Between the Bones Episode 6: Understanding Physiatry & Pain Management with Dr. Gonchikar

Have you ever heard of physiatry? No, not psychology or physical therapy, but physiatry. That’s pronounced FIZZ-eye-ah-tree. These medical doctors are specially trained to treat ongoing pain of the nerves, muscles, and bones using both surgical and non-surgical techniques. The main focus of physiatry is the patient’s function, independence, and quality of life. 

On today’s episode, host Adam Walker talks to Dr. Swaroop Gonchikar. Dr. Gonchikar specializes in physical medicine & rehabilitation and in interventional spine and non-surgical orthopedics at the OrthoCarolina Spine Center. They discuss the basics of physiatry: what it is when this type of medicine was started, and what type of pain it’s used to treat. They also dive into the details and get answers to these questions: What type of pain injections are there? How much do they hurt for the patient… really? And… How long does the pain relief last?


Dr. Swaroop Gonchikar is a musculoskeletal and interventional spine specialist at OrthoCarolina's Spine Center. Dr. Gonchikar is a member of the Spine Intervention Society (SIS) and the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and joined OrthoCarolina’s team in 2018. In the latest Between the Bones Podcast episode, Dr. Gonchikar shares answers and perspectives on physiatry frequently asked questions.  


What is physiatry, and what does it treat?

Physiatry is a medical subspecialty that treats various conditions but focuses on rehabilitation and pain management. Dr. Gonchikar shared in the interview, “Physiatry has always been a hard question to really define, but mostly because of the wide range of conditions that are treated by a physiatrist. But at its core, it's basically a medical specialty that emphasizes the prevention, diagnosis, treatment, and rehab of people disabled by disease, disorder, or injury.” Physiatrists focus specifically on the nerves, muscles, and bones of their patients. 


How does physiatry improve a patient’s quality of life?

Patients may see a physiatrist for a variety of reasons. Dr. Gonchikar specified that people generally come to his practice at OrthoCarolina, “if they're having functional issues or pain from a spinal cord injury or spine condition, brain injury, cancer, or a sports injury.” Whether the patient is experiencing pain from a spinal cord injury or a spine condition or needs help maintaining their independence following an injury, Dr. Gonchikar focuses on a systematic approach to pain management and quality of life improvement.

When people arrive at the office with pain, their condition is treated systematically. Treatment begins with less-invasive, non-surgical methods, in the hope that surgery can be avoided altogether. Dr. Gonchikar typically recommends physical therapy medications first to determine what particular condition is causing the patient pain. These medications are often called pain injections and vary in type and application.


What type of pain injections are there, and how much do they hurt? 

There are three types of pain injections, sometimes called spine injections: epidurals, Facet injections, and sacroiliac injections. Epidural injections are meant to treat irritated nerves as they exit the spine, which can sometimes cause pain down the arms or legs. Facet injections are used for painful joints in the back of the spine, while sacroiliac injections target the joints that connect the spine to the pelvis at the lowest part of the back. For all three injections, physiatrists use x-rays to guide the needles in real-time.   

The injections are not a pain-free procedure, but the level of pain depends on how inflamed the patient's nerve-muscle, joint, or tendon is. However, physiatrists use a local anesthetic to numb the area before the injection to relieve unnecessary discomfort and, in some cases, use a relaxing method called conscious sedation. Dr. Gonchikar explains that pain felt during the injection can be a helpful tool to determine if the physicians are targeting the correct area: “if a patient is having an epidural injection and we're doing an injection for that nerve as it exits the spine, if it reproduces the pain that they usually feel down their leg in the same locations that may let us know that we're targeting the correct source of the pain.” The injections are usually only successful long-term when combined with other holistic treatments. 


How long will the pain relief last?

Pain relief varies from patient to patient. The steroid effect usually lasts for two to four months. For patients who have undergone ablation treatments, the nerve endings will not regenerate and grow back for up to one year. The success of the pain injections is often determined by the patient’s dedication to the active component of healing – exercises and, sometimes, medications. Dr. Gonchikar explains that with the patient’s commitment to this active component, “Pain can subside completely or at least get to a level where it doesn't limit activities, which is our ultimate goal. I sort of think of inflammation as a forest fire. You, you try to stifle it out so that it doesn't have a chance to regrow, in a way.”


>> Click here to listen to the full episode

Take a deeper look at today’s world of orthopedics. Between the Bones, powered by OrthoCarolina, explores adult and pediatric orthopedic conditions, life-changing research, and the future of healthcare. Hear from orthopedic providers and researchers as they examine their impact on the greater community.



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This information is provided as an educational service and is not intended to serve as medical advice. If you are seeking specific orthopedic advice or assistance, please consult with your OrthoCarolina physician or locate one in your area through OrthoCarolina’s website at www.OrthoCarolina.com.

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