Back Pain: Finding the Right Doctor
Start with your primary-care physician; back pain is so common that most family docs have seen lots of it. Your PCP is also a good person to return to if, later, you get conflicting treatment advice from specialists. He or she can help you evaluate what would be your best next step.
Physiatrists (physical medicine and rehabilitation doctors) offer nonsurgical approaches to rehab and pain relief — probably the best thing to try first. Some utilize spinal injections, nerve blocks, and other interventional techniques, and may have taken special fellowship training in these procedures — a plus. Anesthesiologists (at spine centers or in private practice) are increasingly involved in managing back pain with injections and medications.
They offer structured exercise — frequently the only treatment you'll need. Some have received additional training in spine work, which can be reassuring (though even without the extra schooling, many offer excellent treatment).
They can provide spinal manipulation as well as other kinds of relieving treatment. See an M.D., though, if you have significant weakness or severe neck or lower-back pain.
Orthopedic surgeons and neurosurgeons both treat spines. At one time it was thought that if you had significant nerve involvement, a neurosurgeon might be better, but no longer. "The important thing is to find someone — of either specialty — who's taken a fellowship focused on spine surgery," says Rowland G. Hazard, M.D., of the Dartmouth-Hitchcock Medical Center Spine Center.
When your primary-care physician knows you need further help but the optimal approach isn't clear, a back center that includes many kinds of specialists might be best. That way, there's no prejudice toward one approach over another: "You'll be evaluated and get whatever treatment is most appropriate," Dr. Hazard says. Look for a spine center that's affiliated with a hospital, even if it's housed separately.
Anatomy of the Back
Few of us think much about our backs' anatomy — until it goes out of whack. Then we may think of little else. Familiarize yourself with the parts of the back and why they are causing you pain.