Virtually everyone will experience back pain at some time in life. Although the course of back pain is benign for most patients, it is important not to miss the few dangerous underlying conditions that present with back pain as one of the symptoms. Usually only a focused history and physical examination are needed to evaluate a back patient. A summary of guideline recommendations presented by the Agency for Health Care Policy and Research is provided; if these recommendations are followed, few serious mistakes will occur, and a more cost-effective management of the back patient will be possible.