Back pain is very common—most adults will have it at some point in their lives. It’s one of the top reasons people visit the doctor and causes more than $50 billion in lost work time and workers’ compensation each year. For many people, the pain goes away within a few days or weeks. This is called acute back pain. But if the pain lasts more than 3 months, it’s called chronic back pain. Back pain can happen anywhere along the spine, but most people feel it in their lower back, also known as the lumbar spine.

It can be frustrating, uncomfortable, and hard to treat. But the good news is that there are many ways to manage it — and new options that may help if the pain doesn’t get better with rest, exercise, or basic care.

Our doctors work with patients to treat the whole person, not just the pain. Here's what to know about low back pain and the many tools available to treat it.

The back is the part of the body that runs from the neck down to the hips. The most important part of the back is the spine. The spine is like a strong and flexible tower that helps us stand up straight and move our bodies. It supports the head and the rest of the body, letting us twist, bend, and lift things. Understanding spine anatomy is key to knowing how back pain happens.

The spine has two main parts: the spinal column and the spinal cord.

The spinal column is made up of 33 bones called vertebrae. These bones are shaped like rings and are stacked on top of each other. Between the bones are soft discs that act like cushions to keep the spine flexible and protect it from shock. The spine has different sections:

• The neck has 7 bones called the cervical spine.
• The middle back has 12 bones called the thoracic spine.
• The lower back has 5 bones called the lumbar spine.

At the bottom are the sacrum and tailbone (coccyx), which are made of several fused bones.

Muscles, tendons, and ligaments hold the spine together and help it move.

Inside the spinal column is the spinal cord. This is a bundle of nerves that carry messages between the brain and the rest of the body. The spinal cord helps us feel things and move our muscles. Knowing how the spine and spinal cord work can help you understand lower back pain and other spine-related problems.

Back pain can feel different for different people. It might be a sore muscle ache or sharp, shooting pain. Sometimes it hurts a little, other times it can be very bad. The pain can come and go or be there all the time.

Low back pain might make it hard to move or bend. You might find it hard to stand up straight. Sometimes, pain in the back comes from a problem somewhere else in the body.

Low back pain can be a sign of a serious problem if it comes with other symptoms like:

• Fever
• Trouble controlling your bladder or bowels
• Weakness in your legs

Low back pain can happen for many reasons. Sometimes it starts suddenly, like after an injury or accident. Other times, it builds up slowly over time. Here are some common causes:

Sometimes, doctors can’t find a clear reason for low back pain, even with scans or X-rays.
 

Low back pain happens most often in middle-aged people. There are many reasons for this. As people get older, their bodies change. Also, not getting enough exercise, feeling stressed or sad, worrying too much about pain or moving, being overweight, smoking, and other habits can make back pain more likely.

Women tend to have back pain more often than men.

Jobs that need heavy lifting, like working in factories, building sites, trucking, and healthcare, have more people with back pain. But even jobs where people sit a lot can cause back pain.

Before trying more advanced treatments, many people feel better with:

• Physical therapy
  

• Stretching and strengthening exercises
  

• Medications
  

• Heat, ice, or massage

If these don’t work, your doctor may recommend the next level of care.

Injections can help in two ways:

• Diagnostic injections help doctors figure out exactly where the pain is coming from.
• Therapeutic injections can reduce pain and inflammation.

Injections target muscles, joints, or nerves. They are quick, don’t usually require sedation, and are done in an office or clinic. Some common types include:

• Trigger point injections into tight muscles
• Epidural steroid injections near the spine

If injections help but don’t last, RFA might be the next step. RFA uses heat or cold to temporarily “turn off” nerves that are sending pain signals. These nerves usually grow back over time, so the treatment may need to be repeated once or twice a year. It’s done through a small needle, without open surgery, and requires little or no sedation.

One of the most common uses of RFA is for arthritis in the small joints of the spine.

Think of neuromodulation like a “pacemaker for pain.” These devices send signals that interrupt the pain before it reaches the brain. This method is based on something called the gate control theory — the idea that only a certain amount of sensation can reach your brain at once.

Some types of neuromodulation use mild tingling to block pain. Others are so gentle you don’t feel them at all.

There are also restorative neuromodulation devices that help re-activate weak back muscles. These devices use gentle stimulation to retrain your body and improve movement.

PNS is a treatment where a tiny wire is placed near a nerve or muscle to reduce pain. It can be temporary (lasting about 60 days) or permanent (with a trial period first). The wires are very small — about the size of a thread — and the procedure is done with just one or two small incisions.

These are special types of neuromodulation that target different parts of the spine:

• DRG stimulation helps reduce pain and inflammation in specific areas, like the legs or feet.
• Spinal cord stimulation sends signals directly to the spine to block pain messages from reaching the brain.

Both treatments involve a trial period before a more permanent system is placed. The devices are adjustable, and batteries can be replaced over time.

Some patients benefit from minimally invasive spine (MIS) procedures. These include:

Basivertebral Nerve Ablation

This procedure treats nerves inside the spine bones that can become sensitive over time. It helps people with disc-related pain, especially pain that gets worse with standing, walking, or lifting.

Lumbar Decompression

This procedure removes a small amount of tissue to make more space in the spine. It helps people with spinal stenosis, a condition where the spinal canal becomes too tight and presses on nerves. This can cause leg pain or fatigue, especially while walking.

These procedures are done through tiny incisions and usually don’t require stitches. Recovery is quick.

The SI joint connects your spine to your hips. Doctors believe that about 30% of all low back pain comes from the sacroiliac (SI) joint. That’s because it carries a lot of your body weight and can wear down over time. It can also become painful from arthritis or extra stress — especially after a spinal fusion. If you’ve had spine surgery in the past — like a lumbar fusion — it’s common to still have pain later on. In fact, studies show that 40% to 75% of people who’ve had a lumbar fusion develop sacroiliac joint pain within five years. Newer techniques allow doctors to place a small implant or wedge into the joint to reduce painful motion. These procedures are also outpatient and have short recovery times.

Chronic low back pain is highly common, and very treatable. 

At Stanford, we tailor each plan to the patient. Many people feel better with physical therapy, injections, or ablation. But if pain continues, there are advanced treatments that can help restore movement and improve daily life.

Most of these treatments are low-risk, require no or very small incisions, and help people get back to doing what they love.

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