This paper reviews the scientific research on occupational back pain focusing on prevention and the Saudi Aramco experience. The challenges of translating the medical evidence into policy for this multi-factorial condition are discussed. Medical science is currently unable to clearly distinguish between back pain caused by work and that possibly due to other causes but affecting the individual’s capacity to work. Back pain affects the majority of people at sometime in their lives and it is costly to medical services and industry. Once the risk factors for occupational back pain are identified, it can be prevented in the majority of cases or else it can become chronic and disabling. Failure to follow preventive programs may lead to a high incidence of occupational back pain.