If you have occasional flare-ups of back pain, these six steps can prevent it from becoming a chronic problem.

With changes in the aging spine, occasional backaches may grow more frequent and blossom into a chronic and disabling pain condition. It doesn't have to happen to you. To maintain the best back health possible, you have to address both the body and the mind, says Dr. Zacharia Isaac, a physical medicine and rehabilitation doctor at Harvard-affiliated Brigham and Women's Hospital.

The pain reliever acetaminophen is safe when used correctly, but people can become very ill or die if they take too much.

In overweight people with knee arthritis, combining diet and exercise eased symptoms better than either alone, researchers reported in The Journal of the American Medical Association. The 454 people involved in the study were 55 and older, with a body mass index (BMI) classifying them as either overweight or obese. Previously, they all lived relatively sedentary lifestyles. Over 18 months, study participants followed a regimen of either strict dieting, exercise three days per week, or both. Those who dieted and exercised lost 11.4% of body weight, in comparison to 9.5% in people who dieted without exercising. The exercise-only group lost minimal weight.

The diet-and-exercise group saw the most improvements in pain and inflammation, walking speed, and overall mobility. The gains were modest, but could have a positive impact in sedentary and overweight people.

Many doctors overtreat their back pain patients. Instead of following current guidelines and recommending NSAIDs and physical therapy, they are prescribing narcotics and sending patients for imaging scans and more aggressive treatment.

Q. Which is best for pain and stiffness from a sore back—heat or cold?

A. When choosing between heat and cold, you may be a better judge than your doctor. Nerve fibers that carry pain sensation also sense change in temperature. As a result, stimulating the nerves with either heat or cold can diminish your discomfort, so you can choose which one to try. Both may ease your pain.

Stretching and strengthening daily is your best bet to delay the next attack of low back pain.

When low back pain flares up, most men can't do more than grit their teeth, reach for a numbing cold pack, and wait for it to get better. Four out of five of us experience low back pain sometime in our lives, but this common source of suffering is also an opportunity.

What doctors call “routine” back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative—over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals to surgery. A new study of 24,000 people treated for back pain from 1999 through 2010 shows that many were not treated according to established guidelines, which promote treatment with over-the-counter pain relievers and physical therapy when appropriate, and advise against early referral for MRI or CT scans, the use of narcotics, or early referral to other physicians for injections or surgery. For a first-time bout with low back pain, or another go-round with it, try cold and heat, rest followed by gentle exercise, and over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen.

Epidural steroid injections (ESIs) are a common treatment for certain causes of back pain. They received national attention after contaminated epidural injections in several states led to hundreds of fungal meningitis cases and dozens of deaths in 2012. Authorities isolated the source of contamination to one compounding pharmacy; other compounding pharmacies continue to provide valuable service. If you have an ESI, be sure to ask your doctor if the compound prescribed for you is safe, or consult the website below.

The injection

The shot is a combination of an anti-inflammatory medicine called a corticosteroid plus an anesthetic. It's injected into the epidural space, in an attempt to reduce nerve inflammation.

Research We're Watching

Hands-on treatment helps low back pain

Osteopathic manual treatment (OMT) is a safe, effective way to relieve low back pain, according to a study published in the March/April Annals of Family Medicine. In this study, researchers randomly assigned 455 people (ages 21 to 69) to receive various combinations of OMT, ultrasound therapy, or sham (fake) versions of these treatments. At the end of six treatment sessions, participants who received OMT reported less low back pain than those who received sham treatments. OMT-treated participants were also more likely to be very satisfied with their back care, and they needed fewer prescription medicines to relieve their pain. Side effects from OMT were minimal. Ultrasound treatment was not effective, the study found. Researchers did not evaluate the cost-effectiveness of OMT treatments, which can run $100 or more per session. More research is needed to confirm the long-term effectiveness, and cost, of OMT for low back pain.

Many MRI scans for people with lower back pain are not medically necessary, according to a study in JAMA Internal Medicine. Experts used widely accepted criteria to decide, after the fact, if MRI scans ordered for back pain or headaches were really necessary to diagnose or treat the problem effectively. Sometimes a scan is not likely to reveal anything especially useful.

The study found that only 44% of scans of the lumbar spine (the lower back) were appropriate. Of the remaining scans, 56% were deemed either inappropriate or of "uncertain value." The study also looked at MRIs for headache, but found that the clear majority, 83%, were deemed medically valuable.