It depends on what is causing the pain. If it is caused by nerve root compression, inflammation due to recent injury or unknown inflammation. Or if it is caused by bulging or ruptured disc. The treatment is also dependent on your symptoms.

Anti inflammatory drugs and if the doctor is kind he/she may give you pain medication and muscle relaxants for spasm. If the anti inflammatory drugs are not keeping you comfortable, ask for what you need, if the doctor refuses, see a new doctor. Back pain has he ability to be come chronic very quickly. The faster you cut the pain the less chance you have of developing chronic back pain.

Usually the first treatment is rest. Do not allow a doctor to keep you on bed rest for more than a day or two, the muscle atrophy that starts setting in makes it that much harder to get back on your feet.

Ice packs for the first few days, 20 minutes at a time, followed by heat packs. This can be done at home or by a physical therapist. Speaking of which; your PT can become your new best ally if she/he is good and you cooperate with the treatment plan to the best of your ability. Most doctors listen to the therapists. Occasionally better than they listen to the patient. Do your homework, read up on current therapy and what it is supposed to do for you. Do not allow a physical therapist or anyone, to move you in a way that increases your pain.

Physical therapy is usually prescribed and there may be some things around the house and job you need to change. Your PT may in addition to ice/heat packs do traction, ultrasound and electrical stimulation for pain relief, none of these should hurt - they should feel good. If they hurt ask the therapist to stop. Your PT will also advice you in exercises designed to strengthen your core muscle group, strong ab and lower back muscles are vital to reducing your pain and preventing a new injury. Many back pain patients swear by warm water exercise as the safest way to improve all around muscle tone and relieve sore muscles at the same time. If you spend much of your day sitting, you may want to replace the office chair with a therapy ball.

Physical therapists can also show you positions and exercises designed to minimize the pain; important to note do not sit, stand or lie in any one position for too long, if you do when you try to move, you may be stuck due to muscles tightening down. If this happens slowly move in towards the position you held and slowly back out of it. It may take a few repetitions to move freely.

Sciatic pain caused by a herniated disk generally gets better with conservative treatment. Most often within six weeks time.

If you start having an increase in pain, numbness or weakness spreading to one or both legs,
urinary incontinence or difficulty urinating even with a full bladder or bowel incontinence, loss of sensation in back of legs, inner thighs, the area around the rectum, or perineum; this may suggest cauda equina syndrome. Because it can cause permanent weakness or paralysis if it's not corrected, this syndrome may require a trip to the emergency room and even emergency surgery. Don't be shy, if you feel these symptoms define your situation get help, time matters.

Alternative treatments help many people who haven't been helped by traditional or conservative methods. Yoga. Will teach you deep relaxation and breathing techniques, improve your posture and often relieve pain in patients who have been in pain for years. There are yoga positions you need to avoid so choose your instructor carefully. Other pain patients are usually very helpful in finding the best in their field and sharing which to avoid.
Massage and spinal manipulation can benefit people with low back pain. My preference is to use a Chiropractic who does both. Especially since not all insurance companies will pay for massage, but most will now pay for Chiropractic. Studies have shown that Acupuncture in which fine needles are inserted into your skin in very specific order, to release energy is helpful for some patients. If it doesn't relieve pain it may improve circulation, help constipation often caused by inactivity and drugs and even increase you energy level. For any needle-phobes, there is no pain when done correctly. Although there are some spots on your hands and feet that not so much feel the needle prick, do react to the placement itself. the needles themselves are truly hair fine. Your doctor or PT may also recommend a Tens Unit a battery pack, electrodes and pads that adhere to your skin, causing a tingling sensation, may help. Relaxation through Guided Imagery and Guided Meditation. This may be one of your most valuable tools. It requires no special equipment besides a CD player, many can be down loaded on the Internet, and played on your computer. Once you get some practice you can do this for yourself with the music playing in your mind. The most use full tool I own. Tai chi: if your pain is under control, is great for stress relief and core muscle strength. Art Therapy is an excellent stress release. And biofeedback all great ways to release stress and relieve back pain.

