Back Pain: When to See a Neurologist or Orthopedist - Neurology

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Your symptoms suggest that you may be experiencing a combination of musculoskeletal issues and possibly nerve-related problems. Back pain, especially when it is exacerbated by certain positions or movements, can often be linked to the spine, muscles, or nerves. Given your description of pain that is particularly intense upon waking and during certain movements, it is important to consider several potential underlying causes.

Firstly, your pain may be related to muscle strain or tension, which can occur due to poor sleeping posture or an unsupportive mattress. When you sleep, especially in a supine position (lying on your back), if your spine is not properly aligned, it can lead to muscle fatigue and discomfort. The fact that your pain improves after some activity suggests that movement may help alleviate muscle stiffness.

Additionally, you mentioned that the pain is localized to the lower right side of your back, where you feel a bony prominence. This could indicate a possible issue with the lumbar spine, such as a herniated disc or facet joint dysfunction. Herniated discs can cause nerve compression, leading to pain that may radiate down the legs or cause numbness and tingling. If the pain is severe or accompanied by neurological symptoms (like weakness or changes in bowel or bladder control), it is crucial to seek immediate medical attention.

Your description of pain worsening with certain movements, such as bending backward or standing for prolonged periods, could also suggest issues with the lumbar spine or sacroiliac joint dysfunction. The sacroiliac joint connects the lower spine to the pelvis, and dysfunction here can lead to localized pain that may mimic other conditions.

In terms of which specialist to see, both neurologists and orthopedists can be appropriate depending on the specific nature of your symptoms. An orthopedist specializes in the musculoskeletal system, including bones, joints, and muscles, and would be well-equipped to evaluate any structural issues in your spine. They may recommend imaging studies, such as X-rays or MRIs, to assess for any abnormalities.

On the other hand, if your symptoms suggest nerve involvement, such as radiating pain or numbness, a neurologist may be more appropriate. They can conduct nerve conduction studies or electromyography (EMG) to evaluate nerve function and determine if there is any nerve compression or damage.

In summary, given your symptoms of back pain that varies with position and activity, it would be advisable to start with an orthopedist. They can perform a thorough physical examination, assess your posture and spinal alignment, and recommend appropriate imaging studies. Based on their findings, they may refer you to a neurologist if nerve involvement is suspected. Additionally, consider discussing your sleeping arrangements and daily activities, as these may play a significant role in your discomfort.
In the meantime, practicing good posture, engaging in gentle stretching exercises, and using supportive pillows or mattresses may help alleviate some of your symptoms. If your pain persists or worsens, do not hesitate to seek medical attention promptly.