In order to ensure the efficacy of the treatment, it is necessary to make a clear diagnosis and choose an effective treatment method from a wide range of complex conditions with different causes. 1.Identify the department of low back and leg pain to avoid delaying the diagnosis and treatment. 2.Take special and safe treatment methods according to the cause of pain and the characteristics of the condition. 3.Know the patient’s general condition to ensure the safety of treatment. 3. Identify the department of low back pain to avoid delay in diagnosis and treatment. Only by clearly identifying the departmental affiliation of low back and leg pain can patients with low back and leg pain who are not treated by the pain department be correctly transferred to the relevant departments to avoid delaying treatment. Fourth, identify clearly the departmental affiliation of low back and leg pain to avoid delay in diagnosis and treatment. Benign tumors: 1. intradural lipoma. 2. spinal meningioma. 3. teratoma. 4. vertebral hemangioma. 5. vertebral myeloma. Malignant tumors: 1. femoral metastases. 2. multiple myeloma. 3. bone metastases from hepatocellular carcinoma. 4. postoperative recurrent metastases from renal cancer. Case 1: multiple myeloma Male, 71 years old, diagnosed as lumbar disc herniation at the beginning, pain worsened after massage treatment, general condition deteriorated, pain department consultation was requested, and the bone marrow image was found to be 80% abnormal plasma cells. Plasma globulin was elevated, and urine Benzo protein was positive. MRI of the lumbar spine showed diffuse and focal infiltration, and sagittal T1-weighted images showed extensive signal reduction in the vertebral body, with multiple nodular or patchy lower signal shadows seen in the low signal background; sagittal STIR images showed heterogeneous signal elevation in the vertebral body, and the diagnosis was multiple-issue myeloma. 1, osseous lumbar spinal stenosis: there are signs of ischemia with cauda equina compression, intermittent claudication, and low back pain, but the symptoms and signs are separated, and the diagnosis can be confirmed with the help of CT. In most of these cases, non-surgical treatment is feasible to relieve the symptoms, but in 20% of the cases in our department, conservative treatment was ineffective, and orthopedic surgery was performed to expand the spinal canal, and the symptoms were relieved. 2, true lumbar spondylolisthesis: case 2 female, 45 years old, Korean. x-ray oblique film and CT film both showed lumbar isthmus cleft and 1st degree lumbar spondylolisthesis, lumbar intervertebral joint subluxation, back to Korea for surgical treatment. 3. Lumbar disc herniation combined with bony spinal stenosis or disc calcification or cauda equina syndrome. V. Take special and safe treatment methods for the causes and characteristics of pain. 1. To clarify the cause of pain in order to use the right treatment. Nerve block therapy is an effective measure for treating pain, and at the same time, it can break the vicious circle of disease development and provide conditions for curing the disease. However, practice has shown that there are still many cases where the analgesic effect of nerve block is not long-lasting, and the cause of the pain must be clearly identified and treated in order to fundamentally relieve the pain. (1) For pain caused by acute infection, effective anti-infection treatment is necessary to completely and permanently relieve the pain. Case 1: Female, 52 years old, with dengue. Case 2: Male, 46 years old, spondylitis. (2) Lumbar TB: once misdiagnosed as lumbar disc herniation, came to our pain clinic and asked for a history of afternoon hypothermia and night sweats. Laboratory tests: ESR 87 mm/h. CT showed: L4.L5 vertebral body destruction. (3) Myofascial pain syndrome (MFPS) limited range, pain point clear: short history of pain point injection of anti-inflammatory analgesic solution or laser therapy, long history of disease then add needle knife therapy, both with NSAIDs. diffuse range, pain point unclear: use Chinese medicine steam therapy, SSP, limited range, find pressure pain point, then injection and/or needle knife therapy. (4) Posterior spinal nerve entrapment syndrome (SPRCS): low back and leg pain without crossing the knee, pressure pain at the projection of the outer edge of the small joint, radiating to the posterior hip or femur can establish the diagnosis. It can be treated with block therapy, acupuncture, cryotherapy, radiofrequency therapy, etc. (5) Small joint dysfunction syndrome (FJDS): history of trauma, limited lumbar flexion to a fixed angle and increased pain, percussion pain at the