10 Types of Back Pain Specialists

What a Spine Doctor is Called

Man complains of arm symptoms to his doctor.
Man complains of arm symptoms to his doctor. ADAM GAULT/SPL/Science Photo Library/Getty Images

Back doctors are not all created equal.   Numerous medical specialties exist for a person with spine pain, and unless you understand the various types, picking out the one (or ones) who can treat you effectively can quickly become overwhelming.   Who do you turn to, and when?  

Here's the short list:

Family and General Practitioners

When your neck or back pain first starts, your family doctor or GP is probably your best bet.

 She may prescribe some pain killers, give you a few exercises to do and possibly send you to a physical therapist.   If she deems your problem a serious one, she'll likely order diagnostic tests and/or refer you on to a specialist such as a rheumatologist or neurologist.

But family doctors can be slow to include new back treatments as they come out, according to a 2006 study published in Spine Journal.  Other than taking your medical history and giving you a physical exam, which are two staples of spine diagnosis, the study found that even as new recommendations were published by leading medical organization, physicians did not adopt them into their practices.

Because of this, taking a pro-active approach when shopping for spine care may be helpful to you.  One way to do this is to research possible diagnostic and treatment options before seeking the doctor.  Asking pointed questions while you're at your appointment is another way.

Pediatricians

Pediatricians provide diagnosis and treatment for a range of childhood health problems including back pain and injuries.  A pediatrician is the family doctor for a child from birth until the early adult years.  If your child's spine condition requires a specialist, your pediatrician will likely refer you.

Emergency Room Doctors

The emergency room is often the go-to destination for people with neck or back pain who need immediate medical attention.   Such injuries may be due to trauma from car accidents, falls or gunshot wounds.  They also include symptoms of  cauda equina syndrome, for example,  loss of bowel or bladder function, or if your legs grow progressively weaker.

If you don't actually need to see a doctor immediately, though, it's best to schedule an appointment with your providers office.

Orthopedists

An orthopedic doctor is a board certified M. D. who specializes in problems - from head to toe - of the musculoskeletal system.   This includes, of course, the spine.  An orthopedist might address conditions such as ruptured discs, scoliosis or other types of neck or low back pain.   Some of the surgeries performed by orthopedic surgeons can also be done by neurosurgeons (see below. )  Examples of such procedures include spinal fusion, discectomies and more.

Rheumatologists

A rheumatologist is a board certified M. D. who treats the many (over 100 according to the American College of Rheumatology) forms of arthritis.  

A sizeable percentage of rheumatologists specialize in inflammatory arthritis; in the spine this type of disease manifests as ankylosing spondylitis, and conditions that may lead up to it.

 

Seeing a rheumatologist for spinal stenosis (which is a progressed form of osteoarthritis) is not out of the question.   But in general, a rheumatologist sees patients who have symptoms of sacroiliitis, axial spondylosis, ankylosing spondylitis, and related issues.

Neurologists

A neurologist is a specialist who diagnoses and treats problems with the nervous system.  Much of this field is focused on people with Parkinson's disease, who have had a stroke, or have been diagnosed with another brain or spinal cord related disorder.

A neurologist might be the doctor of choice if your back or neck pain is chronic and longstanding, as she or he is an expert in the origins of pain.

 A neurologist does not perform spine surgery; instead, she will examine how well your nerves function, prescribe medication and refer you to on to another specialist, as appropriate.

A neurologist can be either an M. D or an osteopathic physician.

Neurosurgeons

A neurosurgeon specializes in diseases and conditions of the central nervous system, and the nerves that branch out from the spine (called the peripheral nervous system.) A neurosurgeon might perform surgery on the brain, the spinal cord or on the spine itself.  While neurosurgeons do provide non-surgical management of back pain, in most cases, you'll be referred to one only after you've exhausted all your conservative care options.

Chiropractors

Chiropractic is a hands-on alternative medicine discipline restores the body's physiological functioning by aligning the spine.  To do this, chiropractors treat subluxations (a term that means something different to the chiropractor than it does to a conventional medical doctor.)  

Chiropractors consider their work to be a combination of an art and a science.  The goal of an adjustment (of a subluxation) is to improve overall health by removing interruptions to the normal flow of nerve transmission.  

It's important to recognize that the strategy of most chiropractic adjustments is to loosen; in other words, to increase flexibility.  Toning and tightening is not really what your chiropractor is going for when they adjust you.  If you're loose jointed, you have a connective tissue compromise or you have osteoporosis, chiropractic may possibly do more harm than good.

Having read news stories of chiropractic patients who suffer a stroke after neck adjustment understandably worries many people. about the safety of this treatment.  

While these incidents do happen, they are rare.  It's a good idea to make your own decision about this, which involves weighing the possibility of a chiropractic induced stroke happening to you against the benefits you anticipate from experiencing the adjustment.

Osteopathic Physicians

An osteopath is board certified physician who, by oath, is bound to work in a patient-centric, holistic way.  Similar to a chiropractor, an osteopath uses her hands to diagnose and especially to treat.  But generally speaking, an osteopath has more education than a chiropractor. .  This is because becoming a board certified osteopath (referred to as a D. O. , or Doctor of Osteopathy) requires graduation from an accredited medical school.  Medical school education tends to be more rigorous than chiropractic school education.  About 20 of medical students are training to be osteopaths.

While osteopaths are licensed to prescribe drugs and perform minor surgeries, more often then not they look to environment and lifestyle and perform hands on manipulation when caring for patients.

Physiatrists

Another type of holistically minded provider, the physiatrist is a board certified physician specializing in physical functioning.   This growing sub-specialty provides rehabilitation for all kinds of conditions and injuries from stroke to low back pain, athletic injuries and more.  Quite often, the physiatrist will coordinate a patient's team of specialists, ensuring a treatment plan that effectively addresses your specific medical needs.

You might understand a physiatrist as a physical therapist M. D.

Source:

Bishop, P.B., Wing, P.C. Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. Spine Journal. May-June 2006. https://www.ncbi.nlm.nih.gov/pubmed/16651222?dopt=AbstractPlus

Breen, A., Austin, H., Campion-Smith, C., Carr, E., & Mann, E.  "You feel so hopeless": A qualitative study of GP management of acute back pain.. Eur J Pain.  Jan 2007. https://www.ncbi.nlm.nih.gov/pubmed/16434220?dopt=AbstractPlus​.

Gould, H.J. III, M.D., Ph.D. (2007). Understanding Pain: What It is, Why It Happens and How It's Managed. New York: Demos.

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