Medical Specialists Who Treat The Back
Unfortunately, part of the problem with back pain is that there is a wide variety of back pain "experts" offering to help the back pain sufferer improve. Because each type of doctor brings along his or her treatment bias, it is important for the medical consumer to be well informed and to understand that every specialty that deals with back pain has a dark side.
Employers and insurers hate it that some chiropractors perform weeks of chiropractic manipulation when it may not be doing any good. On the plus side, chiropractors can't legally prescribe drugs, so there is less risk of their over-medicating a back pain patient, which is the chief problem with general practice physicians who see back pain. Additionally, for some types of back pain, chiropractic manipulation can be very effective and the relief of pain can be instantaneous.
Spine surgeons - orthopedic surgeons or neurosurgeons -- are trained to do surgery and, periodically, some of them are quick to recommend it. But they also may be the most knowledgeable about treating back pain because they see so much of it, and in some cases surgery may be the most prudent and economical solution of all.
A specialty that has gained a lot of attention in the last five years for treating back pain is physical medicine and rehabilitation, also called PMR. These PMR physicians, also called physiatrists, are experts in understanding how muscles work. Because 80 percent of back pain is muscle-related, these physicians are often best suited to treat back pain. A PMR physician, however, may perform unnecessary EMG (electromyography) procedures or administer an excessive number of pain injections. Still, all of these activities are non-surgical and don't burn any bridges as thoroughly as surgery can do. All considered, among centers of excellence that specialize in spine care, PMR doctors are viewed as an ideal specialty for managing back and neck pain. If there is a surgical problem, the PMR physician will typically detect it quickly and refer it promptly to a competent spine surgeon.
Where is the best place to go for back care? That depends on the nature of your problem. Here are some resources to consider for an acute attack of back or neck pain. For chronic back or neck pain, where you have had the symptoms for more than three months, or if you have emergency symptoms, go to the next category.
There are a variety of specialists who see back pain. For simple back pain, a primary care physician - such as a family practice or internal medicine doctor - can do a competent physical evaluation and rule out serious problems.
If you work in a job involving heavy labor and have an injury that happened while at work, your supervisor may suggest that you go to an occupational medicine doctor. Because one-third of the accidents that happen on the job are back injuries, occupational medicine physicians can be very experienced in managing acute back or neck strain.
If there is any one primary care doctor most interested in your quick recovery, it is the occupational medicine doctor. Most "occ. med." clinics depend on having excellent relations with nearby employers for future referrals. Because employers want their employees to return to work as soon as possible, occupational medicine physicians will strive to treat you quickly, get you into physical therapy - often the same day - and check on your progress.
Unfortunately, the same cannot be said all the time for primary care. Because there is a shortage of primary care doctors in most cities, you may find that it is harder to get an appointment to see a primary care doctor than to go right to a back specialist. Also, some primary care doctors may tend to emphasize a medication approach to treating back pain, rather than emphasizing physical therapy.
One complaint some large employers may have about primary care physicians seeing injured workers is that too many times the back pain sufferer is told by the generalist, "Take these pills and call me in two weeks if it still hurts." Consequently, some employers and workers compensation insurance carriers will steer injured workers directly to an occ. med. clinic, or directly to a physiatrist, orthopedic surgeon or neurosurgeon who specializes in back and neck care. These providers are more likely to push the back strain patient to the therapist who will get the person moving again and back to activity as soon as possible.
As we have said, there is evidence that a chiropractor can provide good pain relief for acute back pain. Recent evidence shows that they may also be helpful in controlling symptoms for patients with chronic pain. If you have any red flag symptoms-like loss of control of the bowel, weakness of the leg, foot, or arm and hand - you should seek out an orthopedic surgeon or neurosurgeon. If you are seeing a chiropractor and these symptoms appear, you should expect him or her to obtain a consultation for you with a surgeon to ensure that there is no serious disorder that might require an operation.
The second benefit of chiropractic is that many times there is little waiting time before you can be seen for evaluation. Often, the chiropractor's schedule is flexible enough to work you in on the same or next day. Other benefits of chiropractic are that is doesn't emphasize a dependence on drugs to mask pain symptoms, and it is a non-surgical treatment alternative.
As with any procedure or treatment, you may want to check the coverage under your insurance plan and any restrictions or requirements you might need to meet. Treatment plans should be realistically focused on returning you to as pain-free and active a status as possible in a reasonable time frame. Beware of treatment plans that require you to keep coming back indefinitely for frequent manipulations.
Another good place to start might be the physical medicine and rehabilitation (PMR) specialists mentioned earlier in this article. Many managed care plans favor physiatrists because they are adept at treating back and neck pain with a variety of non-surgical options, including physical therapy and injections. PMR doctors also have a strong understanding of posture and gait and how this may affect back and neck strain.
