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If you're plagued by back pain, it can be a bit confusing about where to go to seek help.

Don't expect doctors to clear things up for you, however. Even they can't agree on where you should start.

A New York City neurologist says he shouldn't be the "physician of last resort" for back pain sufferers. Rather, neurologists should be where those patients begin their search for relief.

"I think a neurologist is equipped more than any other specialist to evaluate such complaints," says Dr. Gary Starkman, who is also a pain specialist.

However, a University of Michigan spine specialist says people with back pain should go to one of the multi-disciplinary spine programs that are becoming common across the country.

These spine programs provide patients with access to many kinds of specialists who can deal with the wide range of psychological and physical issues facing people with back pain, says Dr. Andrew J. Haig, associate professor of physical medicine and rehabilitation and surgery. He's also director of the university's Interdepartmental Spine Program.

Starkman says that back pain patients face a daunting maze as they seek medical help for their condition.

They may be referred to any one of a wide variety of specialists such as an orthopedist, chiropractor, physical therapist, acupuncturist or psychiatrist. Some may even go to a personal trainer or yoga instructor.

"Sometimes they find the right doctor and they get help but, unfortunately, a lot of times they waste time. Often the results are that the acute problem becomes chronic, and the chronic problem is not treated properly. It's either under-treated or over-treated or just mistreated, and results in unnecessary tests or procedures, even surgeries," Starkman says.

He says a neurological exam can be the best way to make a correct diagnosis and a good neurologist is best equipped to probe, pinpoint and analyze back pain.

Seeing a neurologist about back pain isn't overly dramatic, expensive or complicated, Starkman says. It includes an evaluation of the patient's medical history and a complete physical exam. Muscle groups are tested, and there may be diagnostic tests such as X-rays, magnetic resonance imaging (MRI) or computerized tomography (CT).

The neurologist can then determine whether the patient needs more treatment, and which specialist can best provide that treatment.

However, Haig argues, it can be difficult to pinpoint the cause of back pain.

"It's rare that a neurologist or any of us (specialists) will find a specific provable anatomic diagnosis (for back pain). It happens maybe 15 percent of the time. So saying the solution to a back pain problem is diagnosis can't really be supported. That's not the whole picture for most people with back pain," Haig says.

He adds that pain is just a small part of the picture for someone who's suffering serious back problems. Disability associated with back troubles can prevent a person from working or doing daily activities. That can affect their mental health.

"About 40 percent of the patients we see with chronic back pain also have major depression by the time we see them," Haig says.

And about 70 per cent of the patients who come to the Spine Program are in poor physical shape because of the immobility caused by their back problems.

"You're looking at a problem where the person has to be dealt with as a whole person in terms of their disability," Haig says.

That's the emphasis at a spine program, where a patient first sees a physiatrist -- a physician who specializes in physical medicine and rehabilitation. The physiatrist assesses the patient, and determines which spine program specialists would best be able to help the patient, Haig says.

What To Do

For more information about back pain, go to the National Library of Medicine or the American Academy of Orthopaedic Surgeons

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