PURPOSE OF REVIEW: To report and critically appraise the current state of managing chronic (and subacute) low back pain as reflected in recently published guidelines and results from latest trials. RECENT FINDINGS: Although occurrence rates of and social benefits for back pain are apparently on the decline (at least in Germany), it is still one of the most frequent and costly health disorders in Western countries. Ten percent of the adult German population suffers from chronic disabling back pain. For this group, a plethora of interventions is recommended. The most recent guideline from the US alone enumerates eight different treatments based on 'moderate-quality evidence'. Latest (often high-quality) trials from 2006 to 2007 strengthen the evidence base, only modestly, owing to their conflicting and/or confusing results. SUMMARY: Recommendations for the management of chronic disabling nonspecific back pain have made little progress over the past 10 years. The field still suffers from a 'strong weakness' due to a generally weak body of evidence. Progress can be expected when the effects of an intervention can be reliably calibrated against comparators of known (in)effectiveness. At present, an individualized clinical approach seems most appropriate. Patients and doctors are free to choose, according to their experiences and preferences, from recommended treatments.