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Specialists who treat the pain : An expert in each arena
The list of who treats low back and lower extremity pain is exhaustive.
Most people will suffer an occasional episode of low back pain, but when it
persists, or when it radiates to the lower extremities, it is time to consult an
expert. Other causes for concern include weakness in the lower
extremities, loss of bowel or bladder control, fevers and unintended
weight loss.
Family physicians and
internists are usually the first doctors to be consulted when a patient
has low back or lower extremity pain. They are experienced in the
treatment of low back pain, and see a good deal of it. They will be able
to rule out serious problems such as cancer and infection. If these are
unlikely, they may elect to treat with conservative care, medications, and
physical therapy. If things do not improve in follow up visits, they will
often perform additional tests, and/or consult a specialist.
Chiropractors: Many patients with low back
pain will see chiropractors for evaluation and care. Chiropractic
treatment is often beneficial for the treatment of acute low back pain. It
may be less successful for the treatment of radiating pain to the lower
extremities. When one has had a very long history of low back pain,
chiropractic care may not be of great benefit. Chiropractors perform the
majority of manipulative treatments given, but their treatment methods also
include massage, stretching, electrical stimulation, hot and cold packs,
exercise programs, and nutritional counseling. Chiropractors do not
prescribe medications.
Physiatrists: A medical expert in the
rehabilitative treatment of low back pain, also often address issues of
prevention. The comprehensive program they prescribe often includes
physical therapy, exercise, hot and cold packs, and TENS (transcutaneous nerve
stimulation) units. They will prescribe medications if needed. They
may also include physical therapists
and occupational therapists in the
treatment plan.
Neurologists: A physician expert who specializes in
the non-surgical approach to treatment of disorders of the nervous system.
They perform detailed neurologic exams, and order tests to diagnosis the causes
of pain and weakness.
Pain specialists and
Anesthesiologists: The specialty of pain management is a growing one.
Often, patients who don't improve with more conservative approaches, and for
whom surgery is not an option (either because of age, bleeding problems,
personal preference, or lack of surgical pathology), these specialists may offer
significant relief. The scope of their practices varies greatly.
Some prefer medications while others opt for more aggressive measures.
Trigger point injections involve placing anesthetic into certain muscle points.
Facet joints are the joints which hold one spinal segment to another.
Facet joint injections are injections into these joints with steroids or
anesthetics. Epidural injections involve the placement of steroids around
the covering of the nerve roots (called the dura; thus the term epidural).
The are often given in a series of three shots, and can relieve pain and
inflammation. Nerve blocks involve the more selective placement of
steroids around individual nerve roots. Implantable pain therapies (spinal
cord stimulation and intraspinal drug infusion therapy) can be done in
conjunction with a neurosurgeon.
Pain psychologists: An expert who has
a specialized degree in psychology, who evaluates and treats the psychological
component of low back pain. Sometimes, surgically repairing a structural
problem may be of limited benefit if there is a significant psychological
component. Psychological factors which can potentiate pain, and can
inhibit healing, include depression, anxiety, lack of family support or other
significant personal or family stresses, and fear of pain and hospitals.
Bad previous surgical outcomes in the patient, or in friends or family members,
may have an adverse effect. Also, "unrealistic expectations" will result
in unhappy patients. Chronic pain syndromes are often difficult to treat.
In addition, when compensation or litigation issues are pending, psychological
stresses are created, which may affect surgical outcomes.
Neurosurgery: An expert in neurosurgery deals with
the surgical treatment of low back and lower extremity pain. Neurosurgery
involves diseases of the cervical spine, thoracic spine, and brain, as well. The spectrum
of types of lumbar surgery include
- discectomies ( neurosurgery to remove lumbar discs)
- "redo" discectomies ( neurosurgery for recurrent discs)
- spinal decompressions, for stenosis (narrowing of the spinal canal
resulting in pressure on nerve roots)
- lumbar fusions
- posterior fusions using pedicle screws, rods, for instability
- posterior fusions using interbody fusion with cages or bone, for
instability
- posterior fusions using interbody cages or bone, and pedicle screws
- anterior lumbar interbody fusions (primarily for low back pain)
- dorsal column stimulator implantation for low back and lower extremity
pain
- intrathecal medication pump implantation (for pain and spasticity)
Spinal neurosurgery is done with the greatest of care to keep or add stability to
the lumbar spine, while decompressing the nerves to relieve pain and enhance
function. The neurosurgeon usually uses a microscope while dissecting around
the nerve roots, and often uses nerve root electrical monitoring techniques when
nerve root injury is a moderate risk.
Orthopedic spine surgeons:
An expert who is trained in orthopedic surgery, and then complete
additional training in spine surgery. The scope of their spinal surgery
experience is similar to that of neurosurgeons.
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