Who Should Treat Your Back Pain?

Everyday we get e-mails from people asking us what type of doctor they should see for their back pain. Our answer is almost always "it depends". Many different specialists treat back pain, and each has different training, skills and interests. For many people, it may take more than one type of specialist to diagnose, treat and rehabilitate their back condition.

Back Pain is More Complex than Many Health Problems

For many back problems, getting a diagnosis and determining the best back pain treatment can be quite complex. The following issues illustrate what makes it so difficult:

• Diagnostic challenges. As many of you already know, getting the problem diagnosed correctly can often be a challenge. To start with, spine specialists don’t always agree on a diagnosis, diagnostic tests have limited value and some tests are controversial. Bottom line, there is no test that can provide an accurate back pain diagnosis, although some conditions are well correlated as causes of back pain (e.g. disc herniation causing sciatica).
• Trial and error. Identifying the problem does not always reveal a solution. There is often more than one way to treat a back condition, and finding the treatment that works best can be a process of trial and error. For example, some people with leg pain caused by a disc problem find that an epidural steroid injection provides great pain relief, while for others it has no effect at all.

• Individual reactions. Two people with identical conditions or symptoms may need very different treatments. For example, two patients may have a herniated disc that looks identical on an MRI, but one may experience severe pain and disability and find that back surgery is the best way to get better quicker, while the other may find that a few weeks of chiropractic care works best.
• Subjective experience. Pain is actually a very personal experience. What may be mild back pain to one person can feel like severe back pain to another, and for each the level of pain needs to be treated accordingly.

With all these factors, along with advances in imaging and treatments, no one doctor can be an expert in all areas of spinal problems and back pain. See the following article for more information: What's a herniated disc, pinched nerve, etc.?

Integrated Spine Clinics Bring Together Different Skills

To handle the challenges involved with diagnosing and treating back conditions, health care experts from different specialties sometimes combine their skills by working together in one clinic—called a multi-disciplinary or integrated spine care clinic. By having access to a variety of doctors and equipment, a patient can benefit from having a coordinated treatment plan and the expertise of several back pain doctors who specialize in different areas of spine care. The idea is that by working in the same practice, the doctors are able to combine their resources and knowledge, which enables them to provide higher quality healthcare for their patients.

In many local communities, this same concept is approached in a different way. Instead of having all of the specialists in one clinic, each specialist maintains their own clinic but they work together by referring patients to each other as appropriate. For more information, see the following article: The integrated approach to back pain treatment.

Be Proactive in Finding the Right Specialist for Your Needs

When a back problem occurs, it is typically best to first visit a primary care physician, osteopath or chiropractor. That doctor will give you an initial exam, and depending on the situation may refer you to another spine specialist for specific treatment if needed. While there are no absolute rules for when to get a referral, there are some general guidelines. For example, if a patient is not getting pain relief after the first 4 to 8 weeks of chiropractic care, typically the chiropractor should recommend a referral to another practitioner—either another chiropractor or another type of spine specialist, such as a physiatrist, physical therapist, pain medicine specialist or spine surgeon. If seems appropriate for you to consult another spine specialist, we encourage you to research your options as much as possible. See also Specialists who treat back pain.

Coordination of Back Care

For many health conditions there is a medical specialist who coordinates the patient’s care—such as a cardiologist who treats patients with heart conditions and refers them to a surgeon, physical therapist, etc. as needed. In spine care, there is no such specialist. But increasingly—especially in integrated spine care clinics—a physiatrist often coordinates a patient’s care within the multi-disciplinary team. The physiatrists’ broad range of training allows them to diagnose and treat patients with many different types of back problems and to know when a patient should be referred to another type of practitioner. See also What is physiatry?

Final Thoughts

If the treatments you’ve tried aren’t working well, consider researching other types of spine specialists—there may be a different type of back doctor better suited to treat your condition. Also, be sure to prepare well for your consultation—especially in the initial consultation, writing a clear, succinct description of your symptoms and the treatments you’ve tried can help you communicate clearly with the spine doctor. Finally, please don’t be shy about seeking a second (or third...) opinion if you think it will help.

Best wishes,
Peter F. Ullrich, Jr., MD, Medical Director
Stephanie Burke, President

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com. The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board. The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.