Back pain, especially low back pain, is not unique. Experts say that 75 to 85% of Americans will experience back pain at some point in their lives. Although back pain can be debilitating and painful, it is temporary in about 9 out of 10 cases. The pain usually improves without surgery.
Some suffer in silence and avoid seeking relief, fearful of the prospect of major back surgery. Spine surgery is rarely necessary to resolve most back pain issues. In fact, back surgery sometimes fails to provide any relief. In most cases, an orthopedic surgeon should not be your first stop.
The factors that may contribute to back pain are numerous and varied. The most appropriate treatments depend on the cause. While some types of back pain can be helped with major surgery, many others can’t.
While treatment plans will vary widely by individual, the most appropriate kind of doctor to approach first is usually the same for all back pain sufferers. We’ll look at where you should start and why, as well as what your healthcare journey may look like after that first step.
Start with a Physiatrist …
You may have to initially see your primary care doctor for a referral. However, visiting a physiatrist should be your first step if you are experiencing back pain.
Physiatrists, also known as Physical Medicine and Rehabilitation doctors, are particularly adept at providing primary care for back issues. They focus on in-depth diagnostics and non-surgical, minimally invasive treatments of musculoskeletal (muscle and bone) issues.
Physiatrists use their expertise to give patients a big-picture overview of available treatments and preventive measures. They aim to help individuals remain as active as possible regardless of age. Today, physiatry is one of the most comprehensive, multifaceted, and fastest-growing areas of medicine.
Physiatrists also frequently lead the coordination of individual patient treatment plans. They are known for coordinating across multiple medical disciplines and providers beyond their own specialty.
For example, they often collaborate closely with primary care physicians, internal medicine physicians, cardiologists, oncologists, neurosurgeons, neurologists, and physical therapists. This approach helps them provide seamless, patient-centered care. Physiatrists also refer patients to orthopedic surgeons for advanced surgical care when appropriate.
The causes of back pain can be varied, complex, and hidden across difficult-to-isolate individual nerves. This can make back pain diagnosis a challenging, time-consuming process. Physiatrists usually start with a basic treatment plan and then move on to more advanced treatments until they find a solution that works for a patient.
A Physiatrist May Refer You to a Physical Therapist …
Physiatrists often refer patients to physical therapists as part of their initial recommended treatment plans. Physical therapists will create a customized back pain plan that focuses on reducing pain, improving mobility, and strengthening the core and gluteal muscles to support the spine.
This combination of physiatrist-led treatments and physical therapy has proven effective for decades. In fact, Dr. Hans Krause, a path-finding physiatrist, used this approach to relieve President John F. Kennedy’s chronic back pain in the early 1960’s.
If Basic Treatments and Physical Therapy Aren’t Effective, You’ll Likely Get an MRI …
If you’ve finished basic physiatrist-led treatments and physical therapy and your pain hasn’t improved, your physiatrist will probably send you for an MRI. An MRI is an imaging procedure. It is a noninvasive, radiation-free diagnostic tool that uses strong magnetic fields and radio waves to produce detailed, cross-sectional images of organs and soft tissues.
This imaging can help doctors see if a nerve is being pinched, if there’s wear-and-tear on the cartilage or bones, or if there’s another physical problem that might be at the root of your pain.
Your MRI Will Then Be Reviewed in Depth by Your Physiatrist …
A physiatrist will then review the MRI results and develop the next steps in a patient’s treatment plan, which will typically not involve major surgery.
There are many minimally invasive options that can reduce pain. These options are safer than major surgery and enable quicker and easier recovery. Dependent on diagnosis, these might include:
- Fluoroscopy (X-ray) guided spine and joint, diagnostic and therapeutic injections (such as corticosteroid injections)
- Trigger point injections (TPI)
- Radiofrequency ablations (RFA)
- Procedures such as MILD (Minimally Invasive Lumbar Decompression) and Intracept® (basivertibral nerve ablation)
- Neuromodulation pain relief therapies (Spinal Cord Stimulation, Dorsal Root Ganglion Stimulation, Peripheral Nerve Stimulation)
- Advanced interventional spine procedures
In Some Cases, Your Physiatrist May Refer You to a Spine Surgeon …
In some cases, your physiatrist may determine that your condition may be helped with major back surgery. They’ll then refer you to the right spine surgeon, who will then evaluate if spine surgery has the potential to provide relief.
In Other Cases, A Pain Specialist May Be Your Next Stop …
If pain continues to persist after all the treatments you’ve had, a pain specialist physician may be an appropriate option.
Pain medicine is a board-certified subspecialty practiced by several different types of doctors, including physiatrists, anesthesiologists, family medicine practitioners, psychiatrists, neurologists, emergency medicine doctors, and radiologists.
These doctors have specialized training in the assessment, diagnosis, and treatment of pain. Their first step is to conduct a thorough evaluation, discuss how your pain affects your everyday activities and life goals, and then develop a customized treatment plan. This might include physical therapy and at-home exercises.
It is strongly recommended that pain medications be prescribed only when medically necessary. They should also be prescribed in as small a dose as possible for as short a period as possible to help prevent dependency problems.
It’s important to describe your symptoms, goals, and concerns (including any medication-related concerns) with a pain management doctor.
When Should You Seek Out a Physiatrist for Back Pain?
You should consider seeing a physiatrist for back pain if it lasts longer than 1 to 2 weeks, is severe, or does not improve with self-care. You should also seek immediate care for “red flag” symptoms. These include pain with numbness or weakness in your legs, loss of bowel/bladder control, fever, or pain followed by a major injury.
In most cases, it is better to see a physiatrist doctor sooner rather than later. If you get help within the first few weeks or months of having ongoing pain, you might prevent something from becoming a lifelong issue.
Allowing spine pain to linger too long can also change pain pathways from your back to your brain. As pain signals travel back and forth, the pain pathways become more established, which can make it harder to treat the pain later.
Most importantly, when you decide to seek help, you should understand that the treatment process will take time and be a journey.
You shouldn’t expect to have an initial appointment with a physiatrist and walk out with a quick diagnosis and resolution to your issues. Treating back pain requires a step-by-step approach. Sometimes multiple sources of pain need to be diagnosed and isolated individually. But if you give the process adequate time, relief is likely.