small joint projection. Intra-articular injections, joint decompression by acupuncture, and then manual correction are performed. (6) Ankylosing spondylitis (AS): comprehensive treatment: Chinese herbal vapor therapy, acupuncture release, manipulation, NSAIDs and special drugs (torch root, transfer factor, SASP, MTX) and functional exercise. (7) Gout: acute attack: colchicine, anti-inflammatory pain; non-attack: uric acid production reducing drug – allopurin + rapid uric acid excreting drug – propoxur 2. Analyze the pain characteristics and determine the location of the lesion. For back and leg pain diseases that require injectable drugs or needle knife relaxation treatment, only accurate positioning of the lesion can ensure that the treatment is in place and receive the effect of needle to disease. (1) Lumbar disc herniation: First, identify the involved spinal nerve according to the patient’s pain distribution area and physical signs, and then search for the lesion along the spinal nerve pathway, and make a clear diagnosis and determine the location of the lesion according to the pattern. The exact location is measured according to X-ray plain film or CT film, and the collagenase solution is concentrated and injected into the site of disc herniation after the puncture is in place to receive a satisfactory discolytic effect. (2) Radiculitis: the diagnosis is confirmed, and the localization method and procedure are the same as for disc herniation, except that the lesion found by CT is a thickened nerve root and the drug injected is an anti-inflammatory and analgesic. (3) Nerve root adhesions: after disc lysis or injection in the lateral saphenous fossa of radiculitis, the pain disappears or is relieved, but about 60% of patients still have discomfort such as soreness and numbness, and even nearly 20% of patients still have radicular pain after getting out of bed. This is mostly due to edema caused by nerve root compression or inflammation, and after exudation, the surrounding fibrous tissue proliferates, causing nerve root adhesions. In the past, it was more difficult to deal with. Nowadays, the intervertebral orifice or/and the external orifice can be treated with needle knife, which can receive immediate effect. Sixth, know the patient’s general condition, to ensure the safety of treatment. In order to ensure a satisfactory and safe treatment effect, in addition to clarifying the cause of low back pain and the characteristics and location of the lesion, it is also necessary to understand the patient’s general condition, the function of important organs, the history of allergies, whether the planned treatment can be tolerated and the possible adverse reactions, how to prevent and deal with them, etc. For patients with combined hypertension, coronary artery disease and diabetes mellitus, it is necessary to prepare the patient with adequate needles and wait for the blood pressure, new functions and blood glucose to approach the normal range before implementing the special treatment method. The treatment should be closely tested and prepared for all kinds of resuscitation. In patients with severe low back pain caused by severe radiculitis, the possible drug infiltration reaction caused by lateral saphenous injection must be fully estimated. We have encountered 7 patients with severe lumbar and leg pain in whom the high plane of block (up to T4) was reached 30 minutes after lateral saphenous injection of anti-inflammatory and analgesic solution and blood pressure dropped, which was closely observed with oxygen and accelerated infusion, and blood pressure returned to normal within 10 minutes. All of these patients had a smooth puncture, no cerebrospinal fluid on retraction, and a significant nerve root irritation reflex, i.e., severe radiating pain to the area of complaint, on rapid drug injection. We analyzed that the sheath permeability of the inflamed nerve root increased, and the drug could slowly penetrate into the subdural cavity and even the subarachnoid cavity during high-pressure injection of anti-inflammatory and analgesic night. Therefore, we now stipulate that in cases of severe radiculitis, when performing lateral saphenous injection of anti-inflammatory analgesic solution, one should first give a test volume for observation; two, the injection pressure should be small and the injection speed should be slowed down; and three, the observation time after injection should be extended. VII. Conclusion. In conclusion, patients with low back pain faced in the pain clinic have different etiologies, conditions and disease progression, and only by careful analysis can they be correctly treated and obtain satisfactory clinical results.