LBP is the second most common reason for seeing a doctor. Most people see their family physician, whether it be a family medicine or internal medicine specialist. If he or she is not sure about the reason for LBP or if you want another opinion, then a referral can be made. Chiropractors are plentiful and also see many patients with back pain. They can examine and treat initially and usually are successful. Sometimes they may want to order an imaging study in addition to plain X-rays and if a HNP is found and their patient isn’t responding to chiropractic, they may refer to a spine specialist. He/she may refer you to a rheumatologist, a specialist in rheumatic disease, or a PM&R specialist, an M.D. specializing in physical medicine and rehabilitation, who can diagnose as well as treat and is often expert at doing EMGs.
Eventually LBP patients may see a spine surgeon, which will be either an orthopedic surgeon or a neurosurgeon. The disc is part of the bony spine, but it causes the most trouble when it presses on a nerve or the spinal cord, so neurosurgeons see a lot of possible HNP patients. If the spine surgeon doesn’t find a need for surgery, he will send the patient back to the referring doctor, with suggestions for non-operative treatment. One referral choice will be a pain management specialist who is usually an anesthesiologist who doesn’t give anesthesia for surgery as much as treating pain with “shots and pills”. In many large cities, a radiologist specializing in brain and spine imaging, a neuroradiologist, performs and interprets all of the imaging studies and can be key in finding the cause of back pain.