“Although we don’t have chiropractors on staff here, I frequently refer patients to outside chiropractors,” says Johnson. “They can be very effective. Both chiropractic and physical therapy can be good first-line treatments for back pain.”
Integrative Care and Other Practitioners
Depending on your personal situation, your physiatrist or other back pain specialist may suggest that you see other types of caregivers, including:
- Acupuncturist. Many spine clinics have trained acupuncturists on staff, and some physicians have also trained in acupuncture. This Eastern tradition, which uses fine needles inserted at specific points on the body, has been found in some studies to alleviate back pain.
- Biofeedback or relaxation specialist. Biofeedback and guided relaxation have been found to be helpful for people coping with back pain.
- Nutritionist. If you are overweight or obese, that may be aggravating your back pain. A nutritionist can help improve your diet and reduce the burden of your weight on your back.
- Psychiatrist or psychologist. Many studies have found links between chronic back pain and depression. Whether back pain causes depression, depression causes back pain, or both, it’s a good idea to have access to a mental health specialist to help you cope with the emotional challenges of living with back pain.
At some point, back pain may become so severe and debilitating that your treatment team may recommend surgery.
The recommendation may depend on the severity of your symptoms as well as your specific diagnosis, says Johnson. “If you have generalized degenerative disc disease and lots of arthritis, you probably won’t do well with surgery. Surgery for back pain doesn’t work well with multi-level disease."
However, Johnson says, a reasonably young patient with a single herniated disc, or someone in his or her 50s to 70s with single-level spinal stenosis (narrowing of the spinal canal), can do very well with surgery.
If surgery is right for you, what kind of surgeon will you see? You may be treated by an orthopedic surgeon, who specializes in the musculoskeletal system, or a neurosurgeon, who specializes in the brain and central nervous system, including the spine.
In most cases, either a neurosurgeon or an orthopedic surgeon can perform whatever spinal surgery you might need, says Johnson. “Ten years ago, that might not have been the case. Neurosurgeons weren’t always trained to do fusion and the bone procedures that orthopedists do, but now they get the same training that orthopedic spine surgeons receive.”
In addition to procedures like spinal fusion and lumbar disc replacement, surgeons can also implant a device that can help stabilize the vertebrae in the lower back without the restrictions in movement that accompany spinal fusion. They can also implant a device called a spinal stimulator, which uses electrical impulses to help control chronic pain.