Chronic back pain guide

Chronic low back pain (12 weeks or longer), online

For adults 18 to 64 whose low back pain has lasted 12 weeks or longer. You were examined in person for it in the last 12 months. You were told no serious cause was found.

Start online

Start a $59 online review for Chronic low back pain.

Back pain that lasts 12 weeks or longer is called chronic low back pain. About 13 in every 100 adults in the U.S. have it. Doctors' guides say to start with care that is not a medicine. Exercise is the main part. Ways to cope with pain help too. A medicine is added only if that is not enough. Most people with this kind of pain do not need surgery. We do not examine you, so this visit is only for people who were already examined in person for this pain. We do not order scans or tests. You get a written plan. If you tried that care and it was not enough, and a medicine is safe for you, the doctor may send ibuprofen for up to 4 weeks, or duloxetine, never both. They may help some people. We never send opioids, tramadol, gabapentin, pregabalin, or muscle relaxers.

If treatment is appropriate, your physician can send a non-controlled prescription to your pharmacy and provide portal instructions for the next step.

Start this visit See response times

Already in ongoing care with us for this? Check-ins are $39 (your first one is free).

Quick facts

You must be physically located in Virginia or West Virginia at the time of request.
Starts at $59
No insurance needed
No app download
Physician review around the clock
Non-controlled prescriptions can be sent to your pharmacy when appropriate
A work or school note can be included when medically appropriate
Response times apply 24/7, every day

Common symptoms

Pain in your low back that has lasted 12 weeks or longer
Pain that comes and goes, or is there most days, but is about the same as when you were examined
Stiffness or soreness that limits your sleep, work, or daily life
No pain, tingling, numbness, or weakness in your legs

May fit online care

Adults 18 and older
You are 18 to 64
Your back pain has lasted 12 weeks or longer
A doctor, nurse practitioner, or physician assistant examined you in person for this pain in the last 12 months
They found no serious cause, and did not say you still need a scan, tests, a specialist, or surgery
The pain is in your low back and is about the same as when you were examined
You have no leg pain below the knee, and no tingling, numbness, or weakness in a leg
You can walk and stand, and none of the warning signs below

