Types of Doctors

With 7 out of 10 people experiencing low back pain at some point in their lives and low back pain being one of the most common reasons for patient visits to primary care physicians as well as hospitalization, there is no doubt that low back pain exists in epidemic proportions today. The following represent an overview of the most visited physician groups for low back pain.
With chronic pain, patients are often left wondering "who should I go to or who can I depend on?"
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Family Physicians, General Practitionars, and Internists

This group represents the most frequently visited physician group for low back pain. The medical doctor may be called upon to make an initial diagnosis. After taking the history, the medical doctor can review the systems of the body to determine the cause of pain and determine any risk factors. This group is experienced in the treatment of acute low back pain, and while they may not elect to treat the severe, chronic or complicated cases, they are able to rule out the serious problems such as organic disease, cancer and infection.

 
In the absence of high risk factors listed above, this group of physicians may elect to treat low back pain with conservative care, medications, and physical therapy. If symptoms fail to subside or if little improvement is experienced, they will often perform additional tests, and/or consult with or refer you to a specialist.		  
Chiropractors

Chiropractic is the largest alternative and drugless healing profession. Many patients with low back pain will seek chiropractic care for relief. The Agency For Health Care Policy Reform says that chiropractic treatment and exercise is often the most beneficial form of treatment for acute low back pain.

Chiropractors focus on the spinal column, muscles, tendons, nervous system, discs, joints and the relationship to body function.

  Chiropractors perform the majority of manipulative treatments rendered to low back patients and their treatment recommendations may also include passive modalities as electrical stimulation, ultrasound, stretching, hot and cold packs, exercise and nutritional counseling. Chiropractors do not prescribe medications.  
Physiatrists

This physician member group specializes in the treatment of musculoskeletel injuries as low back pain. The therapy they prescribe often includes physical therapy, exercise, therapy modalities, hot and cold packs. They will prescribe medications if needed and order other laboratory or diagnostic testing as indicated. They may also include physical therapists and occupational therapists as part of the treatment plan.
Neurologists

This physician group specializes in the treatment of disorders of the nervous system. They perform detailed neurological exams, and order tests to diagnosis the causes of pain and weakness.
Pain Specialists and Anesthesiologists

Often referred to as “Pain Management”, this specialty of is one of the fastest growing segments in health care today. Often, patients who fail to improve under the more conservative approaches as listed above, are candidates for interventional pain management. This may also include the patient for whom surgery is not an option. The scope practice among this group can vary widely. The arsenal of treatments is usually more on the side of medications and injections than physical medicine as rendered from the groups of physicians listed
  above and some pain management physicians opt for more aggressive procedures.

In the absence of high risk factors listed above, this group of physicians may elect to treat low back pain with conservative care, medications, and physical therapy. If symptoms fail to subside or if little improvement is experienced, they will often perform additional tests, and/or consult with or refer you to a specialist.
  
The more common interventional pain management procedures are known as:
 
Trigger Point Injections involve injections of anesthetic agents into certain, specific points located within the muscle.
Facet Joints Injections involve injections into the facet, joints which hold one spinal vertebral segment to another. Often, steroids are injected into these joints along with anesthetics.
Epidural Injections involve injections of steroids around the tissues that cover the spinal nerve roots (called the dura; thus the term epidural). These are often given in a series of three injections and are known to relieve pain and inflammation.
Selective Nerve Blocks is the term to describe the more selective placement of steroids around individual nerve roots.
 
Implantable Pain Therapies are either stimulation units or drug infusion units that are transplanted under the skin or next to the spine (spinal cord stimulation and intraspinal drug infusion therapy). You may have heard of this after media publicity surrounding actor/comedian Jerry Lewis who has an implant to control his chronic back pain. This can be inserted in conjunction with a neurosurgeon.
 
 
Pain Psychologists

This group has a specialized degree in psychology, for the evaluation and treatment of the psychological component of low back pain. Sometimes, dealing with a structural problem may be limited if there is a significant psychological component. Psychological characteristics, which can accompany pain, are referred to as the six D’s and should be considered as a factor for the determination and the diagnosis of a person suffering from chronic pain syndrome.
 
