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According to the Global Burden of Disease Project (2021), back pain affects over half a billion people worldwide and is responsible for the most years lived with disability of any condition. Only a small fraction of these will ever see a neurologist, but those that do pose a range of difficulties, from attempting an accurate diagnosis to estimating prognosis and providing advice as to whether any interventions, particularly surgery, are likely to be better than the effect of time alone. There are many guidelines, mainly aimed at primary care practitioners. This article tries to provide succinct evidence-based messages for neurologists (and others in secondary care) to use with patients at different stages of back pain duration—from acute to chronic—to help in navigating some of these difficulties.