[5] In most cases, imaging tools such as X-ray computed tomography are not useful or recommended for low back pain that lasts less than 6 weeks (with no red flags) and carry their own risks.

[11] Chronic non-specific low back pain (CNSLBP) is a highly prevalent musculoskeletal condition that not only affects the body, but also a person's social and economic status.

Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects,[15] including high rates of addiction, accidental overdose and death.

[21] Low back pain is not a specific disease but rather a complaint that may be caused by a large number of underlying problems of varying levels of seriousness.

[30] The majority of low back pain does not have a clear cause[1] but is believed to be the result of non-serious muscle or skeletal issues such as sprains or strains.

[34] Nearly half of all pregnant women report pain in the low back during pregnancy, due to changes in their posture and center of gravity causing muscle and ligament strain.

[5] Mechanical or musculoskeletal problems underlie most cases (around 90% or more),[5][41] and of those, most (around 75%) do not have a specific cause identified, but are thought to be due to muscle strain or injury to ligaments.

Diffuse pain that does not change in response to particular movements, and is localized to the lower back without radiating beyond the buttocks, is classified as nonspecific, the most common classification.

[5] Pain that is accompanied by red flags such as trauma, fever, a history of cancer or significant muscle weakness may indicate a more serious underlying problem and is classified as needing urgent or specialized attention.

The presence of certain signs, termed red flags, indicate the need for further testing to look for more serious underlying problems, which may require immediate or specific treatment.

[59] Treatment according to McKenzie method is somewhat effective for recurrent acute low back pain, but its benefit in the short term does not appear significant.

[101] For older people with chronic pain, opioids may be used in those for whom NSAIDs present too great a risk, including those with diabetes, stomach or heart problems.

[19] Although the antiseizure drugs gabapentin, pregabalin, and topiramate are sometimes used for chronic low back pain evidence does not support a benefit.

[17] For those with pain localized to the lower back due to disc degeneration, fair evidence supports spinal fusion as equal to intensive physical therapy and slightly better than low-intensity nonsurgical measures.

[118] Massage therapy is recommended for selected people with subacute and chronic low back pain, but it should be paired with another form of treatment like aerobic or strength exercises.

[59] Prolotherapy – the practice of injecting solutions into joints (or other areas) to cause inflammation and thereby stimulate the body's healing response – has not been found to be effective by itself, although it may be helpful when added to another therapy.

[123][124][21] Multidisciplinary biopsychosocial rehabilitation (MBR), targeting physical and psychological aspects, may improve back pain but evidence is limited.

[26] Older adults more greatly affected by low back pain; they are more likely to lose mobility and independence and less likely to continue to participate in social and family activities.

[56] Workplace ergonomics associated with low back pain include lifting, bending, vibration and physically demanding work, as well as prolonged sitting, standing and awkward postures.

The oldest known surgical treatise – the Edwin Smith Papyrus, dating to about 1500 BCE – describes a diagnostic test and treatment for a vertebral sprain.

Through the Medieval period, folk medicine practitioners provided treatments for back pain based on the belief that it was caused by spirits.

[134] At the start of the 20th century, physicians thought low back pain was caused by inflammation of or damage to the nerves,[134] with neuralgia and neuritis frequently mentioned by them in the medical literature of the time.

[135] In the early 20th century, American neurosurgeon Harvey Williams Cushing increased the acceptance of surgical treatments for low back pain.

[17] In the 1920s and 1930s, new theories of the cause arose, with physicians proposing a combination of nervous system and psychological disorders such as nerve weakness (neurasthenia) and female hysteria.

[135] Emerging technologies such as X-rays gave physicians new diagnostic tools, revealing the intervertebral disc as a source for back pain in some cases.

[135] As a result of this work, in the 1940s, the vertebral disc model of low back pain took over,[134] dominating the literature through the 1980s, aiding further by the rise of new imaging technologies such as CT and MRI.

Since then, physicians have come to realize that it is unlikely that a specific cause for low back pain can be identified in many cases and question the need to find one at all as most of the time symptoms resolve within 6 to 12 weeks regardless of treatment.

[10] Further costs occur in the form of lost income and productivity, with low back pain responsible for 40% of all missed work days in the United States.

[136] Low back pain causes disability in a larger percentage of the workforce in Canada, Great Britain, the Netherlands and Sweden than in the US or Germany.

[17] Researchers are investigating the possibility of growing new intervertebral structures through the use of injected human growth factors, implanted substances, cell therapy, and tissue engineering.