A psychiatrist is a doctor who specializes in treating psychiatric conditions such as depression, schizophrenia, bipolar disease, and other conditions that are associated with psychological impairment as a result of brain dysfunction. Some psychiatrists work with other pain medicine physicians, either to help treat the depression and anxiety that so often accompanies chronic pain, or to assist in managing the patient with medication and psychotherapy.
A radiologist is a physician who specializes in administering and interpreting imaging studies of the brain and body, such as radiographs, magnetic resonance imaging (MRI) studies, and computerized tomographic (CT) studies. Radiologists provide valuable information to other physicians by helping to elucidate a possible anatomic cause of pain. Some radiologists specialize in administering the therapeutic injections commonly performed in pain management.
A rheumatologist is a physician who has received specialty training in diagnosing and managing rheumatologic conditions. Rheumatologic conditions generally include disorders of the immune system, such as lupus or rheumatoid arthritis, or degenerative bone conditions such as osteoarthritis of the hips and knees. Some rheumatologists have a special interest in treating low back pain and other spinal conditions. Sacroiliitis, which is discussed in detail in this article, is an inflammation of part of the lower back that is managed by rheumatologists.
Multispecialty Pain Center
Multispecialty pain centers are comprised of physicians and other clinicians who specialize in diagnosing and managing patients with chronic pain. Such centers may include pain anesthesiologists, pain neurologists, physiatrists, physical therapists, psychologists, and other practitioners who manage chronic pain. Multispecialty pain centers are generally utilized for patients who suffer with chronic pain, including chronic low back pain.
A nurse is a clinician who is trained in the practice of nursing. Nursing is the art and science of providing medical care that is essential to the promotion, maintenance, and restoration of health and well-being in patients. Nursing care also involves the prevention of illness. Nurses work side by side with physicians and often serve as the primary point of contact with the patient. Nurses often develop a specialty, for example pediatric nursing or geriatric nursing. In addition, some nurses receive additional training that qualifies them as a nurse practitioner. Nurse practitioners often work in a physician’s office and manage many aspects of a patient’s medical care, including the writing of prescription medication.
A physical therapist specializes in rehabilitation, but is not a physician. Physical therapists must receive a referral from a physician before treating a patient. Many physical therapists work in their own physical therapy office or practice, and other physical therapists work specifically with a physician. Many physical therapists specialize in sports and orthopedic rehabilitation, and this includes treatment of shoulder, knee, and other joint injuries. Some physical therapists have more specialized training in the spine, but this is not universally so. Some physical therapy techniques center on a concept know as “spine stabilization,” which is a progressive therapy that is developed to ensure maximum strength, movement, flexibility, and stability of the spine. In addition, physical therapists specialize in performing various manual techniques that help to ensure proper patient flexibility and muscle balance. Some physical therapists receive training in spinal manipulation.
Physician assistants practice medicine under the supervision of physicians and surgeons. Physician assistants are trained to provide diagnostic, therapeutic, and preventive health care services, as delegated by a physician. They take medical histories, examine and treat patients, order and interpret laboratory tests and radiographs, and make diagnoses. They may also treat minor injuries. Under special circumstances, physician assistants may be the principal care providers or even make house calls, after which they must confer with a physician.
A psychologist specializes in psychological counseling. Psychologists are licensed professionals. Some psychologists have a doctorate degree, and others have either a master’s degree or a degree as a clinical social worker. Some psychologists specialize in psychoanalysis, and others specialize in cognitive or behavioral therapy. Most pain centers incorporate psychological counseling into their day-to-day practice. For patients who suffer with chronic low back pain, working with a psychologist may be an integral component of proper pain management. Psychologists may help the patient to cope, to learn various behavioral strategies, and to help manage the depression and anxiety that so often accompany chronic pain.
Complementary and Alternative Medicine
Practitioners of complementary and alternative medicine (CAM) provide medical care that is, generally speaking, not part of the core curriculum of medical schools. Increasingly, CAM is being incorporated into more traditional medical care and, in such cases, it is more appropriate to utilize the term integrative medicine. From one point of view, it might best be said that no such thing as “alternative” medicine exists. There should only be good medicine, and all good medicine should be able to withstand the rigors of the scientific method and evidence-based analysis. Thus, if certain treatment claims are to be made, then such claims should be able to withstand scientific scrutiny so that the treatment results can be reproduced by others.
An acupuncturist is a clinician who specializes in acupuncture. Acupuncture has been practiced for more than 4,000 years, beginning as a Chinese medical system. One can become certified in acupuncture in many ways. Some physicians choose to take a specialty course in acupuncture. Others study Traditional Chinese Medicine and still others undertake acupuncture study as part of a broad CAM approach. An acupuncturist uses needles that are inserted into areas of the body lacking a balanced flow of chi or life energy force. In addition, acupuncturists may perform a spinning technique with the needle to obtain a relaxation response in a muscle group. Acupuncture is recognized by the World Health Organization (WHO) as a legitimate treatment for certain medical conditions, and many studies have documented the utility of acupuncture in the treatment of low back pain.
Biofeedback is a technique that utilizes sensors that are attached to a patient’s skin or muscle and then provide signals to a computer. The patient views these signals and is taught how to change them. To change the signals, the patient learns how to relax the skin or muscles. Thus, the computer feedback enables the patient to participate in a relaxation response. Biofeedback specialists are often psychologists who utilize this treatment as one of many ways to help patients obtain a relaxation response.
A chiropractor is a clinician who has successfully completed chiropractic college. Chiropractors are not medical doctors. They have the initials D.C. (Doctor of Chiropractic) after their names. Chiropractors specialize in spinal manipulation, and the chiropractic approach is spine-centered. Chiropractors view the health of the human being as intimately related to the health of the spine, and this includes the structure and form of the spine. Chiropractors may be the first line of management for patients who suffer with uncomplicated low back pain. Chiropractors should refer to a medical physician specialist when low back pain is not improving with treatment, or if other medical concerns arise. For uncomplicated low back pain, some studies have demonstrated increased satisfaction in those patients who have used chiropractors, when compared with patients who have used family medicine physicians, internists, or orthopedic surgeons as part of their initial low back care.
A massage therapist is a clinician who provides massage therapy. Massage therapists have specialty training in working with various muscle groups, using specific hands-on techniques. Some massage therapists work primarily with the acupuncture meridian points (AMMA therapy). Some massage therapists are more sports-oriented, and others utilize more intuitive techniques such as craniosacral technique and myofascial release. Massage therapy generally is used in conjunction with other treatment modalities for patients who suffer with low back pain.
A reflexologist is a clinician who specializes in reflexology. Reflexology clinicians have training in applying pressure to certain areas of the body, generally the feet, which are thought to have meridian connections with other areas of the body such as the low back. By applying pressure, the body becomes more relaxed, and chi energy becomes more balanced.
- Many different types of physicians and other health care providers specialize in managing low back pain. Unfortunately for the patient, no simplistic, universal approach exists for treating this condition.
- For simple low back disorders, many physicians and chiropractors are acceptable for first-line management.
- Both orthopedic surgeons and neurosurgeons who have received specialty training in spine surgery may perform surgery of the lumbar spine.
- Patients who have chronic pain should seek help from a pain medicine specialist or from a pain center.
- Complementary and alternative medicine may be incorporated into good medical practice within an integrative approach.