Navigating Back Pain Treatments: Can a Physiatrist Help?

What is a physiatrist?

Physiatrists, as medical professionals specializing in physical medicine and rehabilitation, play a crucial role in delivering comprehensive and holistic care. Their expertise is dedicated to providing nonsurgical interventions with the primary goal of enhancing functionality in individuals grappling with various conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. In their patient-centered approach, physiatrists frequently take the lead in coordinating a multidisciplinary team, often including professionals like physical therapists and occupational therapists. Additionally, they engage in collaborative efforts with a spectrum of physicians, such as primary care doctors, neurologists, orthopedic surgeons, neurosurgeons, and other specialists, ensuring a well-rounded and integrated approach to patient care.

When should I see a physiatrist?

A considerable number of individuals will encounter back pain at various junctures in their lives. While self-care measures recommended by primary care providers typically provide ample relief for many, persistent or recurrent back pain may necessitate the expertise of a physiatrist. These specialized medical professionals can assist in identifying an optimal blend of treatments to alleviate pain and enhance the individual’s capacity to engage in routine tasks and activities that bring enjoyment.

What could be causing my back pain?

Back pain can originate from various sources, ranging from the spine and supporting muscles to referred pain from other parts of the body. The lower back is particularly prone to pain, and while pinpointing the exact cause can be challenging, physiatrists assess numerous potential sources to formulate effective treatment plans.

Common contributors to low back pain encompass:

1. Intervertebral Disc Degeneration: Over time, wear and tear affect the discs between lumbar vertebrae. These discs, crucial for absorbing spinal impact, may degenerate, leading to issues like disc bulges and herniations. Irritation of nearby nerves can result in leg pain. Activities such as bending forward and prolonged sitting may trigger low back pain in this condition.

2. Spinal Stenosis: The narrowing of the spinal channel through which nerves traverse can induce leg pain, particularly during standing and walking.

3. Lumbar Facet Joint Osteoarthritis: Facet joints, small stabilizing joints in the spine, can contribute to low back pain during activities like bending or turning.

4. Hip Joint Arthritis: This condition may cause referred pain in the buttocks and lower back.

5. Sacroiliac Joint Dysfunction: Dysfunction in this joint can manifest as pain in the buttocks and lower back.

Less common sources of low back pain encompass:

• Fractures: This includes compression fractures of vertebrae, often linked to osteoporosis.
• Infection: Infections can lead to back pain.
• Cancer: Back pain can be a symptom of certain cancers.
• Autoimmune Diseases: Some autoimmune conditions may contribute to low back pain.

Physiatrists carefully consider these potential sources to tailor treatment plans that address the specific underlying causes of low back pain.

What treatment will a physiatrist provide?

When you consult with a physiatrist for back pain, a comprehensive approach is taken to arrive at an accurate diagnosis. The physiatrist conducts a thorough history assessment and performs a detailed musculoskeletal and neurological examination. If the initial findings indicate the need for further investigation, additional tests may be recommended. These tests could encompass blood work, imaging studies such as x-rays, MRIs, or CT scans, as well as assessments of nerve conduction and electrical activity in the muscles through electromyography. The extensive training of physiatrists in musculoskeletal and neuromuscular medicine equips them with the expertise to identify potential sources of back pain throughout the body.

The treatment plan devised by the physiatrist will be tailored to the suspected cause or causes of your back pain. Medications may be prescribed, including nonsteroidal anti-inflammatory drugs (NSAIDs), non-benzodiazepine muscle relaxants, or acetaminophen. In rare cases of severe pain, a short course of opioids may be considered. Physical therapy evaluation and treatment may be recommended for certain individuals to address issues such as poor posture, improve ergonomics at work or home, and enhance low back stability through muscle strengthening. Various noninvasive treatments will be discussed during your evaluation, allowing you to explore the potential benefits, drawbacks, and effectiveness of each option with your physiatrist.

When more treatment is needed

For individuals grappling with severe pain or those who have not achieved adequate relief through conservative treatments, physiatrists trained in peripheral joint injections and spinal injections can provide alternative solutions. Various diagnostic and therapeutic spine injections target distinct causes of back pain, and a physiatrist specializing in spine care can elucidate the associated risks and objectives of these treatment options.

While many individuals find relief through conservative care or injections, some cases may require additional measures, especially if progressive neurological issues arise. In such instances, a physiatrist can assist in making informed decisions about consulting a surgical specialist.

Physiatrists offer a comprehensive array of nonsurgical treatment options for back pain, catering to various stages of the condition. Emphasizing a holistic approach, they collaborate with individuals to formulate personalized treatment plans that focus on enhancing functional abilities, work performance, and the enjoyment of recreational activities. To locate a physiatrist in your area, you can seek a referral from your doctor or health plan or use resources like the American Academy of Physical Medicine and Rehabilitation.