Who treats back pain?

If you have back pain, you may be thinking of going to see your primary care provider. In fact, back pain is one of the most common reasons people go to the doctor. Your PCP knows your health history and may be in a position to diagnose the cause of your back pain and help you get back on a healthier track.

What to expect: Based on your history and the results of your doctor’s exam, your PCP may confirm you are doing the right things to care for your back and ask you to give it some time to heal. Your provider may have some additional suggestions for things to try at home.

• Examination/Diagnosis — Your practitioner may ask you about your symptoms, behaviors and lifestyle, and perform a physical examination.¹ If he or she considers your back condition to be severe, your PCP may order additional diagnostic tests, such as X-rays or an MRI. Note: Imaging tests are not warranted in most cases. Under certain circumstances, however, imaging may be ordered to rule out specific causes of pain, including tumors and spinal stenosis.¹
• Treatments — may include:
  • A prescription for muscle relaxers or painkillers.
  • Referral to physical therapy, chiropractic care, or to an orthopedic surgeon or other specialist.

Be sure to ask about the most conservative care first. Possibly physical therapy, chiropractic care or even acupuncture is the right course of action.

Physical therapy may provide back pain relief without prescription painkillers or invasive procedures. Physical therapists use a variety of treatments to help you improve your movement, reduce your back pain and achieve long-term health benefits.²

What to expect: When you meet with a physical therapist, he or she will do a medical exam, help you develop a plan and use treatment techniques to improve your ability to move, reduce pain, restore function and prevent disability.⁸

• Examination/Diagnosis — Your therapist will do a physical exam that may include testing your mobility and strength.  
• Treatments — may include:
  • Heat
  • Ultrasound
  • Electrical stimulation
  • Muscle-release techniques for your back muscles and soft tissues
  • As your pain improves, the physical therapist can work with you on exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture.²
• What you might feel — There is usually little or no discomfort with physical therapy for back pain. Some treatments provided by the physical therapist, such as massage, heat or ice, may bring some immediate pain relief. Other treatments and education are designed more for long-term prevention and improved mobility.⁹

A chiropractor may be able to help relieve your pain with spinal manipulations or other treatments — and without drugs or surgery.

What to expect:  Your first visit will likely last 30 to 60 minutes. The chiropractor or an assistant will ask about your goals for treatment and your health history. Be sure to explain your current back symptoms to your chiropractor, including any pain, numbness, tingling or weakness you may be experiencing.⁶

• Examination/Diagnosis — Your chiropractor will do a physical exam that may include testing your mobility, checking your blood pressure and taking X-rays. The chiropractor will be looking for problems that may be adding to your back pain.⁶
• Treatments — If you and the chiropractor agree that spinal manipulation is appropriate for you, you will be asked to lie on a table where the chiropractor does the manipulation, most commonly by hand. This involves moving a joint in your spine to the end of its range, followed by a light thrust. This is often called an “adjustment.” The purpose of the adjustment is to realign the bones of your spine to make them straighter. The chiropractor may also do other treatments, like massage and other work on soft tissues.⁶
• What you might feel — Some people are a little achy, stiff and tired for a few days after their manipulations. This is because their bodies are adjusting to the new alignment. You should not feel any pain from the manipulation. More than one session is most often needed to correct a problem. Treatments generally last several weeks and may include 2 or 3 short sessions per week (10 to 20 minutes) to start with.⁶

Each year, doctors of acupuncture (also known as acupuncturists) treat millions of Americans for chronic pain.¹⁰ Some people with low back pain report that acupuncture helps relieve their symptoms.²

What to expect: At your first appointment, the acupuncturist will work with you to determine the treatment that may help you the most.¹¹

• Examination/Diagnosis — Initial evaluations and treatment may take up to 60 minutes. Subsequent appointments usually take about a half hour. Your practitioner may ask you about your symptoms, behaviors and lifestyle and perform a physical examination.¹¹
• Treatments — The acupuncturist will treat you by inserting sterilized stainless-steel needles into your skin at specific points on your body.¹¹ Common treatment plans for a single complaint involve 1 or 2 treatments a week. Six to 8 treatments are typical, depending on the condition being treated and its severity.
• What you might feel — Acupuncture needles are very thin and likely you’ll feel little or no discomfort when they’re inserted or removed. You may feel a mild aching sensation when each needle reaches the correct depth. Some people feel relaxed and others feel energized after an acupuncture treatment.¹¹

Some specialize in surgery of the back and spine conditions. Other specialists you may be referred to include neurosurgeons, pain management specialists, and physical medicine and rehabilitation doctors.

What to expect: The specialist may repeat some of the steps your primary care provider followed. He or she will review your medical history with you and possibly repeat some of the diagnostic tests you’ve had and conduct additional tests.

• A pain management specialist: May recommend treatments such as medications, nerve blocks, spinal injections and other interventional techniques.¹³
• Physical medicine and rehabilitation (PM&R) specialists: A suggested treatment plan may include a combination of physical and occupational therapy, exercise training, movement and activity modification, adaptive equipment and assistive devices along with local and systemic medications.¹⁴
• An orthopedic surgeon or neurosurgeon: Can provide nonsurgical treatment and/or perform one of numerous types of surgeries. If you are considering surgery for your back pain, you’ll want to make sure you’ve tried all other options first and get a second opinion.

Expensive and invasive tests are not always needed if you have back pain. Some of the more common diagnostic tests include:

• X-ray — May be used as the first imaging technique to look for broken bones or an injured vertebra.¹
• CT Scan — Special scans that generate images that can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.²
• MRI — An MRI is a noninvasive way to identify a condition requiring prompt surgical treatment. The test can help reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.² However, in most instances, an MRI scan is not necessary during the early phases of low back pain.¹

Here are some things you can do to prepare so you can make the most of your appointment.²

Make a list of:

• Key personal information, including mental or emotional stressors in your life.
• Your symptoms, and when they began.
• All medications, vitamins and other supplements you take, including doses.
• Questions to ask your provider. Some questions may include:
  • What is the most likely cause of my back pain?
  • Do I need diagnostic tests?
  • What treatment approach do you recommend?
  • If you're recommending medications, what are the possible side effects?
  • I have other medical conditions. How can I best manage them together?
  • How long will I need treatment?
  • What self-care measures should I try?
  • What can I do to prevent a recurrence of back pain?

Bring a friend or family member: You might want to take a family member or friend along to help you remember the information you receive.