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Part of the series: Living with Chronic Low Back Pain →
12 min readSanoLabs Editorial

What Doctor to See for Back Pain That Won't Go Away: GP, Physio, Specialist or Pain Clinic

What doctor to see for back pain that lasts: usually a GP first, then a physio or specialist, depending on the findings. Signs that cannot wait are listed.

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Your back has hurt for weeks, and you are unsure whether to book your GP, a physio or a specialist. For most people the first stop is a GP or primary care doctor, and specialists come in depending on what the examination shows. Until the appointment you can log lower back pain per day in Sam's symptom diary. You then create a monthly report PDF yourself with your symptom days and most logged symptoms (it has requirements, see below).

This guide covers who does what, how referrals work and what to bring. When back pain counts as chronic, and what belongs in a back pain diary, is in When is back pain chronic?. What Sam keeps for back pain is on the chronic low back pain page.

Who should you see first for back pain?

For most people it is a GP or primary care doctor. The NHS suggests seeing a GP if back pain does not improve after a few weeks of home care, stops you doing day-to-day things, or worries you. The symptoms that cannot wait are listed further down.

You may not need a doctor first. The NHS says you may be able to get physiotherapy from community musculoskeletal (MSK) services without a GP referral. In the US, the American Physical Therapy Association reports that all 50 states allow some form of direct access to a physical therapist. Some states attach conditions. NICE, the UK guideline body, speaks of the first point of contact with a healthcare professional. That can be a GP or a physiotherapist, and NICE suggests a short risk questionnaire there.

Whichever door you use, try to keep one clinician who holds the overview. The German national patient guideline (2017 edition, no longer valid) calls this person a pilot. They keep track of tests, refer you on and hear about every result. That can be your GP or a specialist who looks after you.

How will the doctor examine your back?

Expect a conversation and a physical examination. The usual questions are listed in When is back pain chronic?. Germany's Institute for Quality and Efficiency in Health Care (IQWiG) describes the exam. The doctor feels along your spine, stretches the sciatic nerve and checks the reflexes at your knees and feet. If pain spreads into a leg, the German guideline adds checks of muscle strength and feeling in the legs.

NICE asks clinicians to think about other causes, especially when symptoms are new or have changed. Its examples are cancer, infection, injury and inflammatory disease such as spondyloarthritis. When nothing points to a serious cause, NICE says not to routinely offer imaging outside specialist care. The post on chronic back pain linked above explains when a scan does come up.

If you have numbness, tingling or weakness in a leg, the German guideline has your doctor decide how urgently you need further tests or a specialist. New numbness, growing weakness, severe symptoms or signs of paralysis in one leg need medical help straight away. Numbness or weakness in both legs is an emergency. Both are in the list at the end.

Physiotherapist or physiatrist: what is the difference?

A physiotherapist (physical therapist in the US) assesses how you sit, stand and move. A spine surgeon at the Hospital for Special Surgery in New York describes it that way. You reach physiotherapy through your GP or, where it is allowed, by self-referral.

A physiatrist is a medical doctor who specialises in physical medicine and rehabilitation. UCLA Health describes physiatrists as giving non-surgical care for the musculoskeletal system, including any kind of back or neck pain. They often work in spine centres and coordinate care. The term is mostly used in the US. Which kind of movement suits you, and how much, is for your clinician to work out with you. The symptom diary gives no exercises for your back.

When is a rheumatologist the right specialist?

Some long-lasting back pain is inflammatory, for example axial spondyloarthritis. NICE guideline NG65 tells doctors to refer to a rheumatologist when back pain started before age 45 and has lasted longer than three months. That needs four or more further features, or exactly three plus a positive HLA-B27 blood test. They include pain that started before 35, waking in the second half of the night, buttock pain and improvement with movement. A parent, brother, sister or child with spondyloarthritis counts too.

This is a checklist for doctors, not a test to run on yourself. NICE says not to rule the condition out on the presence or absence of any single sign, symptom or test result. A missing feature is no all-clear. The NHS adds that if blood tests suggest inflammation, you will be referred to a rheumatologist, who then arranges imaging. It helps to note how many minutes you are stiff each morning and whether moving eases it.

When does a GP refer you to a pain clinic?

Pain clinics are for pain that keeps going despite treatment. The German national patient guideline (2017 edition, no longer valid) names situations where specialist pain care can make sense:

  • The pain has got worse over the last six months.
  • You need more and more pain medicine.
  • Emotional strain together with a need for close medical support.

The same guideline wants several specialists to assess you together when severe, limiting pain lasts over twelve weeks despite treatment. Its examples are a pain specialist, a psychologist or psychiatrist and a physiotherapist.

Routes differ by area. At St George's in London, only GPs can refer to the pain clinic, through the NHS e-Referral Service. The first appointment there covers your pain history, general health and medicines, may include an examination, and ends with an agreed plan.

When does back pain need a spine surgeon?

