Elite Pain & Health Blog

  • Keley John Booth, MD

Part 1 of 2 Low Back Pain: What to Do - Who to See

Updated: May 4, 2018

Dr. Keley John Booth, MD shares insights from an Interventional Pain Specialists perspective on low back pain treatment options



Low back pain is the most common musculoskeletal condition in adults and as many as 84% of the population will experience low back pain at some point in their lives. In the United States alone, total costs related to back pain is reported to be in excess of $100 billion annually, the majority of which is related to lost wages and reductions in productivity of those who suffer from this disabling condition. Given the widespread occurrence of low back pain conditions, including sciatica, sciatic nerve pain, lumbar degenerative disc disease, radiculopathy, sacroiliac joint pain, and lumbar osteoarthritis, it is likely that you or a family member are personally suffering back pain. The real question is – what should you do if you have back pain?


The answer to that question depends on many factors, not the least of which is - who you are asking? As a spine and low back Interventional Pain Specialist, I have had the opportunity to hear the wide variety of answers provided by the many different types of professions that attempt to evaluate, diagnose, and treat back pain.



What you should do if you have back pain?
Well, it depends on who you are asking?

Consider this, www.health.com wrote in a recent article titled 4 Specialists That Can Help Your Back and How to Pick One, that you need to “shop” for the “back-pain specialist who is right for you”. I am not sure I agree with the advice provided. An individual “shops” for clothes, jewelry, and periodically a vehicle. Making a poor choice when “shopping” should not lead to the potential of a worsening medical condition that ultimately may limit your ability to work, perform home activities, or even move normally.


The list of those that consider themselves back pain specialists includes:

· Doctors (Primary Care, Family Medicine, Internal Medicine)

· Neurosurgeons

· Orthopedic Surgeons

· “Pain” Doctors

· Interventional Pain Specialists

· Anesthesiologists

· Physiatrists

· Interventional Radiologists

· Neurologists

· Psychiatrists

· Physical Therapists

· Chiropractors

· Acupuncturists

· Massage Therapists

· Neighbor’s son - a 2nd year medical student

· Your Sister-in-law that cured herself using a secret remedy

· That guy that talked you into trying CBD ointment last week


Obviously, I was just having some fun towards the end of the list. However, I do want to make the point that the average back pain patient is not able judge the quality of the credentials or experience of the person that is providing them with advice about their back pain. Therefore, “shopping” for a back specialist is not a good option for most. Hence, I have provided this article for those struggling with what to do about low back pain and where to seek low back treatment. Below, I provide a brief overview and perspective. This is not meant to be a comprehensive review of the value of each provider – that was for my medical colleagues that are likely going to call me and provide “constructive feedback”.


Primary Care and Back Pain


The next recommendation is to ask your primary care doctor’s office what to do next. Unfortunately, they don’t always have the time or answers you are seeking for you condition. There are good reasons for this, let’s discuss a few.


According to an article in publication Family Medicine, “primary care physicians spend more than half of their workday interacting with the EHR”. I haven’t seen a study on it yet, but my guess is that the answer to your back pain won’t be found by spending more time with the computer. The reality is that primary care providers are under extreme pressure to be productive and see more and more patients which provides less and less time to spend evaluating and diagnosing a potentially complex low back pain problem.


An article published in 2017 on patient perspectives of communication with their primary care doctors about low back pain in Kaiser Permanente’s The Permanente Journal reports:


“Research has found that patients with chronic low back pain expect physicians to offer diagnostic tests, a diagnosis, information on prognosis, prescription medicines, and referrals”


Also:


“Patients believed that their visit was incomplete when physicians did not perform a physical examination of the affected areas, including touching/palpating painful areas. They also complained about physicians who did not ask them enough questions about their history…”

And in addition:


“Patients wanted physicians to give clear and specific diagnoses with information about what can be done to minimize future damage.”


A theme emerges as you go through the patient reports above, Primary Care physicians can be a bit overwhelmed when attempting to properly evaluate, diagnose, and provide treatment for low back pain. Given the limited amount of time virtually all Primary Care doctors have for spending with patients, it is simply not the best environment to meet the clearly stated needs and wants of the patients suffering low back pain.


See Part 2 for a review of low back pain treatment options



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