Chronic back pain: assessing the patient at risk.

Pain in the lower back is a growing and costly problem. A simple, effective diagnosis can usually be provided by the family physician, based on a clinical history, especially regarding the circumstances surrounding an injury, and physical examination. Work-related risk factors implicated in the cause of the disorder are also important. Spinal X-ray examinations are of little value in diagnosis during the acute stage of low back pain. Chronic cases can be avoided by appropriate early treatment: a short period of analgesia and rest, followed by education about the back, a graduated exercise program, and if the clinical condition is stable or improving, early return to a modified level of work, even in the presence of symptoms.