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.
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.
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.