Diagnostic thermography is a useful test for assessment and management of low back pain syndrome patients. This paper will update the major advances in thermography since Albert et al. first reported its use in diagnosis of lumbar disc disease in 1964. This complex patient population will be discussed, with particular reference to diagnostic thermography in differential diagnosis of low back pain syndromes and specifically in lumbar disc herniation, facetitis, lateral recess syndromes, and reflex sympathetic dystrophy by specific thermal pattern recognition. Medical thermography has taken its place beside such tests as the radiograph, electromyograph, and tomography scan in diagnosis and management of patients with low back pain syndromes and is clearly beyond clinical investigation, as is supported by numerous studies in the literature.