The Six D’s of Pain Are:
 
Duration – this implies to pain, which persists past a point of tissue healing.
Dramatization – referred to as “posturing” by the patient to depict the degree of pain and determine the presence of any maladaptive behavior.
Drugs – considerations for usage, effect, tolerance and dependency
Despair – chronic pain can cause apprehension and changes in lifestyle leading to depression, irritability, hostility, depression or limit social, recreational or occupational functioning.
 
Disuse – people in pain tend to favor the involved body part, which causes disuse of parts and subsequent pain-producing postural changes. This may lead to non-use of body parts to prevent pain. Continued disuse may lead to weakening.
 
Dysfunction – although a complex phenomena, continued disuse might result in the loss of pacing and copying mechanisms of the individual as well as loss of function in an area.
  When they are present, any of the 6 D’s can bring on additional occurrences as lack of family support or other significant personal or family stresses. The fear of pain or going to the doctors or undergoing procedures or bad previous surgical outcomes in the patient, friends or family members may have an adverse effect. While chronic pain syndromes are often difficult to treat, when compensation or litigation issues are pending, psychological factors may enter into the equation and affect treatment outcomes.
 
 
Neurosurgery

This is a physician who is an expert in the surgical treatment of low back and lower extremity pain. Spinal neurosurgery is executed with the utmost of precision and care to maintain or enhance stability to the lumbar spine, while decompressing the nerves to relieve pain and increase function. The neurosurgery is usually performed with a microscope while the surgeon dissects in the area surrounding the nerve roots, and often uses electro diagnostic nerve root electrical monitoring techniques as EMG or NCV when nerve root injury is at a moderate or greater level of risk.
 
 
Orthopedic Spine Surgeons

This physician group is usually initially trained in orthopedic surgery, and then completes additional training in spine surgery. The scope of their spinal surgery experience is similar to that of neurosurgeons.
 

"I have a three level disk problem in my lower back along with tears, fissures, bulge problems and pinched nerves. This is very dilbilitating and can bring on sharp pain and muscle spasms. When this occurs, I’m usually down for a week or so, having to stay off my feet, lying on the floor with my legs up on a stool, taking anti-inflammatories and muscle relaxers. This is a very bad week for me. A moderate week for me would involve a lot of soreness and hurting, but I can deal with the pain with out drugs. I can move around, but can do nothing else. I may have to use my back brace for support, and apply ice and heat to my back.

A good week was when I was in little to no pain. I may have had a twinge or slight discomfort in my back but it wasn’t constantly on my mind. Even in a good week I was very limited with my activities. I was not been able to do anything that required a jarring effect, such as running or jumping etc. I was not able to carry or lift anything over twenty pounds. I was also unable to stand for long periods of time. Occasionally doing things like pulling laundry out of the dryer, cleaning the bathrooms or mopping the floor would put me down on the floor for a day or two.

I knew surgery was in my future. I considered fusion and artificial disc replacements. But a one level fusion surgery or artificial disc replacement surgery is very complicated and the risks are very scary. Much less a three level surgery. My worst fear was coming out of surgery in worse shape than I went in. I tried back injections, but I did not tolerate the steroids well. I had a couple of severe reactions and the pain relief lasted only three to four months.

When my situation began to require that work full time, I knew that short of surgery, I had to do something about my back. My father saw an ad in a magazine describing spinal decompression and gave it to me. After my consultation with the SpinalAid physician I decided to try it. The risk was a small financial loss but in comparison to surgery there was virtually no risk.

It was explained to me that there are many different financial payment plans for me to choose from. I was very excited to learn that finances would never be a hindrance for my treatment plan. My care was very personalized, and I enjoyed the positive atmosphere. I could tell they were very interested in my progress.

Since I have begun my spinal decompression treatment, I have noticed a huge improvement in my back. The biggest change that I have noticed is that my limitations are far less. I can work longer hours and when I have challenged my back, even though I still get sore, it doesn’t knock me down and out of commission for two to seven days trying to recover. When I have gotten sore from challenging my back, the soreness has only lasted for a day or so.

I do believe I will get better still, as I have yet not completed all of my treatments. I would encourage anyone with the same or similar back problems to get spinal decompression therapy. It is worth at least a try before opting for surgery. I believe now, more than ever that surgery should always be the last resort." -Lori

"The last thing I wanted to experience was a surgical procedure on my spine, and I was elated to learn of the Decompression Therapy that was available for injuries such as mine. My recovery has been nothing short of miraculous, and I would not hesitate to recommend your program to anyone suffering back pain." - Jacquiline