluation of someone with back pain?

Each assessment starts with listening to the person’s story. Every story is unique. I can usually narrow the diagnosis down based on the history of the condition itself. Following this, I perform a detailed physical examination, usually head to toe. I assess things such as joint problems, abnormal curvatures in the spine, muscle spasm and neurological abnormalities such as weakness, numbness and change in reflexes. Next, I review all diagnostic studies, including x-rays, CT scans and MRIs.  I may order additional studies if I think it will help me make a more accurate diagnosis.

Based upon the diagnosis, I design a rehabilitation program, which often includes a specific type of physical therapy (PT) designed to address the diagnosis. Just as not all back or neck pain is the same, not all PT is the same.  Like prescribing medication, physical therapy must be custom tailored to the diagnosis. This is an aspect of care that I consider crucial.  Other considerations may be medications, orthotics for mal-alignment conditions, spinal interventions such as epidural injections, nerve injections and radiofrequency procedures designed to reduce pain.

I also council patients about the connection between spinal pain and harmful activities such as smoking and poor nutrition.  I educate patients on the interaction between depression, anxiety, substance abuse and chronic pain. I often discuss nutritional supplements that may be helpful in alleviating chronic pain.  The ultimate goal is to provide the patients with enough tools to manage on their own as much as possible.         

Not all pain can be cured.  What is the goal in treating the patient who must live with pain?

It is true that many of the chronic conditions that I treat do not have a cure per se. Despite this, I am confident that we can improve each patient’s functional abilities, decrease chronic pain and overall improve quality of life.  

The goals of chronic pain treatment are to:

• Educate the patient about the nature of his/her condition.
• Assess the patient’s functional limitations due to the condition and design a rehabilitation program designed to improve function.
• Assess and treat pain with a variety of traditional and non-traditional approaches. Traditional approaches include medications, physical therapy, and minimally invasive joint and spinal interventions, such as injections.  Non-traditional, “alternative approaches” include nutritional interventions, reversal of harmful habits such as smoking and obesity, use of mind body techniques such as meditation, and encouragement to engage in regular exercise.

What is the advantage of seeing a physician who works in an outpatient center that also has therapy services and access to other specialists?

Physiatrists are trained to work in teams. The members of that team include the physician,  physical, occupational and/or speech therapists when needed, and last but not least the patient.

At Spaulding, we also have access to many other rehabilitation specialists, including psychologist, orthotist and prosthetist, and other physicians.  Collaboration with the other team members results in much better outcomes.

What do you find most rewarding about your specialty? 

The most rewarding day for me is when patients come in and tell me they no longer need my services. This means that they have gained control over their acute or chronic condition and have the tools to manage it. It is not my goal to turn people into professional patients. I am happy when they can fly on their own.