Q: I saw an orthopedic surgeon for back and leg pain I just started having. Without even an X-ray or MRI, I was diagnosed with a probable herniated disc and put on medications. I'm supposed to see a physiotherapist, too. Should I get a second opinion?

A: It may not be necessary to go any further for the moment. The current standard of care for best practice is as prescribed for you. Unless the surgeon suspects a fracture, infection, or tumor, X-rays and other more advanced imaging studies aren't always needed.

Many times, the clinical exam and history are enough to point to a probable cause of symptoms. For example, a positive straight-leg raise test points to disc pathology. A protruding or herniated disc can put pressure on the nerve causing nerve pain down the leg called sciatica. A straight-leg raise will aggravate the nerve and reproduce the symptoms. If the pain goes down past the knee, it's very likely nerve pain.

Conservative (nonoperative) care is the first line of treatment for most back pain. Treatment begins with a trial of nonsteroidal antiinflammatory drugs and analgesics for pain control. Chiropractic or physiotherapy care has been shown effective as well.

If there has been no improvement (or your symptoms get worse) in the first six weeks, then your surgeon will want to follow up with you. Usually, at least a three-month course of nonoperative care is recommended. If unsuccessful in alleviating your symptoms, then other treatment may be tried after that.

Benjamin W. Friedman, MD, MS, et al. A Randomized Placebo-Controlled Trial of Single-Dose IM Corticosteroid for Radicular Low Back Pain. In Spine. August 15, 2008. Vol. 33. No. 18. Pp. E624-E629.