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
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.
Lift the sofa to straighten the rug underneath, carry a case of soda from
the car...and you may feel a shot of pain so severe you think you've broken
your back. Far more likely: You have a strain, sprain, or spasm — an extremely
common cause of back pain. And while you may be in agony, these uncomplicated
muscle aches usually ease within two weeks and disappear in six.
After years of wear and tear (or, rarely, a sudden trauma), the gelatinous
pads that act as cushions between bony vertebrae can become thinner, leaving
back bones with less of their natural shock absorbers. The vertebrae crunch
closer together and shift from side to side, putting extra strain on the joints
and on the muscles and ligaments that support the spine. A disc may also begin
to bulge out, or the gel may start to leak out of a rupture — a condition
officially known as "herniated," though often called "slipped" (and, if the
disc is pressing on a nerve, sometimes by names that can't be printed here). If
it's the sciatic nerve that's hit, you'll feel it down your leg, as sciatica —
which is painful, but rarely permanent. Herniated discs tend to shrink on their
own, which reduces the pain-causing pressure. It may feel like three centuries,
but within three months, as many as 90 percent of sufferers feel much