Ongoing back pain

01st Sep 2018

Suffering from ongoing back pain and unsure of where best to start?

When it comes to treating ongoing back pain, it can be a bit of a minefield from a patient’s perspective in terms of navigating a pathway through the appropriate specialists. Exactly where you should start and who you should see can be loaded questions given the array of practitioners who could be potentially involved: do you need your GP, a physiotherapist, an osteopath, a chiropractor, a pain management specialist, a neurosurgeon, or all of the above?

Here is some guidance about where to begin, looking at different health professionals who treat back pain.


It’s time to see your GP

Strictly speaking, you can go straight to a physio, osteopath or chiropractor without the necessity to get a referral from your GP first. That said, as a general statement, I’d recommend that you do visit your GP if you have pain that has persisted for more than a few days.

Also, it’s important to visit your doctor if you’re getting any numbness or weakness in your arms or legs, or experiencing pain in them. Otherwise, it’s unlikely that such problems will resolve by themselves, especially without some form of treatment or therapy.


Surgery as the last resort

Patients suffering from back pain can often panic and jump to the worst case scenario, especially if they’ve heard horror stories about people who have had ongoing, painful and sometimes unsuccessful back surgeries.

These days, specialists will go to lengths to explore other measures, reserving back surgery as a last resort. These steps may include cortisone injections (which are often extremely effective for reducing inflammation and consequently reducing pain in inflamed joints, tendons, bursa and muscles), hydrotherapy, physiotherapy programs, medications, anti-inflammatories and pain modifying agents.

Occasionally, if these forms of treatment are unsuitable or ineffective, things such as key-hole decompressions and spinal surgery may be necessary, and if the back remains unstable, a more extensive operation may be required.


Seeing a chiro or osteo after surgery

I’m often asked whether a patient should receive osteopathic and chiropractic treatment following back surgery, and the answer is, it depends. The crux of the matter is whether —if you have simple mechanical or arthritis-type lower back pain—physical therapy will be helpful or yield demonstrated improvements following surgery.

In my opinion, physical therapy will help recovery after surgery, and there’s good research to prove it. Among other benefits, physical therapy can improve a patient’s mood. That said, the research is inconclusive about whether the changes yielded by physical therapy would have happened irrespective of the treatment.

However, the value of feeling better mentally shouldn’t be underestimated, but I do encourage patients to be a bit more cautious around their expectations in terms of other improvements.


About Dr Richard Parkinson

Dr Richard Parkinson is a Fellowship trained neurointerventional neurosurgeon and minimally invasive spinal surgeon based in Sydney. He has been performing minimally invasive and complex spinal surgery for 18+ years and has built his reputation on his conservative approach to surgery. He operates at Sydney’s leading private hospitals and has performed surgery on a very significant volume of patients requiring both straight-forward and complex spine surgery. Read his full biography here.