A 48-year-old woman presents to the nurse practitioner with a history of nonspecific back pain between the lower rib margin and the gluteal folds for 3 months. She reports significant emotional distress and functional impairment related to this ongoing pain. She denies a history of injury or trauma to her back or neck. Which of the following is INCORRECT about chronic lower back pain?

Choice A reason: This is correct; most low back pain is nonspecific and does not require imaging unless there are red flags. Choice B reason: Imaging may be indicated if pain persists despite conservative management or if there are neurologic deficits, making this statement accurate. Choice C reason: Combining cognitive behavioral therapy with physical therapy is evidence-based and effective in improving outcomes for chronic low back pain. Choice D reason: This is incorrect. Opioids are not first-line treatment due to risks of dependence, overdose, and limited efficacy. First-line management emphasizes non-pharmacologic strategies and non-opioid medications.