Low-back pain is a common problem that is usually caused by a strain on the muscles, ligaments and bones of the spine. Low-back pain is one of the most common reasons for workers under age 45 to miss work. Almost two-thirds of all adults will have a problem with low-back pain at some point.

It is often hard to find the exact cause of low-back pain, and rarely will treatment cause the pain to go away quickly. In most cases, the pain will go away or lessen within four to six weeks without medical attention. But patients often receive "imaging" (X-rays, MRIs or CT scans) that they do not need in an effort to find or fix the problem.

Unfortunately, imaging can lead to more procedures, including surgery, that put you at additional risk and add to the cost of your care, and that you may not even need in the first place.

What can patients do?

• Go to your primary care provider first to seek care rather than a specialist or the emergency room.
• Work with your primary care provider to rule out any conditions that might suggest rare but serious underlying problems and that would warrant an X-ray, MRI or CT scan.
• Follow your health care provider’s recommendations to manage back pain.
• Avoid opioids to treat pain. Opioids are highly addictive (PDF) and should generally not be the first line of treatment for acute pain, such as low-back pain.
• Return to normal physical activity as quickly as possible and keep moving.
• Consider exercises to help strengthen your low-back muscles.
• Be patient. Four to six weeks may seem endless when you are in pain, but keep reminding yourself that with time the pain will very likely end.
• After waiting six weeks, for low back pain that persists and is not getting better, work with a health care provider to learn about the risks and benefits of different approaches before you agree to any type of test or procedure.
• Use the Community Checkup website to see which providers score well on avoiding imaging for low-back pain.

What should your doctor do?

• Screen you to rule out any serious condition that requires prompt medical attention.
• Talk with you about the usual course of low-back pain and the importance of staying active.
• Recommend nonsteroidal anti-inflammatory drugs, such as ibuprofen. Your doctor should avoid giving you an opioid.
• Offer same day access so that you don’t have to go to the emergency room.
• After six weeks, if more aggressive therapy is being considered, discuss treatment options with you to help you understand the risks and benefits and to make a decision that is right for you.