Chronic Lower Back Pain: Which Specialist Should You Consult?

Lumbar pain

Hello, Doctor.
I would like to ask a question before describing my issue.
I have lower back pain; seeing an orthopedic specialist hasn't helped.
Should I see a neurologist (either internal or external) or a rehabilitation specialist? Here's my situation: About six years ago, in the last two to three months before my military discharge, I suddenly experienced discomfort in my lower back, with a slight aching pain around the first and second lumbar vertebrae, which is commonly referred to as the tailbone area.
Since I had never experienced this issue before, I consulted a medical officer.
However, the matter was left unresolved.
After my discharge, I visited an orthopedic clinic, where I had an X-ray taken.
The doctor said there were no issues with my bones and prescribed medication, which I believe included a muscle relaxant.
My condition slightly improved, but I did not fully recover (the symptoms returned once the medication wore off).
Initially, the pain was mild and sometimes disappeared after a long hot shower.
After moving north for a job, I sought medical attention intermittently due to my busy schedule, only going when the pain became unbearable.
Over the years, there were two or three instances where I could barely get out of bed in the morning.
I first went to a general clinic, had another X-ray, and was again told that my bones were fine.
I received injections (presumably for pain relief and inflammation), but nothing improved.
I was even advised against playing sports.
Later, I sought treatment at a larger hospital, but the results were nearly the same: no signs of spondylitis, normal bones, and only a slight proximity of the last one or two intervertebral discs.
However, I was asked to see a rehabilitation specialist, and I was often questioned about whether my lower back pain radiated to my legs.
I used to say no, but now it seems to be the case.
Does this indicate a worsening condition? I hope you can provide some advice on where to start in order to address this chronic issue, as it has been quite painful.

Wai qiang zhong gan, 20~29 year old female. Ask Date: 2009/07/25

Dr. Ye Boshou reply Neurology

As you mentioned, it may be myositis.
Please consult a rehabilitation specialist first.

Reply Date: 2009/07/25

More Info

Chronic lower back pain can be a complex issue, and it’s understandable that you’re feeling frustrated after seeking help from various specialists without finding a lasting solution. Based on your description, it seems that you have already consulted orthopedic doctors and undergone imaging studies like X-rays, which have not revealed any significant structural problems. This situation often leads to a common dilemma: which specialist to consult next?
Given your history of chronic pain and the fact that you have not found relief through orthopedic consultations, it may be beneficial to consider seeing a specialist in physical medicine and rehabilitation (PM&R), commonly referred to as a rehabilitation doctor. These specialists focus on restoring function and improving quality of life for patients with musculoskeletal issues, including chronic pain. They can provide a comprehensive evaluation of your condition and develop a tailored rehabilitation program that may include physical therapy, exercise, and other modalities.

Additionally, since you mentioned that you sometimes experience pain radiating to your legs, it’s essential to rule out any potential nerve involvement. Consulting a neurologist or a neurosurgeon could be helpful, especially if you start experiencing symptoms like numbness, tingling, or weakness in your legs. These specialists can perform nerve conduction studies or electromyography (EMG) to assess the function of your nerves and muscles, which may provide further insight into your condition.

Physical therapy is often a cornerstone of treatment for chronic lower back pain. A physical therapist can work with you to strengthen the muscles supporting your spine, improve flexibility, and teach you proper body mechanics to prevent further injury. They may also employ modalities such as ultrasound, electrical stimulation, or manual therapy to alleviate pain and promote healing.

In addition to traditional medical approaches, you might also consider complementary therapies such as acupuncture or chiropractic care. Some patients find relief through these alternative treatments, although it’s essential to ensure that any practitioner you consult is licensed and experienced.

It’s also worth noting that lifestyle factors play a significant role in managing chronic pain. Regular exercise, maintaining a healthy weight, and practicing good posture can all contribute to reducing discomfort. Engaging in low-impact activities such as swimming, walking, or yoga can be beneficial. Additionally, stress management techniques, including mindfulness, meditation, or cognitive-behavioral therapy, may help you cope with the emotional aspects of chronic pain.

In summary, given your ongoing symptoms and the lack of improvement from previous consultations, I recommend the following steps:
1. Consult a Physical Medicine and Rehabilitation Specialist: They can provide a comprehensive evaluation and develop a tailored rehabilitation program.

2. Consider a Neurologist or Neurosurgeon: If you experience any new symptoms related to nerve involvement, these specialists can help assess and address potential issues.

3. Engage in Physical Therapy: A physical therapist can guide you through exercises and treatments to strengthen your back and alleviate pain.

4. Explore Complementary Therapies: Acupuncture or chiropractic care may provide additional relief.

5. Focus on Lifestyle Modifications: Incorporate regular exercise, maintain a healthy weight, and practice stress management techniques.

Chronic pain can be challenging, but with the right approach and a multidisciplinary team, it is possible to find relief and improve your quality of life. Don’t hesitate to advocate for yourself and seek out the care that feels right for you.

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