Usually only when other treatment has not helped. That mostly means leg symptoms such as sciatica, not back pain alone. NICE says to consider spinal decompression for sciatica when non-surgical treatment has not improved pain or function and scans match the symptoms. For sciatica it also says your BMI, smoking status or psychological distress should not influence a referral for a surgical opinion. For low back pain itself, NICE says not to offer disc replacement. It also says not to offer spinal fusion unless as part of a randomised controlled trial. The German patient information advises against spine surgery when the cause of the pain is unclear. The NHS says surgery may be an option when a condition such as a slipped disc causes the pain and other treatments have not helped.

Spine surgery is done by orthopaedic spine surgeons or neurosurgeons, as the Mayfield Clinic describes. Spine surgeons treat disorders such as herniated discs and spinal stenosis. Whether you need a surgical opinion is your doctor's call, made with you.

How do referrals and waiting times work?

In England, specialist referrals usually come from your GP; at St George's, for example, through the NHS e-Referral Service. MSK physiotherapy may also take self-referrals. In the US, ask your insurer or the clinic whether you need a referral before you book. Waiting times vary by area and specialty.

While you wait, contact your GP if the pain gets clearly worse or new symptoms appear, without waiting for the specialist appointment. The symptoms in the last section need help at once.

What should you bring to the first specialist visit?

The St George's pain clinic asks GPs to include your pain history, earlier treatments and their results, current and past medicines, the impact on work and home life, and your goals in every referral. Bring the same to any back pain appointment, plus your papers:

  • Your referral letter, if you have one, and earlier scan reports and clinic letters. See getting a copy of your medical records.
  • A list of all your medicines, current and past. See what to put on a medication list.
  • What you have tried, such as physiotherapy, and whether it helped.
  • How the pain affects work and home life.
  • What you hope to get out of the visit.
  • Your diary of the past weeks: how many days, how bad, what you could not do.
  • Your questions, written down.

For the rest of the visit, use the doctor appointment checklist for a chronic condition.

Emergency department, urgent help or GP: where do these symptoms go?

Back pain rarely has a serious cause. Some symptoms still belong with emergency or urgent care, not with a specialist appointment weeks away. The groups follow the NHS, IQWiG, the German patient guideline (table 2; 2017 edition, no longer valid) and the German patient information.

Call your local emergency number (112 in the EU, 999 in the UK, 911 in the US) or go to an emergency department if back pain comes with any of these:

  • Pain, tingling, weakness or numbness in both legs.
  • Numbness in your buttocks or around your genitals or anus.
  • Changes in your bladder or bowels, such as difficulty peeing, or losing control of your bladder or bowels.
  • Changes in how your penis or vagina feels during sex, not being able to get or keep an erection, or not being able to orgasm.
  • Chest pain.
  • Pain that started after a serious accident, such as a car accident.

Do not drive yourself. Ask someone to drive you or call an ambulance.

Get medical help straight away, without waiting for your next appointment, for any of these. In the UK that means an urgent GP appointment or NHS 111. Elsewhere, ask for a same-day appointment or your local out-of-hours service.

  • Signs of paralysis, severe symptoms, new numbness or growing weakness in one leg.
  • A fever, chills, night sweats, or feeling hot, cold, shivery or generally unwell.
  • Severe pain that starts suddenly or gets worse quickly.

See a GP or your doctor about any of these:

  • Weight loss without trying, loss of appetite or a general feeling of physical weakness.
  • A history of cancer.
  • Severe pain at night or at rest.
  • Pain that gets worse at night or when you lie on your back, or that does not ease with rest.
  • Pain after a fall or, with osteoporosis, after heavy lifting or an awkward twist of the spine.
  • Pain spreading down a leg, especially past the knee or into the foot, also with numbness, tingling or weakness.
  • Several signs of inflammatory back pain together: pain lasting more than twelve weeks, a gradual start, morning stiffness that eases with movement and gets worse with rest.
  • Back pain together with psoriasis, inflammatory bowel disease, joint or tendon inflammation or inflammation of the middle layer of the eye.
  • A lump or swelling in your back, or your back has changed shape.
  • Pain that is worse when sneezing, coughing or pooing.
  • Pain between the shoulder blades rather than in the lower back.
  • Back pain that does not improve after a few weeks at home, stops your day-to-day activities, or leaves you worried or struggling to cope.

With the first two groups, do not wait for it to pass. For the third group too, a diary entry does not replace the check by a doctor.

What can you keep in Sam?

In Sam's symptom diary you log lower back pain and morning stiffness per day as mild, moderate or severe. Muscle weakness, numbness and tingling can be logged too, and for those you can tap a coarse body region, such as the left lower leg. New numbness or growing weakness in one leg is not for logging and waiting. It needs medical help straight away, see the section above. There is no 0-to-10 scale, no time of day and no note, so those stay on paper. Sam gives no medical assessment of your entries.

You create the monthly report yourself. The linked page also describes the doctor report. That exists only in the diaries of certain conditions, not for back pain. The monthly report needs notifications allowed, Apple Health access and an answer to the chronic-condition question. From the second report on, you also need to have logged how you felt on at least 15 of the last 30 days: good, a bit off or sick. Symptom entries do not count toward that. Scan reports and clinic letters go into the Health Vault. Pain medicine you only take when needed goes on your medication list, where you tick off each intake; there is no reminder for it. More on the chronic low back pain page.

