The pain in your lower back persists. It has been two, three days "” or maybe a week.

You barely feel like getting out of bed, let alone going to the office.

What are your options?

Most spinal experts urge patients to take the conservative route first: rest; nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or aspirin; and a temporary activity modification.

Dr. Robert Bohinski, who has both a medical degree and a doctorate in molecular and developmental biology from the University of Cincinnati, says back pain "” as long as it doesn't continue into the legs or arms "” can be managed with self-care and generally should start clearing up within 72 hours. He cautions, though, that those who also have bowel/bladder problems, severe leg pain or a history of cancer should be seen by a doctor immediately.

If the pain persists, physical therapy and an epidural injection "” in which a needle is placed into the epidural, and a solution of steroids is injected to help shrink the inflammation "” are also options.

Bohinski, who does about 500 operations a year as part of the Mayfield Clinic, says only about 10 percent of patients with back problems need surgery.

Herniated discs in the neck or the lower back are the biggest problems, Bohinski says. "Those are, by far and away, the two most common conditions that we see."

The vast majority of deteriorating discs are related to routine wear and tear. The damaged discs can weigh on the nerves, which can cause pain elsewhere. That's when surgery might be necessary.

Dr. Raj Kakarlapudi, who in August will join Commonwealth Orthopaedics in Edgewood, in association with St. Elizabeth Healthcare, agrees that surgery should be a last resort.

"You don't want to do surgery for back pain," says Kakarlapudi. "There's really no great surgery for lower-back pain. But we do have great surgery for nerve pain."

Spinal surgery is more complicated than, say, knee or hip surgery, Kakarlapudi says. With those, doctors can replace a single joint, "but there are a lot levels on the spine. You can't just do one surgery, one location "” it's hard to isolate what's causing the back pain."

Fortunately, spinal surgery has come a long way. Both Bohinski and Kakarlapudi say the biggest advance in the past five years has been minimally invasive surgery, which involves small incisions instead of cuts large enough for the surgeon to put his fingers into the problem area.

"The learning curve for that is steep, but once you perfect it, it's better," Kakarlapudi says. "There are more and more minimally invasive procedures being done now" than when he started his residency and subsequent spine fellowship six years ago.

Doctors now see reduced post-operative complications, shorter hospital stays, less blood loss and faster recoveries.

As far as new technology goes, the Food and Drug Administration approved the first artificial cervical disc three years ago. The artificial-disc surgery is almost identical to the fusion procedure, in which doctors fuse two vertebrae to make one stronger one, except the problem disc is replaced with an artificial one.

Artificial discs "hold much promise for the future," Bohinski says. "The one caveat is that the long-term outcomes are not known." Plus, insurance companies are not covering artificial-disc surgery because it is still considered experimental.

The other huge trend in spinal care is the stand-alone, specialized spinal treatment center, Bohinski says.

"That trend is happening all around the country," he says. "It clearly lowers costs and improves outcomes. Everyone involved in the care of the patients is a specialist."

In many cases, patients can return home the same day as the surgery, which also means they are less likely to be exposed to infections or superbugs that often roam the halls of hospitals.

And there's something to be said about recovering in the comfort of your home. â–