Severe Lower Back Pain: When to See a Neurosurgeon or Internist? - Neurosurgery

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When it comes to severe lower back pain, the decision on whether to see a neurosurgeon or an internist largely depends on the specific characteristics of your symptoms and any accompanying issues you may be experiencing.
Lower back pain can arise from a variety of causes, including muscle strain, ligament sprain, herniated discs, spinal stenosis, or even conditions affecting the nerves. If your pain is localized to the lower back and is triggered by certain movements, such as lifting objects or bending, it may suggest a musculoskeletal issue. In such cases, an internist or a primary care physician is often a good starting point. They can perform a thorough evaluation, including a physical examination, and may order imaging studies like X-rays or MRIs to determine the underlying cause of your pain.

If your symptoms include neurological signs—such as numbness, tingling, weakness in the legs, or bowel and bladder dysfunction—this could indicate nerve involvement, which may warrant a referral to a neurosurgeon. Neurosurgeons specialize in conditions affecting the nervous system, including the spine, and can provide surgical options if conservative treatments fail.

In your case, since you have been experiencing severe pain for 1-2 months, it is advisable to seek medical attention. Here are some steps you can take:
1. Initial Consultation with an Internist or Primary Care Physician: They can assess your symptoms, perform necessary tests, and determine if you need further evaluation or referral to a specialist.

2. Physical Examination: A thorough physical exam can help identify the source of your pain. The doctor may check your range of motion, reflexes, and muscle strength.

3. Imaging Studies: Depending on the findings from your physical exam, your doctor may recommend imaging studies such as X-rays, MRI, or CT scans to visualize the structures in your lower back.

4. Conservative Treatment Options: Before considering surgery, many patients benefit from conservative treatments such as physical therapy, pain management (including medications), and lifestyle modifications.

5. Referral to a Specialist: If your internist suspects a serious underlying condition or if conservative treatments do not provide relief, they may refer you to a neurosurgeon or an orthopedic surgeon specializing in spinal disorders.

6. Monitoring Symptoms: Keep track of any changes in your symptoms, especially if you experience new neurological signs, as this may necessitate urgent evaluation.

In summary, while an internist is typically the first point of contact for lower back pain, if there are signs of nerve involvement or if conservative treatments fail, a referral to a neurosurgeon may be warranted. It is essential to address your symptoms promptly to prevent potential complications and improve your quality of life. Don't hesitate to seek medical attention; early intervention can often lead to better outcomes.