Log your back pain days in Sam before the specialist visit

You arrive with counted symptom days and your reports in one place, instead of guessing at weeks from memory.

  • Instead of a note in your coat pocket: you log lower back pain on your phone, per day, as mild, moderate or severe.
  • Instead of a tally sheet: you create the monthly report yourself; the PDF shows your symptom days on a calendar and your five most logged symptoms.
  • Instead of a folder of loose pages: scan reports and clinic letters sit in the Health Vault, and you open them in the app during the visit.

The symptom diary keeps no 0-to-10 scale, times of day or notes, and the report has the requirements listed above. New numbness or growing weakness in one leg needs a doctor straight away. More on the chronic low back pain page.

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Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Sources

Updated: October 2026

More on Chronic Low Back Pain

Frequently Asked Questions

What doctor should I see for chronic back pain?+

Usually a GP or primary care doctor first. They examine you, look for signs of a serious cause and refer you on if needed. Depending on what they find, that can be a physiotherapist, a rheumatologist, a pain clinic or a spine surgeon. In the US, a physiatrist, a doctor specialising in non-surgical care of the musculoskeletal system, is another route.

Can I see a physiotherapist without a GP referral?+

Often, yes. The NHS says you may be able to get physiotherapy from community musculoskeletal (MSK) services without a GP referral. In the US, the American Physical Therapy Association reports that all 50 states allow some form of direct access to a physical therapist, though some states attach conditions. Ask the service or your insurer what applies to you.

What is a physiatrist, and should I see one for back pain?+

A physiatrist is a medical doctor who specialises in physical medicine and rehabilitation. They provide non-surgical care for the musculoskeletal system and look after back and neck pain of all kinds, according to UCLA Health. The term is mostly used in the US. Whether one fits your situation is something to discuss with your primary care doctor.

When is a rheumatologist the right specialist for back pain?+

When there are signs of inflammatory back pain, such as axial spondyloarthritis. NICE tells doctors to refer to a rheumatologist when back pain started before age 45, has lasted longer than three months and comes with four or more further features, such as waking in the second half of the night or improving with movement. This is a checklist for doctors, not a self-test, and NICE says not to rule the condition out on the presence or absence of any single sign, symptom or test result.

When does a GP refer you to a pain clinic?+

When pain keeps going despite treatment. The German national patient guideline (2017 edition, no longer valid), for example, mentions pain that has worsened over six months, needing more and more pain medicine, or emotional strain that calls for close medical support. Referral routes vary: at St George's in London, only GPs can refer, through the NHS e-Referral Service.

When does back pain need a spine surgeon?+

Usually only when other treatment has not helped, and mostly for leg symptoms such as sciatica rather than for back pain alone. For sciatica, NICE says to consider spinal decompression when non-surgical treatment has not improved pain or function and scans match the symptoms. For low back pain itself, NICE says not to offer spinal fusion outside a randomised controlled trial, nor disc replacement, and the German patient information advises against spine surgery when the cause of the pain is unclear. Whether you need a surgical opinion is your doctor's call, made with you. The emergency signs in the last answer are different: they need help at once.

What should I bring to my first specialist appointment for back pain?+

Your referral letter if you have one, earlier scan reports and clinic letters, and a list of all your medicines. Add what you have tried and how it worked, how the pain affects work and home life, your diary of the past weeks and your questions. A London NHS pain clinic asks GPs for similar points in every referral.

When should back pain go to the emergency department instead of a specialist?+

Call your local emergency number or go to an emergency department for pain, tingling, weakness or numbness in both legs, numbness in the buttocks or around the genitals or anus, difficulty peeing or loss of bladder or bowel control, changes in how your penis or vagina feels during sex, erection problems or not being able to orgasm, chest pain, or pain after a serious accident. Get medical help straight away, without waiting for your next appointment (in the UK, an urgent GP appointment or NHS 111; elsewhere, a same-day or urgent appointment with your doctor or your local out-of-hours service), for signs of paralysis, severe symptoms, new numbness or growing weakness in one leg, a fever, chills, night sweats or feeling generally unwell, or severe pain that starts suddenly or gets worse quickly. See a doctor about weight loss without trying, loss of appetite or a general feeling of physical weakness, a history of cancer, severe pain at night or at rest, pain that gets worse at night or when you lie on your back or does not ease with rest, pain after a fall or, with osteoporosis, after heavy lifting or an awkward twist of the spine, pain spreading down a leg, especially past the knee or into the foot, also with numbness, tingling or weakness, several signs of inflammatory back pain together (pain lasting more than twelve weeks, a gradual start, morning stiffness that eases with movement and gets worse with rest), back pain together with psoriasis, inflammatory bowel disease, joint or tendon inflammation or inflammation of the middle layer of the eye, a lump, swelling or change of shape in your back, pain that is worse when sneezing, coughing or pooing, pain between the shoulder blades, and back pain that does not improve after a few weeks at home, stops your day-to-day activities, or leaves you worried or struggling to cope.

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