A Woman With "Life-Long" Low Back Pain

A 42-year-old woman had a "life-long" history of mild to moderate low back pain, without radiation, anesthesia, weakness, or incontinence. She denied recent trauma or an inciting event. 

The pain was constant and worse at the end of the day and with prolonged activity. Physical therapy, NSAIDs, tramadol, opioids, and manipulation provided minimal relief.

What's your diagnosis?

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