Dec
When confronted with the discomfort of low back pain, you might find yourself contemplating the appropriate course of action. Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center, provides reassurance: “In most cases, you won’t need a specialist.”
When pain strikes
Low back pain can stem from various sources, including muscle or tendon injuries (strains), ligament injuries (sprains), and issues like a herniated or “slipped” disc, where the material inside a disc between spinal bones irritates nerves. Many of these problems tend to resolve over time without specialized intervention.
However, certain causes of low back pain, such as spinal stenosis (narrowing of the spinal canal), may necessitate the expertise of a specialist. Dr. Shmerling advises seeking a referral when conservative measures fail to address the pain, symptoms persist or worsen, or there’s a potential need for surgery.
Where to turn
When experiencing back pain, it’s advisable not to self-diagnose. Instead, seek the expertise of a professional for an accurate assessment. A primary care physician or a chiropractor can serve as the initial point of contact for back pain evaluation, according to Dr. Matthew Kowalski, a chiropractor at the Osher Clinical Center for Integrative Medicine at Harvard-affiliated Brigham and Women’s Hospital. Approximately 35% to 42% of individuals with their first episode of back pain consult a chiropractor.
Chiropractors employ posture exercises and hands-on spinal manipulation to alleviate back pain, enhance functionality, and facilitate the body’s natural healing processes. They often collaborate with other healthcare professionals and can recommend diet, exercise, and stretching programs. A well-trained chiropractor can determine whether you should be under their care or that of a physical therapist or medical doctor, as explained by Dr. Kowalski.
The next step
If specialized care is required for back pain, various experts can offer assistance based on specific needs. Depending on the circumstances, a referral might be made to:
1. Neurologist: Specializes in treating the nervous system and can address back pain associated with lower-extremity symptoms, such as numbness and tingling. Neurologists can differentiate between spine-related and non-spine-related neurological conditions like multiple sclerosis.
2. Physiatrist: A doctor with expertise in physical medicine and rehabilitation, useful for back pain related to sports injuries, where surgery may not be necessary, and medications are not yielding the desired results.
3. Rheumatologist: Specializes in treating diseases of the joints, muscles, and bones. Referral is suitable when there is joint inflammation in the back or when back pain may be linked to an inflammatory disease like psoriatic arthritis.
4. Physical Therapist: A licensed therapist who can assist in strengthening back and core muscles to alleviate pressure on the spine.
5. Pain Management Physician: A doctor who can prescribe medications, administer injections, and explore alternative approaches, particularly beneficial for individuals whose symptoms are not responding to standard treatment.
6. Orthopedic Spinal Surgeon or Neurosurgeon: These specialists may be involved if surgery is deemed likely for severe and persistent pain, potentially arising from disc or spinal column issues.
Keep in mind
To identify the precise cause of back pain, various diagnostic tests such as x-rays, MRIs, and blood tests may be necessary. In some cases, more than one specialist may be involved in managing back pain, depending on the complexity of the situation. Dr. Shmerling notes that individuals seeking assistance from multiple experts often have more than one problem or have not experienced improvement with previous treatments.
However, for conditions like back sprains, strains, and herniated discs, a visit to a primary care physician or chiropractor may be sufficient for effective relief. It is advisable to initiate contact with a healthcare professional if back pain is disrupting daily activities.
