r, A ■ SPRING1993 ISSUE ■ SINAI HOSPITAL THE CONQUEST OF PAIN: SINAI'S OUTPATIENT PHYSICAL MEDICINE PROGRAMS ou knew it as soon as it happened. You must have bent down wrong. When you tried to stand up and twist with that crate in your arms, your back muscles cramped and a pain shot down your leg. You approached your supervisor with your torso angled at about 45-degrees. Silently, you both shook your heads, despairing the disability absence and pos- sible surgery that would ensue. y It Ain't Necessarily So U. ) Cr) U_J F- F- LU LU H- 12 But your employer had been in touch with Sinai Hospital and suggested that you consult its outpatient programs to reduce your pain, improve your strength, help you avoid surgery, and teach you prevention on the job. In fact, to get you back to the job where you really want to be. "Our mission is one of clini- cal excellence provided in a cost- effective manner," says William H. Restum, Ph.D., Assistant Vice President for Clinical Programs, about the Department of Physical Medi- cine and Rehabilitation at Sinai. The goal, Physical Medicine and Rehabilitation Chairper- son Joseph C. Honet, M.D., says, is to help the patient restore function with the most conservative treatments pos- sible. "Our strength is the conservative care of various pain and motion problems; for example, pinched nerves in the back and neck; repetitive motion nerve injuries, as in carpal tunnel syndrome; and various hip, knee and shoulder problems. Among the patients who entered Sinai's program and Back School with herniat- ed or slipped discs, only five percent went on to have surgery," Dr. Honet reports. You may undergo a diag- nostic electromyogram, or EMG, by a physiatrist such as Dong Lee, M.D., which tells the consulting physiatrist just what the injury is and permits him or her to design an individualized treatment program for you. Those who suffer from sports injuries are also eased into the culprit activity, starting with stretches and abbreviated par- ticipation. Some- times the advice gets very basic. "Our tennis players learn to use two words," says Dr. Honet: "Nice shot." Return to Work Program, Aptly Named Sinai's Return to Work Program aims to conquer disability before it becomes chronic. Consulted soon after an injury, Sinai's multidisci- plinary team of rehabilitation experts can keep you on the job or get you back to work much sooner, restoring your self- and others with nerve or mus- cle injury-induced pain will be scrupulously evaluated and precisely treated. The Functional Recovery Program (FRP) is designed for individuals with long-standing pain problems, those lasting more than six months. The FRP has had outstanding suc- cess relieving painful disabili- ties that have plagued people for up to eight years and get- ting them back to work, says Dr. Maury Ellenberg, Associate Chairperson of the Physical Medicine and Reha- bilitation Department and Medical Director. "Pain does reduce," Dr. You've Been Recruited for the Team In FRP you will benefit from a team of professionals including physical, occupa- tional and recreational thera- pists, psychologists, vocational counselors, nurses, physicians and outside consultants. With their help, people who have been debilitated by nerve or muscle pain return, not just to work, but to the tennis courts and ski slopes. As part of the industrial medicine program, you will be assigned a rehabilitation case manager who will follow you while you are in therapy and who will follow-up after you've resumed your normal ac- tivities. And you'll be invited to join what is fondly called the Team meeting that gives you the opportunity to pose any problems you may be having. "We feel strongly that every person is extremely important and we want every- one to have a voice," says Dr. Honet. Cutting Out Surgery Families are also involved in rehabilitation treatment. Children, particularly, are taught with disabilities. esteem along with your function. To your employer it means a reduced worker's com- pensation payroll and reduced losses of productivity. If you have more limiting pain, you may enroll in Sinai's Functional Recovery Program which is primarily held at the Jewish Community Center in West Bloomfield. Here you Ellenberg says, "but the focus is on functional rehabilitation — the resumption of normal activities. We retrain the body and the mind. The pain no longer tells our patients what to do and not do. The body can compensate, and we can help people exploit that through treatment and education." A recently published clini- cal study was conducted at about living Sinai and pre- sented at the American Acade- my of Physical Medicine and Rehabilitation using non-in- vasive C-T scans after the pa- tient completed non-surgical treatment. Sinai's physiatrists determined that half of the discs had shrunk significantly in size and, while the other half were still protruding from their natural spaces, they were no longer irritating the nerves. Healing Is Only Part of the Job At Sinai, physical medicine professionals recognize it is not enough to heal you if you must return to a situation that threatens re-injury. So they will also try to alter the cause of the injury. "We evaluate the job site," says Dr. Restum. "We help the employer make mod- ifications which facilitate returning to the job." A Body Rebuilding Department with Muscles of Its Own Dr. Honet's department has some muscles of its own to flex. It hosts one of the most respected residency programs in the State. "All of our residents have passed their Boards," boasts Dr. Ellenberg, who is Chair- man of the National Academy's Committee responsible for writing physician and resi- dency training assessment ex- ams. Dr. Ellenberg has been a guest award-winning lecturer on the subject of back pain to the national organization. Dr. Restum is an influential member of the Michigan Asso- ciation of Hospital Rehabilita- tion Program Administrators (MAHRPA), of which he is past Chairman A Past President of the Academy of Physical Medicine and Rehabilitation, Dr. Honet chairs the National Residency Review Committee of the Accreditation Agency for physical medicine and reha- bilitation residency programs in the U.S. and also serves as a director of the American Board of Physical Medicine and Rehabilitation. Each describes his work as "gratifying." Thinking of, for example, stroke patients, Dr. Honet says, "We have a specialty that doesn't always cure people. But most of our patients can still get to live a much more normal life. You get tremendous gratification." For information on support groups. and programs.44 call Sinai I lospit al at , 1-800-248-3627.