Back pain is one of the most common reasons for people to see their primary care physician, but who do you turn to if you need back pain specialists? If neurologists handle brains and cardiologists handle our hearts, which kind of doctor do you need for back pain?
The answer is a little more complicated than it might first appear, largely because back pain can result from a wide variety of causes. As such, there are a number of different health practitioners that help care for patients with back pain stemming from these various causes.
Choosing the right health professional depends, then, on establishing the root cause of back pain. This begins by assessing back pain symptoms, typically at the level of primary care with a family doctor. The doctor will ask questions about the nature of symptoms and how long they have been present. They will also often carry out a physical assessment to see if there are any clear issues indicating broken bones, torn ligaments, infection, or cancer.
Once this assessment has been carried out and a diagnosis is made or suspected, the physician may then refer the patient to a back pain specialist. In most cases, however, assessment by a primary care physician, chiropractor, or osteopath is sufficient to determine the likely cause of pain and to devise a treatment plan.
If a more serious issue is suspected, or if conservative treatment for back pain does not prove effective, the patient may be referred to a specialist for further assessment. For instance, if there is evidence of spinal cancer, a patient will undergo more testing and be treated by an oncologist. If rheumatoid arthritis is suspected, the patient will be referred to a rheumatologist.
Patients with chronic back pain are likely to be referred to a pain management specialist. This back pain specialist may work in tandem with other specialists to help a patient manage multiple health issues linked to back pain.
Who are the back pain specialists?
Back pain specialists work in multiple fields in hospital and clinic settings and include:
- Spine surgeons
- Physical therapists
- Occupational therapists
The last three professionals in this list work specifically to help a patient rehabilitate or maintain or improve their quality of life while coping with back pain.
Back pain specialists – Chiropractors
For some people, back pain or neck pain will prompt a trip to a chiropractor or osteopath instead of a more traditional primary care physician. Doctor of Chiropractic (DC) are trained to assess and treat back and neck pain. Their training is not as widespread as that of a Medical Doctor, and instead focuses on the musculoskeletal system including the bones, joints, and muscles, as well as the nervous system.
Chiropractors go through extensive training, including four years of academic education, followed by a one-year internship. Various levels of education, training, and examination are required for a chiropractor to become board certified. Additional training is required for chiropractors wanting to use physiological therapeutics in practice, in addition to more basic assessment procedures. Chiropractors may continue their professional development to add skills in diagnostic imaging.
The philosophy behind chiropractic medicine is that the spine is at the root of many bodily functions as it affects the central nervous system. As such, problems in the spine can result in pain and dysfunction elsewhere in the body. By manipulating the spine and vertebral structures, or other joints, chiropractors aim to relieve symptoms and correct imbalances.
Many chiropractors also make use of complementary therapies such as hydrotherapy, light therapy, massage, ultrasound therapy, heat and cold therapy, and taping or other types of physical support. Typically, chiropractors will take a more holistic view of health compared to most primary care physicians. This means that a DC may offer guidance on nutrition, exercise, lifestyle and stress management.
If a chiropractor suspects a serious condition that requires surgery or medication, they must refer the patient to an MD or the appropriate back pain specialist for further assessment and treatment. Chiropractors do not prescribe drugs or perform surgery, unless they are also qualified to do so.
Back pain specialists – Osteopaths
A Doctor of Osteopathic Medicine (DO) is a specialist who is trained to diagnose and treat all illnesses and injuries. They are particularly interested in preventative medicine and take the approach that good health relies on the body’s systems functioning holistically.
The focus of an osteopath is typically on neuromusculoskeletal issues and their relationship to wider health issues. Osteopaths also treat patients with back pain through adjustments and spinal manipulation, and can also prescribe medications as needed. Some osteopaths are also board certified in orthopedic surgery or another specialty related to spine and joint health.
Back pain specialists – Orthopedic and Neurosurgeons
Most surgical procedures related to the spine and back pain are carried out by orthopedic surgeons and/or neurosurgeons. Orthopedic surgeons focus on bones and joints (ortho means bone in Latin), while neurosurgeons focus on the nervous system.
Spinal problems that result in back pain are often a combination of issues with bones and nerves. For instance, arthritis that has caused changes to the vertebrae may be putting pressure on nerves. Both specialists may be involved in treatment to maximize the chances of a successful outcome.
Orthopedic surgeons and neurosurgeons are both trained to do the majority of spine surgery procedures. There are some differences, however. For instance, an orthopedic surgeon is usually chosen for surgeries related to spinal deformity such as scoliosis, while neurosurgeons typically perform surgery for spinal tumors inside the thecal sac.
Back pain specialists – Rheumatologist
A Rheumatologist can be an MD or DO and is a specialist in the diagnosis and treatment of arthritis and other musculoskeletal diseases. To become a rheumatologist you have to undergo four years of medical school followed by three years of training in internal medicine or in pediatrics. This is followed by two to three years of training in rheumatology itself.
Rheumatologists typically have around ten years of training before they become board certified by the American Board of Internal Medicine. Their experience and credentials make them valuable back pain specialists, enabling them to diagnose and treat a huge swatch of chronic musculoskeletal diseases.
If you have any of the following conditions or diseases you are likely to end up working with a rheumatologist for ongoing care:
- Rheumatoid arthritis
- Musculoskeletal pain disorders
- Some autoimmune diseases
Rheumatologists are often able to differentiate complex conditions that look very similar to less specialized physicians. This is important for making sure patients get the most appropriate type of care. Rheumatologists also work alongside other back pain specialists to create tailored treatment plans. They may lead a team of specialists, including primary care physicians, physical therapists, and even clinical counselors or psychologists to enable comprehensive patient care.
These are the main back pain specialists likely to be involved in care for patients with acute or chronic back pain. Their work often overlaps and successful treatment relies on such relationships to provide depth and breadth of expertise.