Look for another care setting

New loss of control of your pee or poo, new trouble starting to pee, or not being able to pee (call 911 or go to the ER now).
Numbness around your genitals, bottom (anus), or inner thighs, or new loss of feeling during sex, or new trouble getting or keeping an erection or having an orgasm (call 911 or go to the ER now).
A leg or foot that is newly weak, or weakness that is getting worse (call 911 or go to the ER now).
New numbness or tingling in both legs, or a part of a leg that does not feel touch at all (call 911 or go to the ER now).
Chest pain, severe belly pain, a pulsing feeling in your belly, or fainting (call 911 or go to the ER now).
Pain from a serious accident, like a car crash (call 911 or go to the ER now).
Pain so bad that you cannot walk or stand (call 911 or go to the ER now).
Any of these after you start ibuprofen or duloxetine: trouble breathing or wheezing, hives, swelling of your face, lips, tongue, or throat, blisters, a peeling rash, sores in your mouth, chest pain, weakness on one side of your body, slurred speech, vomiting blood, bloody, black, or tarry poo, or feeling faint. Stop the medicine and call 911 or go to the ER now.
Any of these after you start duloxetine: you feel very agitated, you see or hear things that are not there, you are confused, your heart races, you sweat a lot with a fever, you shake, your muscles twitch or feel stiff, or you have a seizure. Stop the medicine and call 911 or go to the ER now.
Eye pain, a change in your vision, or swelling or redness in or around your eye, after you start duloxetine. Stop the medicine and call 911 or go to the ER now.
Thoughts of ending your life, or of hurting yourself or someone else. After you start duloxetine, acting on dangerous impulses too. Stop the medicine. Call or text 988 now, and call 911 if you are in danger.
A fever of 100.4°F (38°C) or higher, shaking chills, or feeling very sick (go to the ER today).
Injecting drugs (go to the ER today).
A serious infection lately, like an infection in the blood (go to the ER today).
New severe back pain, together with cancer now, a weak immune system, or back surgery or a spine shot in the last 3 months (go to the ER today).
A fall or blow to the back in the last 4 weeks that was not a serious accident (go to the ER or urgent care today).
Pain that is severe and started suddenly, or is getting worse quickly (go to the ER or urgent care today).
New numbness in a leg, or numbness that is spreading (go to the ER or urgent care today).
After you start ibuprofen or duloxetine: yellow skin or eyes, dark pee, itching, or pain in the upper right belly. Stop the medicine (go to the ER or urgent care today).
After you start duloxetine: bleeding that will not stop, large bruises you cannot explain, or a bad headache with feeling weak, unsteady, or unable to think clearly. Stop the medicine (go to the ER or urgent care today).
After you start ibuprofen: belly pain that does not get better, swelling in your arms, legs, hands, or feet, or much less pee. Stop the medicine (go to the ER or urgent care today).
Burning when you pee, or blood in your pee (see a doctor in person today).
Red or swollen skin over your back or spine (see a doctor in person today).
After you start ibuprofen or duloxetine: any new skin rash. Stop the medicine (see a doctor in person today).
After you start duloxetine: new or worse sadness, worry, or panic attacks, feeling very agitated or restless, new anger or irritability, a burst of high energy with little need for sleep, or racing thoughts. Stop the medicine (see a doctor in person today).
Pain that is different or feels worse than when your doctor examined you (see a doctor in person within 7 days).
Pain that is worse when you lie down, wakes you at night, or does not ease with rest (see a doctor in person within 7 days).
Weight loss without trying (see a doctor in person within 7 days).
Cancer in the past (see a doctor in person within 7 days).
Cancer now or being treated for cancer, a weak immune system, or back surgery or a spine shot in the last 3 months (see a doctor in person within 7 days).
Weak bones (osteoporosis) (see a doctor in person within 7 days).
Back symptoms that began before age 45, with morning stiffness for more than 30 minutes that gets better as you move, or pain that wakes you in the second half of the night (see a doctor in person within 7 days).
Back pain for 6 to 12 weeks (see your own doctor).
Never examined in person for this pain, or the last exam was more than 12 months ago (see your own doctor).
A serious cause was found, like a break, an infection, a tumor, or nerve damage, or you do not know what was found (see your own doctor).
The doctor said you need a scan, tests, a specialist, or surgery that you have not had yet (see your own doctor).
Pain down a leg below the knee, or tingling, numbness, or weakness in a leg, even if it is old (see your own doctor).
Taking any opioid for any reason, or gabapentin, pregabalin, or a benzodiazepine for this pain, or wanting a prescription for one or for a muscle relaxer (see the doctor who prescribes it).
Under 18, or 65 or older (see your own doctor).
Taking ibuprofen for 4 weeks and still needing it (see your own doctor).
No blood pressure reading from the last 7 days, or a reading of 140/90 or higher, when you ask for a medicine or at a check-in (see your own doctor).
Not clearly better after 12 weeks of your plan (see your own doctor).
Back pain for less than 6 weeks (use our acute low back pain visit).
Pregnant, might be, or trying to get pregnant (see your pregnancy doctor or midwife).
If more than one fits, follow the first one.

What to have ready

The date and the findings of your last in-person exam, and any scan results you already have
What exercise or therapy you have tried, for how long, and whether it helped
Every medicine, vitamin, and supplement you take
A blood pressure reading from the last 7 days (a pharmacy machine or a home cuff is fine), with the date and where it was taken. You need one before any medicine

What happens next

Standard

$59

Within 6 hours

Priority

$99

Within 3 hours

Rush

$149

Within 1 hour

Start the request on the website, answer a few questions to check that this visit fits you, and choose how fast you want an answer (the response window). If your concern still fits this service, a physician reviews it and sends you a secure update after you sign in. When appropriate, non-controlled prescriptions can be sent to your pharmacy, and a basic work or school note can be included at physician discretion.

