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Thinking of seeing a doctor for your back pain? You probably have several questions, like:

• Do I start by seeing a back doctor or my primary care provider?
• Which specialties treat spine problems?
• What kinds of spine doctors and other specialists might I see along the way?

Sheela Vivekanandan, MD, neurosurgeon, will walk through what a typical spine team looks like, including what types of providers you might see. From your first visit through recovery, she’ll offer some tips about what you can expect.

Getting a Diagnosis

Most adults have a spell of back pain at some point. According to the American Association of Neurological Surgeons, back pain is temporary and gets better without surgery about 90% of the time. Back pain may or may not be associated with leg pain or pain in the buttocks region.

“But sometimes — about half the time — back pain returns within one year. It may go away again on its own. But for some people, it can become chronic,” explains Dr. Vivekanandan.

Chronic back pain means the pain lasts for 12 weeks or more.

This is usually the point at which people think about seeing a doctor. Back pain that lasts for several months can affect your quality of life in many ways. You can miss work, school, and other activities. Chronic back pain has been shown to be associated with anxiety and depression, like most chronic pain conditions.

Most of the time, your primary care physician (PCP) is the best place to start. They can often make an initial diagnosis based on a medical history, a physical exam, and imaging.

Talking to your PCP about your symptoms helps them rule certain conditions out and others in. It also helps them know where to refer you. After they refer you, they can help coordinate your care.

Referrals might include:

• A physical therapist.
• An image of the spine (X-ray, MRI, CT scan)
• A physiatrist.
• A pain management specialist.
• A surgeon specializing in the spine.

Let’s look at what each member of a spine care team does.

Seeing a Spine Surgeon

“You need to see a spine surgeon” may seem like a scary thing to hear.

“Remember that most of what spine surgeons do isn’t necessarily surgery. They’ve had training to do surgery and can offer it. But they nearly always start with nonsurgical treatments,” says Dr. Vivekanandan.

Put another way: Most people won’t need spine surgery. Before a surgeon suggests surgery, they may:

• Talk to you about lifestyle changes.
• Prescribe medicine.
• Refer you for physical therapy.
• Prescribe bracing or other devices.
• Refer you for pain-relieving injections that a pain management or physiatry specialist can perform with collaboration from the spine surgeon.

Surgery is usually the last resort unless you have a medical emergency that requires immediate action. Your spine doctor may recommend it if other treatments have failed and your pain severely affects your quality of life. Surgeries can range from a wide range of procedures, and depending on your specific pathology, you can discuss with your surgeon regarding all options for surgery, and the pros and cons of each approach.

If you need spine surgery, you’ll likely work with a nurse navigator or care coordinator. They’ll make sure you have guidance and support before, during, and after surgery.

What’s the difference between an orthopaedic spine surgeon and a neurosurgeon?

Both orthopaedic surgeons and neurosurgeons treat spine problems.

Orthopaedic surgeons focus on bone, muscle, and joint problems. This means they do things like knee and hip replacements. They also treat a variety of injuries, such as broken bones and carpal tunnel syndrome.

But some orthopaedic surgeons do spinal surgery as well. This makes sense because your spine has bones, muscles, and joints.

Neurosurgeons specialize in problems that affect the brain, nerves, or spinal cord. This includes spinal surgery, as the spine houses the nerves and spinal cord.

Neurosurgeons and orthopaedic surgeons handle many of the same procedures, including surgery for herniated discs, spinal stenosis, and compression fractures.

One difference is that neurosurgeons are the only ones who can operate inside the dura mater of the spinal cord. (The dura mater is the thick membrane layer of your spinal cord.) For spinal tumors or abnormalities involving the spinal cord, you’d want to see a neurosurgeon.

“At UPMC, our orthopaedic surgeons and neurosurgeons work collaboratively together to provide the optimal care approach for our patients,” says Dr. Vivekanandan.

How Physical Therapists Help

Physical therapists (PTs) are vital in helping you manage back pain. You might see a PT as the first line of treatment. A PT can help you:

• Focus on core strength.
• Stretch tight muscles.
• Strengthen muscles and joints.
• Help with muscle imbalances.
• Help you learn the proper techniques for certain activities.

Sometimes, just a few appointments with a PT and a six-week exercise program can dramatically relieve pain.

Physical therapists are also a key part of your care team if you have surgery. Your PT will help you get back to full strength. This usually includes in-person therapy and an exercise program they give you.

You might also need to see an occupational therapist (OT) after surgery.

OTs focus on helping you with daily living activities. They help you relearn work-related skills (especially if your injury happened on the job) and at home.

Physical therapy is often required prior to obtaining more specialized spine imaging such as an MRI or CT scan.

What Do Pain Management Specialists Do?

During your treatment, you may also see a pain management specialist. Pain management specialists are medical doctors who diagnose and treat chronic pain conditions. They use a variety of nonsurgical treatments to manage pain and improve function.

Pain management specialists take a comprehensive approach to treating back pain. They understand the complexities of the musculoskeletal system (bones, muscles, joints) and the nervous system.

These specialists may offer treatments such as:

• Lifestyle and ergonomic advice.
• Medication management.
• Nerve blocks.
• Pain-relieving injections (such as epidural steroid injections).
• Radiofrequency ablations that target the joints of the spine.
• Physical therapy referrals.

A pain management specialist can also refer you to a spine surgeon if more conservative treatments don’t work. The collaboration between the pain management specialist and the spine surgeon can be vital to properly diagnose which part of the spine could be causing your symptoms.

Nurse Navigators: Your Guide to Spine Care

At UPMC, nurse navigators play a crucial role in spine care. They’re specially trained nurses who help triage patients and ensure they see the appropriate spine specialists.

Nurse navigators assist in coordinating appointments, managing referrals, and providing education and support throughout your treatment journey. They’re your primary point of contact, guiding you through each step of your care plan.

Other Members of Your Spine Care Team

Other specialists and providers can also help treat back pain.

They sometimes do so at an orthopaedic, sports medicine, or neurosurgery practice. For example, UPMC has a Center for Integrative Medicine that works closely with back pain specialists.

These other members of your spine care team can include:

• Acupuncturists: Acupuncturists insert very thin needles into precise points on the body to promote healing. For many people, this can help improve function.
• Chiropractors: Chiropractors have training in spinal manipulation. Chiropractic care can help relieve pain. Many chiropractors also provide therapies like trigger point massage and ultrasound.
• Massage therapists: Massage therapists use different techniques to help relieve muscle tension. Massage therapy can help you relax and reduce muscle pain.

Comprehensive Spine Care at UPMC

“When you’re in pain, doing something about it can feel daunting. But each step of the way, the doctors, nurses, and therapists at UPMC can help guide you to what’s next,” says Dr. Vivekanandan. “We work together to help you get your life back and do the things you love.”

Learn more at UPMC Spine Care.