Back pain can be caused by various etiological factors, and its development is mediated by various pathogenetic mechanisms. Anatomical structures that can participate in the formation of pain include muscles, fascia, ligaments, tendons, facet joints, intervertebral discs and vertebrae. Changes in the central pain modulation system are an important factor in the development of chronic low back pain (LBP). Accumulating evidence allows us to consider LBP not as a series of isolated unrelated episodes, but as a long-term condition with a variable course. In the practice of a rheumatologist, LBP can occur as a manifestation of the underlying disease or as a comorbid pathology on the background of rheumatic pathology. In this case, it may be difficult to determine the activity of the underlying disease and the effectiveness of the therapy.