I would encourage anyone with who is still able to walk, who has severe back pain to try all options before having surgery. Don't wait for the doctor to say you need surgery to explore other options. Also get a second opinion before any irreversible options are explored.

The correct diagnoses, you would think this would be the simple part, not always. . In most cases of herniated disk or sciatica, the physical exam is all that's needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, or if there is no symptom improvement after four weeks of conservative treatment, one or more of these diagnostic tests may be performed:

MRI Scan: it's like a very noisy X-Ray. Although some hospitals or radiology clinics have open units, most are a large doughnut shaped machine you go into head first. If you are claustrophobic you can be given a mild sedative, no pain involved except for lying still on the hard surface for the test. This test can be used to confirm the location of the herniated disk and to see which nerves are affected.

CT scan: An X-ray unit creates cross-sectional images of your spinal column and the structures around it.

Myelogram: A dye is injected into the spinal fluid, and then X-rays are taken. This is one of the most painful tests I've ever had, there would have to be a really good reason for me to ever have this again. A simple diagnoses would not be enough. Unlike the other X-Rays that use dye put into your vein, this dye goes into the spinal fluid, giving the possibility of causing a spinal headache. (mine lasted 3 weeks).

Discogram: dye is injected into the center of your spinal disks, under pressure, then an X-ray or CT scan is performed to see if the disks are damaged Procedurally similar to a mylelogram - with the same risks.

EMG (Electromyograph) is to assess the health of your muscles and the nerves that control them. During an EMG, a needle with an electrode is inserted into your muscle. The electrode records the electrical activity in your nerve and muscle. Some doctors, because they don't use this often have a trained tech with portable equipment come to their office. Request a referral to a neurologist who will do the test on his equipment. This was the 2nd most painful test I've had. This test can cause some minor bruising or muscle pain following the exam. I did not experience this the pain was limited to contracting muscles with a needle stuck in it.

Surgery: When all else fails; a discectomy involves removal of the herniated portion of a disk to relieve irritation and inflammation of a nerve. It's done as an open surgery. Microdiskectomy achieves the same results with a smaller incision, and only a couple stitches or staples to close. My experience is this is done by a Neurosurgeon, an Orthopedic Surgeon performs the discectomy of course depending on what your spine looks like, what your doctor would be looking to repair, the Neurosurgeon is capable of performing either operation.
Laminectomy: the removal of the bone overlying the spinal canal, enlarges the spinal canal to relieve nerve pressure on the nerve.

Spinal fusion* relieves pain by adding stability. It also causes the level of the spine to be forever frozen, unable to give along the spine the way it is intended. This can be done by a bone graft taken from your pelvis, from donor graft or from artificial graft. Ask your doctor about your options.

Vertebroplasty or kyphoplasty is done to relieve pain and add stability, an artificial bone glue or cement is put into the space, in kyphoplasty a balloon is placed to expand the compressed vertebrae before the cement is added.

Artificial disks are a treatment alternative to spinal fusion, for disk degeneration or injury the idea is to reduce pain on movement. Still new, not all doctors are offering this treatment.

*Some doctors prefer to use titanium screws and plates in patients when a fusion is done.

Do not allow anyone tell you it's all in your head, when you know it is in your back!

I had my first microdiskectomy when I was 23 years old, after 2 years of pain following an accident at work that was misdiagnosed as a strain. Because the first surgery failed I ended up with nerve damage all the way to my toes on the right side.

The first pain specialist I went to way back when the profession was brand new, tried twice to put a nerve stimulator with electrodes into my spine without success. Unless there is no other way to get relief I do not recommend this option.

I also do not recommend pain medication pump implants, unless someone is dying from bone cancer or some other horrific pain that has no relief. There are too many severe possible side effects including having it fail after your body has become tolerant to the drugs which will put you in to withdrawal.