Caitlin Whyte (Host): Managing pain can be a terribly frustrating process. But physical therapy can be an essential part of your treatment plan. To tell us more about how to implement it into your life is Dr. Anthony DiFilippo. He is a Licensed Physical Therapist who is Board Certified as an Orthopedic Clinical Specialist.

 This is Southwest General Health Talk. I'm Caitlin Whyte. Well, to start us off today, Doctor, when we are talking about pain management in general, what does that include?

Anthony DiFilippio, DPT: Well, kind of the simplistic answer to that is, we as medical professionals are trying to decrease someone's pain to increase their function, and some of the medical professionals use injections, some use medication, and we as physical therapists use a variety of tools and techniques to help us achieve that.

We use some stability exercises, depending on the situation. We have some manual therapy techniques that we tend to use, one of those being soft tissue mobilization. Another one would be joint mobilization to where we make sure that the joint is moving appropriately. Then we have several modalities that we use.

One of them is ultrasound, but, it's not the kind that takes pictures. This is a treatment tool that's more like a deep heat. We have a variety of electrical simulation devices that we use. Some people might be familiar with a TENS unit. That's one of the types of electrosimulation we have. We can use low level laser.

We also have aquatic therapy at some of our offices where we try to unload or unweight a person's lower extremity, maybe their spine, and even upper extremity to some extent. And at one of our centers, we actually have an anti gravity treadmill, which instead of unweighting someone with water, we unweight people with air, and then we can have them do a variety of activities on the treadmill.

And then we also have something called dry needling. We use a real thin filament needle, and we put it in trigger points to try to reduce trigger points, which typically helps reduce some of the pain that people have. So there's a variety of techniques that we have to assist us with decreasing an individual's pain.

Host: Gotcha. So how would you say that you quantify pain in your practice? Or in other words, how would I know as a patient when it's time to go to a doctor to get help with my pain and not just deal with it at home?

Anthony DiFilippio, DPT: I think that's a great question, and I think a lot of people do have that question. The thing that I look at the most is the circumstances surrounding the onset of the pain. So if it's something traumatic, so if you fell or you're lifting something heavy, I would consider that a traumatic event, and I would see somebody as soon as you can on that.

So the quicker we can get to an individual, we can triage them as physical therapists and see if we are the right person for them to see at that particular time. We're trained to send people out if needed to another provider. But the traumatic injury that people have, I would get in fairly quickly, as opposed to if they're more of a gradual onset.

So you wake up one morning and your shoulder's starting to hurt and you know, it doesn't go away in the next few days. Yeah, I would wait maybe a week or two on that and just see if some of the self help techniques do assist with decreasing the pain. But after that, I would say a give it one to two weeks and if it's not getting any better, I would, make an appointment.

Host: Okay. And with so many different treatment options available to us when it comes to pain management, how can physical therapy specifically fit into the mix?

Anthony DiFilippio, DPT: I think we're unique in terms of we actually spend a lot of time with an individual, but the other thing that we really look at is what's the cause of the pain. So we do, an exam again, to make sure that we're the right person at the right time. But why does somebody have the pain? Pain just doesn't start. It starts because of some, something's not working right. So whether a nerve's getting pinched or whether you don't have enough range of motion or there's scar tissue or there's a muscle imbalance. So we want to find out what the root cause of the problem actually is. So we can do more of a long term progression in terms of getting somebody not only their initial pain decrease, but to make sure it doesn't come back in the short term or the long term.

So we do the exam, we come up with an individualized treatment plan at that point in time, and then we typically start treatment the same day. So it's nice that we get to be able to do the exam, figure out what's going on, and then get on board with treating someone right then and there to decrease their pain and increase their function.

Host: Now what does physical therapy do Doctor, that maybe medications can't?

Anthony DiFilippio, DPT: Yeah, I think that's great question. You know one thing with the medications, medications don't really fix much, in terms of pain medications. They mask the pain. It may temporarily allow you to increase your function, but again, it doesn't fix the problem. Anti inflammatories are another popular medication that's given and they do decrease the inflammation, but kind of what we talked about before is pain and inflammation are there because of something happened. So, the result of either some movement impairments or pinched nerve, those types of things.

So, again, temporarily they'll help you out a little bit, but in the long term, typically they come back. You know, I think that's a big benefit to what we can do is there's very few side effects to physical therapy as opposed to a lot of medications.

 And the CDC actually recommends physical therapy as their number one choice of a non pharmacological intervention for low back pain. We have a lot of benefits in terms of physical therapy and very few side effects.

Host: So, as we wrap up here, Doctor, how would I go about setting all of this into motion? Should I call my primary doctor first or can I call you and your team directly to schedule an appointment? How does all that work?

Anthony DiFilippio, DPT: The shorter answer is you can just call our team to make an appointment directly. I like the easy button. The easier it is for someone to get to see a medical professional, I think the better it is. Ohio law was actually changed 20 years ago to allow an individual to see a physical therapist directly.

So there's plenty of benefit to that. So there's no referral needed. Typically we can get someone in within 24 to 48 hours sometimes it's the same day depending on schedules. But, the sooner we can get to somebody, the better it is.

So one of the other things that I kind of look at is how many visits it takes me to get somebody's pain down and the person to be able to get back to their function or whatever they were doing. And if someone sees me directly, I typically, my average number of visits I see somebody is three. When somebody goes to another medical professional and gets referred to me, my average visits are nine.

So there's quite the difference in there. So the sooner we can get to someone, the quicker we can help them, and the quicker they're on the road to recovery. They've done some studies with that also, in terms of somebody sees a physical therapist directly, the average cost of the episode of care is decreased by 1,500 dollars to the patient, which is a big number.

So there's definitely some benefits to doing that. And a lot of people have questions on if their insurance is going to pay for it or not without a referral from a physician or someone like that. And, most of the insurances in Ohio do not require any of that.

Host: Wonderful. Well, thank you so much for joining us today, Doctor, and for all the work that you do. To learn more or to request an appointment, visit swgeneral.com or give us a call at 1-8-3-3-SW-Rehab. That's 1-8-3-3-7-9-7-3-4-2-2. I'm Caitlin Whyte and this is Southwest General Health Talk. Thank you for listening.