Do I Need a Rheumatologist?
There are many people who are referred to a surgeon the minute they complain of back pain. The truth is very few of these patients would actually benefit from surgical management. Because of the pain, and the desperation the patient feels, they generally think that their only choice is surgery.
As discussed in previous blogs and videos, the only time surgery is necessary is if there is a significant threat to life, or an important bodily function. Though pain can be very severe, it is not the only reason you should pursue surgery. The source of the pain should be identified, and if there is the potential to cause a serious problem then surgery may be necessary, and even sometimes on an emergent basis.
On the other hand, there are people who have back pain, but after workup, there is no evidence of a limb, life, or a bodily function risk. This often upsets patients, but further diagnostic testing may be necessary. What they thought was a herniated disc could be arthritis in the spine. There may be inflammation causing referred pain. Patients should be asked additional questions about other conditions such as joint pains, migrating areas of pain throughout the body, and family history of conditions such as rheumatoid arthritis.
In this scenario, a patient may be referred to a rheumatologist. Rheumatologists are very specialized physicians who understand that there may be another source of pain. Rheumatologists deal with complaints related to inflammation of the joints and tissues caused by the body abnormally reacting to that tissue. For certain rheumatological conditions, the body thinks its own tissues are foreign, and may need to be removed, or isolated.
Rheumatologists will perform a detailed physical examination, and then use various laboratory tests to determine if you have one of these conditions. There are a significant number of medications that can help alleviate, or reduce, the pains associated with certain conditions. At times, these conditions may deteriorate to the point surgery may be necessary.
When a surgeon recommends further nonsurgical options, or consultation with other non-surgical specialists, it is because the surgeon has determined that surgery is not the answer at that time. This is not being dismissive, but thorough. The surgeon’s goal, like the patient’s, is to have the patient as comfortable as possible.
- Moi JHY, Phan U, de Gruchy A, Liew D, Yuen TI, Cunningham JE, Wicks IP. Is establishing a specialist back pain assessment and management service in primary care a safe and effective model? Twelve-month results from the Back pain Assessment Clinic (BAC) prospective cohort pilot study. BMJ Open. 2018 Oct 10;8(10):e019275. PubMed PMID: 30309987
Last modified: December 11, 2020