Back Pain – When is it Time to See a Specialist?

What to consider when the at-home treatments aren’t providing relief.

Most bouts with occasional back pain can be well-managed with at-home treatments. If the pain persists, however, or has led to other symptoms that affect your quality of life, it might be time to visit the doctor. When you decide to make that appointment, you can rest assured that you’re not alone. Each year, back pain is one of the most frequently cited reasons that people pay a visit to the doctor. But what type of doctor is best for your type of back pain? The answer to that question depends on a variety of factors, but I do have some tips to help you navigate the decision.

Most initial doctor’s office visits for back pain result in a discussion about options and medical treatment recommendations that are considered conservative and non-invasive. These options may include but are not necessarily limited to: physical therapy, acupuncture, lifestyle modifications (like gentle exercises or weight loss) or medication.  Sometimes, a treatment provider recommends a combination of these treatments for a while. In back pain cases that resolve on their own with minimal intervention or therapy, this is enough to help people through the initial episode, while providing them with tools to use in the future should back pain strike again.

If you’ve already seen your general practitioner or chiropractor for a physical exam and you’ve been diagnosed with a back problem that has not resolved, you should consider seeking recommendations from a board-certified spine specialist. This is especially true if you’re experiencing any of the following symptoms with the back pain, which can indicate nerve or other spine problems that need to be addressed by an expert:

1.    Pain that travels down one arm or leg, or both.

2.    Fever, chills, night sweats, or otherwise unexplained weight loss.

3.    Immobility in an arm or a leg, or numbness or weakness in a previously  properly functioning limb.

4.    Bowel or bladder control issues.

5.    Difficulty controlling one or both feet.

Even without the above accompanying symptoms, back pain can still become chronic. Chronic back pain refers to unresolved pain that has lasted for three or more months. The vast majority of my medical practice involves helping people who find themselves in this category of the back pain cycle. Chronic pain of any kind is no fun. But especially for those who are battling constant back pain, it can be debilitating and life-altering. People who suffer constant back pain have also likely tried just about everything to get rid of it outside of surgery before they get to me. They’re weary, and sometimes they’re wary as well. I understand. Because I am a spine surgeon, some new patients think that we will immediately jump to invasive spine surgery as the next best option to treat their pain. Most cases of back pain won’t require something as extreme as surgery to fix them. However, surgery can address spine problems that cause intense back pain. But we don’t “treat pain” with spine surgery. The goal of spine surgery is to fix the spine problem that is causing the pain. That is an important distinction.

There are also some circumstances under which it’s wise to seek a spine surgeon’s advice immediately. These would include experiencing back pain following a significant trauma such as from a fall or a vehicle collision. Other essential factors to consider when deciding to see a spine surgeon include your level of back pain and your ability to function. What if the pain continues and is not alleviated through non-surgical treatments or you’re unable to perform regular activities such as working, driving, or sitting at a computer without experiencing pain? In this case, it’s advisable to consult with a spine specialist.

If you’ve visited your primary physician for your back pain concerns and still feel unsure about how to proceed, a second opinion can help. Seeking out other expert opinions can assist you in deciding whether or not surgery is necessary or if other non-invasive options can help your condition. Most importantly, remember that it’s crucial to feel confident in your treatment provider and their plan for your care. 


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