Herniated disk. This occurs when disk material presses on a nerve.
        Sciatica. This condition often occurs when a herniated disk impinges on the sciatic nerve causing sharp, shooting pain through the buttocks and back of the leg.
        Spinal stenosis. This condition occurs when the space around the spinal cord and nerve roots narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.
        Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerative changes in the spine that often come with aging.
        Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward over another.

        Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control.
        Cancer in the spine. A tumor on the spine can press on a nerve causing back pain.
        Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection.
        Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain.

        Is constant or intense, especially when lying down or at night
        Spreads down one or both legs
        Causes weakness, numbness or tingling in one or both legs
        Causes new bowel or bladder problems
        Is associated with abdominal pain or pulsation (throbbing), or fever
        Follows a fall, blow to your back or other injury
        Is accompanied by unexplained weight loss

        X-ray. These images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks.
        Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
        Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.
        Nerve studies (electromyography, or EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

        Physical therapy and exercise. A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurring.
        Prescription medications. Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain that doesn't get better with over-the-counter pain relievers.
        Cortisone injections. If pain isn't relieved using other measures and you have pain radiating down your leg from a "pinched nerve," your doctor may prescribe cortisone injections - an anti-inflammatory medication - into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots.
        Electrical stimulation. A procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points on the skin to nerve pathways. This is thought to interrupt pain signals, preventing them from reaching your brain. Although safe and painless, TENS doesn't work for everyone or for all types of pain. It's generally more effective for acute pain than for chronic pain and is often used with other treatments. TENS may be a good option to try for people who can't take or don't get relief from medications.
        Back schools. These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves back anatomy and function, followed by practice sessions on how to protect your back at home and work.

Treating chronic back pain
Treatment for chronic back pain may also include using:

        Antidepressant medications. Low doses of certain types of antidepressants have been shown to relieve pain, independent of their effect on depression.
        Narcotics (opioids). These medications, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor.
        Other treatments. These may include anesthetic injections or self-administered pain medications that are sent directly to the spinal cord through a thin tube (catheter) attached to a programmed pump.

Surgical and other procedures
Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Types of back surgery include:

        Laminectomy and laminotomy. These procedures involve removing part of your vertebra - the bony part of your spinal column. This procedure may relieve leg pain caused by bone spurs or disk fragments that protrude into your spinal canal or press on nerve roots within your spine.
        Fusion. This surgery involves joining two vertebrae to eliminate painful movement.
        Intradiscal electrothermal therapy (IDET). In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation. It's unclear whether this treatment is effective for back pain.

        Exercise. Regular low-impact aerobic activities - those that don't strain or jolt your back - can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you.
        Build muscle strength and flexibility. Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
        Quit smoking. Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.
        Maintain a healthy weight. Being overweight puts strain on your back muscles. If you're overweight, trimming down can prevent back pain.

        Stand smart. Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back.
        Sit smart. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
        Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.
        Sleep smart. People with back pain have commonly been told to use a firm mattress, but recent studies indicate that a medium-firm mattress might be better. Use pillows for support, but don't use a pillow that forces your neck up at a severe angle.

        Keep moving. Prolonged bed rest isn't a good idea for back pain. Light activity speeds healing and recovery. If your back hurts, stop the aggravating activities, but try to keep up activities that aren't painful.
        Apply cold, then heat. Sources of heat and cold, such as a hot bath and hot or cold compresses, can soothe sore and inflamed muscles. Use cold treatment first. Immediately after injuring your back, apply ice several times a day, for up to 20 minutes at a time. Put the ice in a bag, then wrap the bag in a cloth or towel to keep a thin barrier between the ice and your skin. Use ice for as long as spasms persist. After spasms and acute pain subside, you can apply heat from a heating pad or heat lamp to help loosen tight muscles. Limit each heat application to 20 minutes.
        Use pain relievers. Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen (Advil, Motrin, others) and other medications such as acetaminophen (Tylenol, others) may help control pain, swelling, and stiffness. Your doctor may recommend taking pain relievers on a schedule, rather than as pain arises.
        Consider using a support brace or corset. But talk to your doctor first. Braces, corsets or back belts are available over the counter at pharmacies and medical supply stores. Your doctor may prescribe a brace customized for your back. However, research studies are divided as to whether back braces and corsets relieve back strain. They can provide warmth, comfort and a degree of support to your back. But some devices may be uncomfortable. Another drawback is that your back muscles may weaken with prolonged use of a brace or corset. It's best to use a brace or corset only for short periods or during back-straining activities, if at all. The best brace or corset you can give yourself is your own "muscle corset." You can build up your muscle corset through back strengthening and stability exercises.

        Chiropractic care. Back pain is one of the most common reasons that people see a chiropractor. If you're considering chiropractic care, talk to your doctor about the most appropriate specialist for your type of problem. In addition to chiropractors, many osteopathic doctors and some physical therapists have training in spinal manipulation.
        Acupuncture. Some people with low pack pain report that acupuncture helps relieve their symptoms. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts sterilized stainless steel needles into the skin at specific points on the body. Acupuncture is thought to stimulate your central nervous system to release the body's natural pain-relieving endorphins. Acupuncture may also alter how your blood pressure, blood flow and body temperature are regulated and respond to pain.