From the Guidelines
For continued back pain, you should refer to a primary care physician first, who can evaluate your condition and recommend appropriate initial treatments. This approach is supported by the American College of Physicians and the American Pain Society, which recommend that clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options 1. The primary care physician can assess the severity of baseline pain and functional deficits, and consider the use of medications with proven benefits, such as acetaminophen or nonsteroidal anti-inflammatory drugs, in conjunction with back care information and self-care 1.
If the patient does not improve with self-care options, the primary care physician may consider referring them to specialists such as:
- An orthopedic specialist or neurosurgeon if severe or progressive neurologic deficits are present or if serious underlying conditions are suspected 1
- A pain management specialist for patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis 1
- A physiatrist (physical medicine and rehabilitation doctor) for intensive interdisciplinary rehabilitation, exercise therapy, or other nonpharmacologic therapies with proven benefits 1
- A chiropractor or osteopathic physician for spinal manipulation, which may provide relief for some patients 1
- A physical therapist to develop exercise programs to strengthen core muscles and improve flexibility, which can help alleviate back pain 1
It is essential to note that the choice of specialist depends on the specific characteristics of the patient's pain, its duration, and the presence of any red flags such as numbness, weakness, or problems with bladder or bowel control that might indicate a serious condition requiring immediate attention 1.
From the Research
Referral Options for Continued Back Pain
For patients experiencing continued back pain, referral to the following healthcare professionals may be considered:
- Primary care physician: According to 2, patients who visited a medical doctor for low back pain received recommendations for both pharmacological and non-pharmacological treatment approaches.
- Physical therapist: As reported in 2, 60% of respondents were recommended physical therapy for their low back pain.
- Specialist (e.g., orthopedist, pain management specialist): The study 3 found that less than 20% of patients with low back pain received evidence-based information and advice from their family practitioner, suggesting a potential need for referral to a specialist.
- Alternative therapy providers (e.g., massage therapist, acupuncturist): 2 found that 37% of respondents were recommended massage, acupuncture, or spinal manipulation for their low back pain.
Considerations for Referral
When referring patients with continued back pain, consider the following:
- The patient's treatment history and previous responses to therapy
- The presence of any underlying medical conditions that may be contributing to the back pain
- The patient's preferences and values regarding treatment options
- The availability of healthcare resources and specialists in the patient's area
- The need for ongoing monitoring and follow-up care, as discussed in 4.