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Back Pain: Finding the Right Doctor


WebMD Feature from "Good Housekeeping" Magazine

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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.

 

Pain Specialists

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.

Physical Therapists

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).

Chiropractors

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.

Surgeons

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.

Multispecialty Groups

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.

Muscles

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.

Discs

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 better.

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