In my practice I start with an thorough search for active pain generators using interview, physical examination, and various imaging and other laboratory tests. Selective spinal injections may be valuable at this point, both diagnostically and therapeutically. The goal during this phase is to identify specific pain generators and reduce the pain being experienced. Trials of various medications or physical therapy may be included. The next phase is pain management with medication, exercise, counseling, acupuncture, and various other modalities with the goal of achieving an optimal level of comfort and function.

Basic anatomy of the spine
It is important to have a basic understanding of the anatomy of the spinal column in order to be able to visualize what is going on in your back and avoid misconceptions about the source of your pain. The spinal column is composed of a stack of vertebrae. Each vertebra has a box of bone in front and an bony arch in back, with the back of the arch flattening into an armor plate (lamina). The stack of arches forms the spinal cannel which protects the spinal cord and nerve roots. Each pair of vertebrae is separated by a shock absorbing disc in front. The arches rest on each other in back on a pair of joints called facet joints. The whole structure is held together by ligaments (think of strapping tape).  There are then muscles which attach to the spine to move it. The spine joins the pelvis at the sacroiliac joints.