In theory, a Doctor of Osteopathy, or DO, is a good blend between an MD and a chiropractor. Because DOs are able to prescribe drugs, like MDs, and have training in manipulation, like chiropractors, one would think they would be perfectly suited for treating back pain. Not all DOs do manipulation on their patients, however. One study found that, on average, only 18 percent of patients of DOs received manipulation.
Often, the geographic region in which you live dictates how osteopathic physicians are perceived in the medical community. In some locales DOs are perceived as a notch below MDs, but that is largely a regional bias. Some people believe osteopaths provide a healthy blend between traditional MDs and a more holistic approach to health care.
Generally speaking, these two specialties are highly trained in treating all types of back pain - especially complex surgical cases. Because they are oriented toward surgery, some of the other physicians cited above may be better choices for simple, acute back pain.
Neurologists are experts in dealing with a variety of neurological disorders, including epilepsy, sleep disorders, brain disorders, headache, stroke and chronic pain. Rheumatologists are experts in treating arthritis and other diseases affecting joints, muscles, bones, and tendons. Both specialties may become involved in your case if the other physicians listed above are unable to resolve your pain.
For complex back or neck symptoms that you have had for several months, or for complex emergency symptoms, it is better for you to search for a center that specializes in back pain. Typically, a spine center will include a multidisciplinary team of back care providers: doctors, physical therapists, exercise physiologists as well as access to diagnostics, injections, biofeedback and chiropractic.
Within a spine center there may be several other types of specialists. Neurologists for example, focus on the nervous system, which includes the structure, functions, and abnormalities of the spine, brain, and nerve tissue. They can provide in-depth tests and evaluation of back pain to determine the root of the problem.
Most spine centers will be directed by either orthopedic surgeons or neurosurgeons. Both specialties are extremely experienced with treating the most complex cases imaginable.
The best spine centers focus exclusively on back and neck problems, that is, they don't treat knee, shoulder or brain disorders. Look for a spine clinic where at least 75 percent of patients treated are there for back or neck pain.
Regina Herzlinger, a Harvard Business School professor, believes health care in the future will be transformed into clinics that specialize and have extensive experience in treating complicated problems. She envisions clinics that will cater to people suffering from particular ailments like asthma, diabetes, cancer or spine problems, or in her words, "focused factories."
In Herzlinger's focused factories patients would find all the specialists they might need under one roof. Such is the case at several spine centers of excellence already in existence today. These centers combine skill sets like physical medicine and rehabilitation, neurosurgery, orthopedics, neurology, chiropractic, physical therapy, exercise physiology, psychologists, occupational therapists, athletic trainers and hydrotherapists-all focused on back and neck problems.
If you go to this type of center, you will be assured of receiving the right type of care for your particular back problem.
It can be very important to find a doctor whom you can trust. If you end up with a physician who does not connect with you, or doesn't show genuine concern for your medical problem, you may not believe their recommendations and you may not stick with the therapy or treatment plan prescribed. Too many times patients give up on therapy before they give it a chance to work.
Secondly, it is important to find a doctor who takes the time to listen to you and hear about your back pain story-how you first got it and what it feels like. You are not a widget on an assembly line and shouldn't be treated as such. It is reasonable to expect the physician to spend at least 15 minutes with you in the exam room. For simple acute back pain, a physician shouldn't perform a lot of unnecessary x-rays and diagnostic tests because most back pain will get better on its own.
Once the physician performs the physical exam and begins to have an idea of what may be causing your problem, you should receive a thorough explanation of what may be causing your problem and what the doctor recommends as a next step. Keep in mind that at this point, after a preliminary examination, a doctor may still not know precisely what is causing your problem, and that is okay.
Don't misinterpret statements like, "First we will try a course of physical therapy to relieve pain, but if that doesn't work, we may then try. ." Some people may think, "Do these doctors even know what they're doing?" The physician is not being indecisive, but rather is letting you know in advance that there are many alternatives to treating your back pain, and is involving you in the decision process.
Doctors are people, and they have their own personalities. Some older people like a doctor with an authoritative manner, who may appear decisive and confident and provide orders to be followed explicitly by the patient. "Don't ask questions. Just do it. You don't need to know why."
Other baby boomers find this style unappealing and prefer a physician who collaborates with the patient, taking time to make sure the patient understands the medical aspects of problem as well as the recommended treatment. The younger you are, the more likely you are to want to understand why physical therapy is supposed to work, before you commit to waking up at 6 a.m. for daily exercise sessions with the therapists.
