Low back pain is one of the most common medical complaints, so family doctors see a lot of back pain patients. But if four to six weeks of painkillers and exercise therapy doesn't help a patient, it may be time for a specialist. Many insurance companies require that you get a referral from a family doctor or another primary care physician before they will cover the cost of a specialist.
Between orthopedic surgeons, chiropractors, physiatrists, neurosurgeons, and osteopathic physicians, it's hard to know which doctor can best treat your pain.
Each approaches treatment from a different perspective. No treatment is guaranteed to give relief, so your choice will depend in part on your attitude toward the body and medicineand your doctor's own philosophy.
The back pain caregiver menu
Chiropractors are often the go-to caregivers for back pain. In 2002, approximately 15 million Americans used chiropractic care, about 40 percent of them for low back pain. To become a Doctor of Chiropractic, students must complete four years of education and training at an accredited chiropractic college as well as a one-year internship. Be sure to choose a chiropractor who holds a board certification and is state licensed. Like osteopaths, chiropractors favor physical manipulation of the body, and chiropractic treatment focuses on manipulation of the spine. Be aware that some practitioners make greater claims about what they can cure than others. Choose a chiropractor who is honest about your chances of improvement.
Osteopathic physicians hold Doctor of Osteopathic Medicine (DO) degrees and their training is similar to that of MDs, though osteopathy puts more emphasis on whole-body treatment and musculoskeletal manipulation. Like MDs, they can write prescriptions and perform surgery.
Physiatrists are MDs who specialize in physical medicine and rehabilitation. It's a fairly new specialty. "The field started in the 1940s out of returning vets from World War II and a lot of the injuries they sustained," says physiatrist Joel Press, MD, medical director of the Spine and Sports Rehabilitation Centers at the Rehabilitation Institute of Chicago. "A whole area of medicine evolved to evaluate and treat brain injury, spine injury, and amputees," says Press.
Today physiatrists often have broad practices, but some concentrate on one area such as pediatrics, sports medicine, geriatric medicine, or brain injury. With just 8,000 board-certified physiatrists around the country, they tend to be clustered in big cities, and many people have not heard of this specialty.
By definition, surgeons focus on more invasive treatments. Both neurosurgeons and orthopedic surgeons perform spine surgery. Most people think that neurosurgeons are "brain surgeons" but in fact they perform the majority of their operations on the spine. Becoming a neurosurgeon requires six to seven years in residency, as opposed to the four to five for orthopedists, and neurosurgeons tend to specialize in more delicate casesthat involve areas like the lining of the spinal canalthan orthopedic surgeons.
Which way should you go?
The wide array of back-pain treatment choices can be daunting, suggests Penney Cowan, executive director of the American Chronic Pain Association. "There is no road map that says turn left here and then turn right here," says Cowan.
The advice of a trusted family doctor is a logical place to start your journey. Once a serious problem such as a tumor has been ruled out, back pain treatment is often a collaborative course of treatment. Make sure your general practitioner understands the range of caregivers and the variety of approaches, and start shopping.