Physiatry and Pain Management in Skilled Nursing Facilities

This manual is a comprehensive bedside resource for physicians, nurse practitioners, physicians' associates, and the entire rehabilitation team. The physiatrist is the ideal clinician for managing issues in skilled nursing facilities, as physiatry education encompasses the pathologies and conditions encountered in these facilities. In the same vein, while most conventional medical specialties focus on life-or-death situations, the physiatrist focuses to a greater degree on quality of life. The physiatrist considers the patient's medical history and status, home situation and discharge environment, the patient's ability to manage pain, and social situations. They serve as a team member and often the team captain, working in concert with social services, internal medicine, orthopedics, PT/OT/ST, and, of course, nursing. As consultants in skilled nursing facilities, the physiatrists assess each patient and give clinical recommendations. In most states, it is then up to primary care to assess the consultation and take action if they agree with the recommendations. Excellent rapport between primary care and psychiatry is essential. Of extreme value to the skilled nursing facility, the patient, and the patient's family is the physiatrist's ability, when ordered by primary care, to perform bedside interventional pain procedures such as hip, shoulder, knee, nerve, and muscle injections for pain management. Without this service, either the patient simply remains in pain, must rely on opioids, or is transferred to an orthopedic center for the procedure, which can take weeks to obtain at a significant cost to the patient and family. Oftentimes, this can be as simple as a therapist or nurse advising that the patient is not progressing due to joint pain. The physiatrist can often remedy this beside the same day or shortly thereafter. Lastly, this manual is meant to be a living document. As medicine progresses, this manual will be updated with the newest information on medication and treatments. Together, we look forward to receiving clinical comments via email. Our online presence will continue to grow and hopefully become an excellent resource for the entire rehabilitation team.