If you’re dealing with back pain and hesitant to seek help, perhaps fearing surgery, it’s important to understand that spine surgery isn’t always the answer, and sometimes, it’s not even beneficial.
“Back pain is complex with many variables,” explains Dr. Dowdell. “The right treatment depends on the cause. Surgery can help some types of back pain, but not others.”
For instance, surgery might be an option for a herniated disc, where tissue between vertebrae is displaced. However, arthritis of the spine, involving cartilage breakdown, is often managed with physical therapy, exercise, and anti-inflammatory medications. A lower back strain from lifting heavy objects might improve with home care like rest, stretching, ice or heat, and over-the-counter anti-inflammatories. (Seek immediate medical attention for back injuries from accidents or falls, especially if bowel or bladder control is affected.)
Dr. Dowdell highlights a consistent first step for almost everyone experiencing back pain: knowing the right type of doctor to consult initially.
Here’s his guidance on where to begin, what to anticipate, and what steps may follow if your pain persists.
Start with a Physiatrist for Your Back Problem
Unless your insurance requires a primary care physician referral, Dr. Dowdell recommends a physiatrist as your initial point of contact for back problems. “A physiatrist is essentially the primary care doctor for back pain,” he states. Physiatrists specialize in diagnosing and treating musculoskeletal issues non-surgically, giving them focused expertise compared to a general practitioner. Even if you’ve discussed your back pain with your family doctor, consulting a physiatrist is advisable, especially if your current treatments aren’t providing relief.
Physical Therapy: A Likely Recommendation
Typically, the first line of treatment for ongoing back pain involves a six-week course of physical therapy, alongside home treatments like those mentioned earlier.
Physical therapists are skilled in assessing your posture, movement patterns, and ergonomics. They can advise you on improving your workspace setup and posture and create a personalized exercise and movement plan to alleviate your back pain.
MRI Scans for Persistent Back Pain
If physical therapy doesn’t bring improvement, your physiatrist will likely order an MRI. This imaging test uses powerful magnets to visualize the internal structures of your body. An MRI helps doctors identify potential causes of your pain, such as nerve compression, cartilage or bone degeneration, or other physical issues.
Spine Surgeon Consultation for MRI Review
Often, a spine surgeon, like Dr. Dowdell, will review your MRI results to determine the next treatment step, which may or may not involve surgery.
“My role as a spine surgeon extends beyond performing surgery. It includes accurate diagnosis and guiding patients to the most appropriate doctor, even if surgery isn’t the solution,” Dr. Dowdell explains. “Some patients are disappointed when I rule out surgery, but it’s far worse to perform unnecessary surgery that doesn’t help or even worsens their condition.”
Surgeons may also recommend non-surgical treatments, such as corticosteroid injections, which can provide pain relief and help pinpoint the pain source.
Even if surgery is recommended, minimally invasive procedures are often possible, leading to less pain, fewer complications, and a faster recovery.
Pain Management Specialists for Non-Surgical Back Problems
If your pain continues despite various treatments and surgery isn’t advised, consider consulting a pain management physician. These doctors have specialized training in pain assessment, diagnosis, and treatment, with some specializing specifically in back pain.
Pain management doctors conduct thorough evaluations to understand how pain impacts your daily life and goals. They then create a tailored treatment plan, which may include physical therapy and home exercises.
Prescription medications are used judiciously, aiming for the lowest effective dose for the shortest possible duration to minimize dependency risks. Open communication about your symptoms, goals, and medication concerns is crucial for finding a compassionate and respectful pain management team.
Psychiatry and the Mental Aspect of Back Pain
Dr. Dowdell points out that a psychiatrist can also play a valuable role in managing chronic pain, which is often linked to anxiety and depression.
“I assure my patients that their pain is real and acknowledge its impact on their mental well-being,” he says. “Addressing the mental health aspect can significantly improve their overall condition.” Pain perception is subjective, and understanding its brain mechanisms is vital. HSS pain management doctors undergo extensive training, including psychiatry, to comprehensively address pain.
When to Seek Help from a Back Problem Doctor? The Sooner, The Better.
Dr. Dowdell notes that people rarely seek help for back pain within the first week. More often, individuals endure pain for months or years before seeking medical advice.
However, as with many health issues, early intervention is beneficial. “Seeking help within the first few weeks or months of persistent pain can potentially prevent it from becoming a chronic, lifelong issue,” he advises.
Prolonged back pain can establish pain pathways between your back and brain. The more established these pathways become, the more challenging the pain can be to treat later.
Dr. Dowdell emphasizes that seeking treatment for back pain is often a process.
“It’s unlikely you’ll get a quick diagnosis in a single doctor’s visit,” he says. “Treating back pain requires a step-by-step approach, which is an important message to understand when you’re in pain.”
