Most low back pain tends to get better on its own within 4 to 6 weeks, regardless of how it’s treated. But if it doesn’t, it’s time to seek more specialized care.
Decades ago, most people who sought treatment for low back pain went to their primary care provider for medication and an X-ray. If their pain became intolerable, perhaps they ultimately saw an orthopedist for back surgery. But today, back pain is managed by a team of experts, each with his or her own specialty.
“It’s no longer the time when you have one person in the room saying, ‘Here’s how I’m going to treat your back pain,’” says David Fish, MD, a physiatrist at the University of California, Los Angeles, Spine Center and an associate professor in the department of orthopedics at the David Geffen School of Medicine at UCLA. “The standard of care now is a multispecialty team, a group effort. It’s not just medication, not just physical therapy, not just injections -- it’s a combination.”
So who should be on your treatment team for low back pain?
Primary Care Physician
Most people with low back pain usually consult their primary care physician first. Increasingly these days, say experts, your primary care provider is likely to refer you to a multispecialty spine center for the management of significant low back pain. Often, the person in charge of back pain care is a physiatrist.
A physiatrist is a medical doctor with specialized training in the musculoskeletal system, physical medicine and rehabilitation, and pain management.
“We’ll take a history and do a physical exam, and may order imaging, to make a diagnosis,” says Victoria Johnson, MD, a physiatrist at Carle Spine Institute, Urbana, Ill. Two other forms of testing performed by physiatrists to help diagnose back pain are nerve conduction studies and electromyelograms, or EMGs. These tests measure the electrical activity of muscles and nerves.
The next step depends on the specific back problem, says Johnson.
The physiatrist might simply order a combination of anti-inflammatory and muscle relaxant medication. “The goal is to interrupt the pain and open a window to let physical therapy work and allow the spine to heal,” says Fish. “Epidural injections can also improve the diagnosis of where the pain is coming from, and open a therapeutic window.”
“Epidural” refers to a particular space in the spinal cord and not a particular type of medication. Epidurals are familiar as a pain relief measure during labor, but the epidural Fish is referring to doesn't numb your lower body. In the case of low back pain, the physiatrist may inject a small dose of medication and steroid in the epidural space.