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.

Let’s talk….

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.

I'm Dr. John Shim, and today I would like to talk about why you may need to see a rheumatologist. As a spinal specialist, and with my experience with thousands of surgeries, I see patients on a daily basis who have frustrations about their neck and back pains. The truth is very few of these folks actually would benefit from surgical management. But because of the desperation, they may seek a surgeon to see if there is an invasive option. As I've stated in several other videos, the only time surgery is necessary is if there is a significant threat to life, or an important bodily function. I know sometimes the pain can be very severe. But pain by itself is not the only reason you should pursue surgery. The source of the pain should be identified, and if the source of the pain has potential to cause a serious problem and is amenable to a surgical solution, then surgery may be necessary, and sometimes even on an emergent basis. On the other hand, these folks who have back pain, but after workup, there is no evidence of a limb or life threatening bodily function are taking a significant amount of risk. In this situation, nonsurgical options, and further diagnostic testing may be necessary. To give an example, throughout the spine that rotates around may be a rheumatologic condition that would not benefit from surgery. Should there be somebody with significant pain, but without a defined risky situation, spinal specialists may ask additional questions about other conditions such as joint pains, migrating areas of pains throughout the body, and family history of conditions such as rheumatoid arthritis. In that scenario, spinal specialists may refer you to a rheumatologist. Rheumatologist are very specialized physicians who understand that sometimes that persons own body may be the source of pain. To try to simplify the understanding, rheumatologists deal with complaints related to inflammation of the joints and tissues caused by the body abnormally reacting to their own tissue. For certain rheumatological conditions, the body thinks its own tissues are foreign, and may need to be removed, or isolated. The body basically attacks its own tissues. The rheumatologist will perform a detailed physical examination, and then use various laboratory tests to determine if you have 1 of these conditions. Rheumatologist have a significant number of medications that can help alleviate, or reduce the pains associated with this condition. Rheumatologist can help people with neck and back pain from these various disease conditions. Rheumatologist work together with an orthopedic surgeon to determine treatment options for these conditions. At times, the conditions may deteriorate to the point surgery may be necessary. On the other hand, with the various treatment options including medications, it is possible rheumatologist may have an effective treatment for certain pains that may suggest a spine specific condition. As always, I remind patients that when a surgeon recommends further nonsurgical options, or consultation with other non-surgical specialists, it is because the surgeon has determined that there was not a current need for urgent surgery, and that currently the risks of surgery may not outweigh the potential benefits. Also, if there are concerns that there is a condition that will not improve with surgery, a prudent surgeon would always recommend against surgery at that time. Every spinal specialist recommends a rheumatologic evaluation, I would certainly encourage that person to see such a doctor. As I always say, I am not tell you what to do. As your consultant, I can only recommend what I would do. This is Dr. John Shim, talking about why a spinal specialist may recommend a rheumatology evaluation. I hope you learned something in this video.

Last modified: October 9, 2019

2 thoughts on “Do I Need a Rheumatologist?

  1. Are you suggesting one sees a rheumatologist before going to a doctor who specializes in conditions concerning the spine?

    1. No, we are suggesting that if your symptoms do not directly correspond with a spinal problem (such as a disc herniation with clear nerve involvement), it is best to rule out other problems before undergoing surgery.

Leave a Reply

Your email address will not be published. Required fields are marked *

*
*