Low Back Pain
Low back pain is managed per the American College of Physicians 2017 guideline, which favors non-drug treatment first for both acute and chronic pain.
Symptoms
Pain in the lower back, sometimes radiating into the buttock or leg, that can be sharp or dull and may worsen with certain movements or prolonged sitting.
Causes and risk
Most cases are non-specific, without a single identifiable structural cause. Prior back pain, physically demanding work, obesity, and psychological stress all raise risk of a prolonged course.
How it is evaluated
Imaging is not routinely recommended in the absence of red flags, neurologic deficit, or failure to improve over time, per ACP and ACR 2021 guidance -- most imaging findings don't correlate with symptoms and don't change management.
Treatment
For acute pain, first-line options are superficial heat, massage, acupuncture, or spinal manipulation. For chronic pain, exercise, cognitive behavioral therapy, and multidisciplinary rehabilitation come first. NSAIDs and muscle relaxants are reasonable next steps; duloxetine, tramadol, or opioids are reserved for when those aren't enough, given their side-effect and dependence profiles.
When to seek care
Saddle numbness, new bowel or bladder dysfunction, or bilateral leg symptoms suggest cauda equina syndrome, a surgical emergency requiring an urgent MRI -- this combination should never be managed as routine back pain.