Your physician

Every visit is personally reviewed by Ankur Fadia, MD. He is board-certified, has extra training in heart care (a cardiology fellowship), and is a member of Alpha Omega Alpha, a medical honor society. He is licensed in Virginia and West Virginia, and your care is never handed off to someone else.

About Ankur Fadia, MD Verify Virginia medical license Verify West Virginia medical license Verify board certification

How does the visit work?

The doctor reads your answers. We do not examine you. We do not order scans or tests. You get a written plan. It has these parts: stay active, take a short walk every day, and build up slowly. See a physical therapist for safe exercises. Learn ways to cope with pain. Use heat. If you tried that care and it was not enough, and a medicine is safe for you, the doctor may send ibuprofen for up to 4 weeks, or duloxetine. Never both. If you are not clearly better after 12 weeks, see your own doctor.

Can this visit prescribe tramadol or an opioid?

No. We never send opioids, tramadol, gabapentin, pregabalin, or muscle relaxers. Experts say muscle relaxers do not help long-term back pain. If you take an opioid now, or you want a prescription for one of these, please see your own doctor.

Do I need an X-ray or MRI?

We do not order scans or tests. If the doctor who examined you said you need a scan, tests, a specialist, or surgery that you have not had yet, please see your own doctor. If you already have scan results, tell us in the visit.

I have never had my back examined. Can I use this visit?

No. Please see your own doctor first. Doctors' guides say people with long-term back pain should be examined in person to look for serious causes, and we cannot do that. This visit is for people who were examined in person for this pain in the last 12 months.

Does this replace physical therapy?

No. Exercise and physical therapy come first. A physical therapist can show you safe exercises for your back. You book one yourself. Ask your own clinician for names of therapists that your insurance covers.

Which medicines can the doctor send?

Only ibuprofen or duloxetine, never both. You must have tried exercise or similar care, and it was not enough. You need a blood pressure reading from the last 7 days below 140/90. The safety questions must be clear. Ibuprofen is for 4 weeks at most. Duloxetine (Cymbalta) is for ages 25 to 64. It starts at 30 mg for 7 days, then 60 mg, for up to about 12 weeks. They may help some people. Duloxetine comes with a free 2-week form. A plan to stop duloxetine slowly is free.

Will I need a check-in?

If the doctor sends a medicine, we check in with you. The first check-in is free. Later check-ins have a price that is shown before you pay. We ask for a new blood pressure reading each time. If you have no reading, or it is 140/90 or higher, we cannot send more medicine, and you see your own doctor.

When do I need care right away?

Read the lists from the top. If more than one fits, follow the first one. Do not wait for our reply. Call 911 or go to the ER now if you have any of these. You lose control of your pee or poo. You have new trouble starting to pee. You have numbness around your genitals, bottom, or inner thighs. You have new loss of feeling during sex, or new trouble with an erection or an orgasm. A leg or foot is newly weak. You have new numbness or tingling in both legs. You have chest pain, severe belly pain, a pulsing feeling in your belly, or fainting. Your pain is from a serious accident. Your pain is so bad that you cannot walk or stand. Do not drive yourself. If you have thoughts of ending your life, or of hurting yourself or someone else, call or text 988 now.

What does the visit cost?

This is one visit. The price is shown before you pay. If the doctor sends a medicine, the first check-in is free. Later check-ins cost less than a new visit, and the price is shown before you pay. The 2-week duloxetine form and a plan to stop duloxetine slowly are free. You pay the pharmacy for the medicine.

Other conditions we treat

Not quite what you have? Here are other conditions we treat.

Achilles tendinitis Acute low back pain Acute muscle strain Ankle / wrist sprain Bursitis Costochondritis support