Which Doctor to See for Back Pain: General Practitioner, Neurologist, Orthopedist

About 95% of people experience back pain at least once in their lives, and five out of ten working adults encounter it every year. Most often it resolves on its own within a few weeks, but the question "which doctor should I see" arises almost immediately. Below is how the roles are divided among the family doctor, neurologist, and orthopedic traumatologist.

Which Doctor Treats Back Pain

There is no single "back doctor." Usually the first person consulted is a family doctor or general practitioner; the question of a specialist is decided by the doctor based on the examination findings. The general orientation is well known: radicular pain is typically associated with a neurologist, while a vertebral fracture or displacement is associated with an orthopedic traumatologist. By location, pain is distinguished in the neck, in the middle part of the back, and in the lower part, that is, lumbar pain, or lumbago. By duration: acute lasts up to 6 weeks, subacute — from 6 to 12 weeks, chronic — more than 3 months.

Where to Start: General Practitioner or Family Doctor

The cause of pain often cannot be established: in 90% of cases diagnostic tests find no physiological abnormalities. Such pain is called nonspecific; its source may be a strain of the muscles or ligaments of the back. A family doctor is consulted in the following situations:

• the pain does not ease after several weeks of home measures;
• the pain interferes with ordinary activities or the person finds it hard to cope with it;
• unintentional weight loss has appeared, swelling in the back or a change in its shape;
• there is no relief at rest, and the pain is worse at night;
• the pain intensifies when coughing, sneezing, or having a bowel movement.

A separate reason is pain in the upper part of the back, between the shoulder blades, rather than in the lower back.

When a Neurologist Is Needed

Pain involving a nerve — radiating into the leg, with tingling, weakness, or numbness — is radicular pain. Intervertebral disc disease occurs when the nucleus pulposus ruptures and compresses the nerve roots. Most often this is at the L4–L5 or L5–S1 level; the risk is higher with excess weight, and in men this pathology occurs twice as often. Spinal canal stenosis usually manifests after age 60: pain in the lower back, buttocks, or legs intensifies when standing and eases when sitting.

Which Cases Require an Orthopedic Traumatologist

A structural break — a fracture or displacement of a vertebra — is what is typically associated with an orthopedic traumatologist. Vertebral compression fractures occur in 4% of patients with lower back pain; risk factors are age, female sex, a history of osteoporosis, and long-term use of glucocorticoids. Such a fracture can occur without trauma and often runs without symptoms. Spondylolisthesis — displacement of a vertebra forward relative to the adjacent one — is associated with age-related changes, injuries, and congenital anomalies. Very rarely, back pain is a sign of a serious problem, such as a fracture, tumor, or infection.

Back Pain and Fever: When to See a Doctor Urgently

Fever, chills, or general malaise together with back pain is a reason to see a doctor urgently rather than wait for a scheduled appointment. Infectious causes include osteomyelitis, septic discitis, paraspinal and epidural abscess. Spinal osteomyelitis is most often caused by staphylococci. Sharp pain that begins suddenly or increases rapidly requires urgent evaluation. Referred back pain is possible with diseases of the gallbladder, pancreas, aorta, and kidneys — therefore fever and lower back pain are not always related to the spine.

Back pain by itself is not a reason to call an ambulance; 103 or 112 — if numbness, tingling, or weakness has appeared in both legs, sensation around the genitals and anus has been lost, bladder and bowel function has changed, sensations during sexual intercourse have changed or erection has been lost, and also if back pain is combined with chest pain or began after a serious accident.

What Is Usually Prescribed to Determine the Cause

The examination begins with an assessment: where it hurts, whether the pain radiates, what makes it worse; if necessary, the doctor orders additional tests. In most cases diagnostic tests do not reveal a physiological cause of the pain. This material is for reference: it helps choose a direction but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer