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Low back pain (LBP), a prevalent costly condition, has evidence-based pharmacological and nonpharmacological treatments. Because the prevalence of LBP and the use of opioids differ between the U.S. Census Regions, we compared the treatments used for LBP and their related costs between regions.Deidentified patient health claims data from persons with LBP along with treatments received were extracted from a large commercially insured data set (2007–2009; N = 1,630,438). Descriptive statistics and analyses of variance were used during data analysis.An opioid was used by 49.8% (n = 812,479) of this sample, whereas nonpharmacological therapies were used less frequently (8%, psychological therapies; 19%, exercise therapies; 12%, physical therapy). The median costs for pharmacological and nonpharmacological treatments are variable. We found significant differences in the medications and therapies used in the U.S. Census Regions (p < .0001).Overuse of pharmacological treatment and underuse of nonpharmacological treatment are common among persons with LBP. Differences exist in the receipt of various LBP treatments geographically.