Posted by Brigham and Women's Hospital July 1, 2013
Today’s blog post is written by Dr. Donald B. Levy, Medical Director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Matthew H. Kowalski, DC, a chiropractor at the Osher Center.
You have many choices when seeking options for treatment of low back pain; however, many people become overwhelmed trying to identify the most appropriate health care provider. So when should you seek treatment for low back pain and who should you see? This post discusses how to navigate the health care system to get proper care if you are suffering from back pain.
Not all back pain actually requires treatment. Consider a dose of self-care as your first treatment choice. Often, a combination of patience, over-the-counter medications, ice and/or heat, avoidance of injurious activities, and remaining active will relieve uncomplicated low back pain. (Uncomplicated low back pain is an episode of pain without other health concerns or “red flags.”)
Pay Attention to “Red Flags”
Generally, there are certain symptoms or conditions (“red flags”) that you should not ignore if they occur with back pain. If you experience any of the following “red flags” with your back pain, it is important to consult a medical or chiropractic physician immediately:
- Sustain a substantial trauma and/or have weak bones (osteopenia or osteoporosis).
- History of cancer
- Prolonged fever of unknown origin
- Back pain that is waking you from sleep
- Back pain that is not relieved, to some degree, by rest
- Sudden problems controlling your bladder or bowel*
- Loss of feeling, numbness, tingling, pain or weakness in the lower extremities.*
- Unexpected weight loss
- Pain lasting longer than two weeks which has not responded to self care strategies.
*a combination of these two “red flags” may represent a serious condition called cauda equina syndrome, which requires immediate surgical consultation.
Whom Should You Consult?
If you are seeking pain relief through prescription medication, you must consult a medical practitioner (including physician assistants, nurse practitioners, and osteopaths). If you have a complex medical history, or any of the red flags mentioned above, first consult your personal physician who understands your health best.
There are number of health care providers who can assess your condition, provide advice on self-care, and make treatment recommendations. You may receive a variety of explanations about the cause of your pain from different specialists. You should not be concerned about differing opinions since there can be many explanations for spine pain. Most importantly, all specialists agree on the red flags that indicate a serious health problem. Here is some information about the different types of providers who see patients with back pain (in alphabetical order):
- Chiropractor – Provides evaluation and care for non-surgical patients. They administer manual procedures, prescribe therapeutic exercises, and provide advice on ergonomics and nutrition.
- Primary care provider (internist, nurse practitioner, physician’s assistant) – Manages patients with complex medical histories. A primary care provider also may prescribe short-term medication to get you through the acute phase of your back pain.
- Osteopath – Physicians who provide traditional medical treatment, as well as some manipulative therapies.
- Pain management specialist – Physicians who offer a range of services to help patients cope with back pain, including biofeedback, counseling services, acupuncture, spinal injections, implantable therapies, palliative care, hypnosis, cognitive behavioral therapy, interdisciplinary care, pharmacy consultations, and more.
- Physiatrist – Trained in rehabilitation and pain management, most physiatrists specialize in non-surgical treatments. They can evaluate patients, prescribe medications or physical therapy, and administer various types of spinal and musculoskeletal injections when appropriate.
- Physical therapist – Treats patients with both acute and chronic pain, often as part of a spine care team. They integrate manual therapies, exercise, ergonomic training, and soft tissue therapies into their care strategies to help restore strength and endurance.
- Rheumatologist – Evaluates and manages certain arthritic diseases of the spine, such as ankylosing spondylitis.
- Spine surgeon –Provides surgical treatments after other options have been exhausted. Spine surgeons include both orthopedic surgeons and neurosurgeons who have been trained in spinal surgery techniques.
How Long Should It Take to Respond to Treatment?
Your response to treatment is dependent upon a number of factors, including the complexity of your health problem, personal health status, the number of prior episodes of pain, your perception of pain, the severity of your pain, and how well you follow the advice provided. In most instances, you should see a response to non-pharmacologic and non-invasive treatment within a couple of weeks. If you are not responding within two to four weeks, the problem should be further investigated and treatment modified.