Back pain is among the top three complaints I hear from patients coming to my neurology practice. By the time they see me, they’ve heard advice from their friends and family, and often their primary-care doctor, neurosurgeon, or orthopedist, each with his or her own (often conflicting) recommendation. They’ve also searched the Internet and read about an endless assortment of lower-back pain treatment options. No wonder they’re confused.

Study after study has shown a wide variation in the management of lower-back pain. If you go to your primary-care doctor, you’re likely to get an X-ray and a prescription for physical therapy. If you see a chiropractor, you’re sure to be treated with spinal manipulation. Anesthesiologists and pain-management specialists tend to favor injections, and many orthopedic spine surgeons and neurosurgeons lean toward surgery.

To illustrate how subjective your care may be, just take a look at the Dartmouth Atlas Project*. Medicare patients in some regions of the country were far more likely to have had back-fusion surgery than patients in other areas. For example, out of 10,000 Medicare patients living in Newark in 2002, about 4 had back-fusion surgery. In a similar group of patients living in Bradenton, Fla., that year, about 29 had back-fusion surgery—more than seven times the rate of surgery in Newark. Some regions had more than 20 times the rate of back-fusion surgery than in other areas.