According to an article appearing in Scientific American (1998;279(2):48-53) approximately 80% of all American adults will experience low back pain at some time in their lives. It is the fifth most common reason for visits to the doctor. The yearly cost (in 1998) of low back pain, including doctor visits, hospitalization, surgery, medication and disability compensation comes to about $50 billion. At any given time about 1% of the workforce is disabled because of back problems, but for the most part only a small percentage of people miss work because of back pain.
Approximately 85% of patients with back pain never receive an exact diagnosis. There are some problems associated with the imaging used to diagnose back pain. X-rays do not show the soft tissues and there are issues with radiation exposure. CT scans and MRIs allow for more detailed view of the problem, and can be used to see conditions disc protrusions and spinal stenosis. The problem is that MRI has found herniated discs in about 20% of patients without back pain. Similarly, spinal stenosis is frequently found on asymptomatic patients with MRI imaging. Herniated discs are not a common cause of back pain, and frequently they resolve on their own.
Long term bed rest, as long as two weeks, had been a common treatment; recent research has shown that two days bed rest is as effective as seven days in bed. Also, studies show that people, who remain active, in spite of being in acute pain, are less likely to develop chronic pain in the future. Various treatments like steroid injections and TENS have not shown much promise for permanent relief. Rehabilitation exercises have been shown to be of value. Also, there is mounting evidence that spinal manipulation, or chiropractic, may be valuable for short term relief.
As far as surgery goes, the article noted the increase in surgery for spinal stenosis between 1979 and 1990 (over 340%) and the increase in surgery for herniated discs (up nearly 40% for that same period). It points out that patients who get surgery for back pain often get relief initially, but over time do not do any better than patients who do not have surgery.