A neurologist treats back pain when the discomfort originates within the nervous system. Neurology is the medical specialty dedicated to diagnosing and treating conditions affecting the brain, spinal cord, and peripheral nerves throughout the body. When back pain involves nerve compression, damage, or irritation, a neurologist possesses the expertise to investigate and manage the condition. Their focus is on diagnosing issues that affect sensation, movement, and reflexes, making them the appropriate specialist when back pain involves the nerve pathways.
The Neurological Focus of Back Pain
Back pain is broadly categorized into mechanical and neurogenic types, which determines the appropriate specialist. Mechanical pain arises from issues with the spine’s structures, such as muscles, ligaments, joints, or the discs themselves. This discomfort is often localized to the back, aggravated by movement, and typically managed by orthopedic specialists or physical therapists.
Conversely, neurogenic back pain stems from irritation or compression of a spinal nerve or the spinal cord itself. This nerve-related pain often presents as radicular pain, a sharp, burning, or shooting sensation that radiates away from the spine and into the limbs. When nerve root compression causes neurological deficits like numbness, tingling, or muscle weakness, it is termed radiculopathy. The neurologist focuses on identifying and treating these conditions where the nervous system drives the symptoms.
Specific Conditions Addressed by Neurologists
Neurologists commonly address back pain stemming from conditions that compromise the spinal nerves. Radiculopathy, or a pinched nerve, is frequent, often caused by a herniated disc or spinal stenosis (narrowing of the spinal canal). In the lower back, this manifests as sciatica, characterized by pain, tingling, or numbness traveling down the sciatic nerve into the leg or foot.
They also diagnose and treat spinal cord disorders like myelopathy, which involves compression of the spinal cord itself. Peripheral neuropathy involves damage to nerves outside the brain and spinal cord, sometimes causing burning pain or weakness in the extremities. Symptoms like foot drop, changes in bladder or bowel control, or pain unresponsive to anti-inflammatory medication strongly suggest neurological involvement.
Diagnostic Procedures Used in Neurology
Neurologists employ specialized tests to precisely locate and characterize nerve dysfunction related to back pain. A diagnostic tool is electrodiagnostic testing, which includes Nerve Conduction Studies (NCS) and Electromyography (EMG). NCS measures the speed and strength of electrical signals through a nerve to detect damage or compression. EMG involves inserting fine needles into muscles to record electrical activity, revealing if muscle weakness is caused by nerve root damage.
These tests provide physiological evidence of nerve injury that imaging alone cannot offer. Neurologists utilize imaging like Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans, focusing on identifying structural issues such as disc herniations or spinal stenosis that compress the nerve roots. A myelogram, involving contrast dye injected into the spinal canal, may enhance visualization of the nerve roots. Diagnostic injections, such as a selective nerve root block, are also used to confirm the exact nerve causing the pain by temporarily numbing it.
Treatment Strategies for Nerve-Related Pain
The neurologist’s primary role is to offer non-surgical treatment options aimed at relieving nerve-related discomfort. Pharmacological management includes prescribing medications to calm irritated nerves, such as certain anti-seizure drugs or antidepressants that modulate pain signals. They may also recommend muscle relaxants to address associated muscle spasms.
Interventional procedures often involve targeted injections to reduce inflammation and pain. Epidural steroid injections deliver anti-inflammatory medication directly into the epidural space, providing temporary relief for nerve root irritation. Neurologists also coordinate care with physical therapists for tailored exercises to strengthen core muscles and improve posture. If non-surgical treatments fail to resolve nerve compression, the neurologist refers the patient to a neurosurgeon or orthopedic spine surgeon for surgical evaluation.