Within the realm of neurology?

[cartoondoc]

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I'm a physiatrist and I recently got a consult from a neurologist for back pain. I was a little surprised because I always thought back pain was a "specialty" of neurology (as well as PM&R). Am I wrong? How comfortable do most neurologists feel dealing with back pain?

 

[GopherBrain]

I'm a physiatrist and I recently got a consult from a neurologist for back pain. I was a little surprised because I always thought back pain was a "specialty" of neurology (as well as PM&R). Am I wrong? How comfortable do most neurologists feel dealing with back pain?

Personally, I am happy to help in the management of radiculopathy, symptomatic spinal stenosis, and other situations where the back pain has clear neurological implications, but I don't think of musculoskeletal back pain as being within the realm of neurology.

 

[cartoondoc]

Do you guys do fluoroscopic ESIs?

 

[michaelrack]

I'm a physiatrist and I recently got a consult from a neurologist for back pain.

Maybe you were being consulted to do physical therapy

 

[cartoondoc]

If the consult were from a surgeon, you would definitely be right.

 

[GopherBrain]

Do you guys do fluoroscopic ESIs?

I had to google to even learn what that was!

 

[cartoondoc]

I had to google to even learn what that was!

Oh 🙂 Well, I don't either, so I don't have any extra tools in my belt.

So with that in mind, what could you offer in the way of treatment to a patient with radiculopathy that you couldn't offer to someone with, say, facet-mediated back pain?

 

[GopherBrain]

Oh 🙂 Well, I don't either, so I don't have any extra tools in my belt.

So with that in mind, what could you offer in the way of treatment to a patient with radiculopathy that you couldn't offer to someone with, say, facet-mediated back pain?

Nothing aside from neuropathic pain medications and a detailed exam to follow their weakness (and decide whether it warrants surgery).

It's not so much that neurologists feel unqualified to treat musculoskeletal back pain, as that it really doesn't have anything to do with the nervous system, and therefore isn't our bag. It's the same reason that patients with inexplicable multifocal pain should probably go to pain clinic, rather than neurology, once rheum says it's not a rheum issue (unless there is something specifically suggesting a neurological cause).