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STUDY DESIGN Retrospective analysis of inpatient and outpatient medical insurance claims data from a database containing over 100 million individuals. OBJECTIVE To quantify the healthcare resource utilization (HCRU) of non-surgical treatments in the first 2 years after a chronic, refractory low back pain (CRLBP) diagnosis. SUMMARY OF BACKGROUND DATA Patients with persistent low back pain (LBP) despite conventional medical management and who are not candidates for spine surgery are considered to have chronic, refractory low back pain (CRLBP) and incur substantial healthcare costs over time. Few data exist on the HCRU of this specific population. METHODS The IBM MarketScan Research databases from 2009 to 2016 were retrospectively analyzed to identify US adults with a diagnosis of non-specific LBP and without cancer, spine surgery, failed back surgery syndrome, or recent pregnancy. We required > 30 days of utilization of pain medications or non-pharmacologic therapies within both the 3-12- and 12-24-month periods post-diagnosis. Annual total healthcare costs, costs subdivided by insurance type, and use of non-surgical therapies were determined for 2 years after diagnosis of LBP. RESULTS 55,945 patients with CRLBP were identified. Median total cost was $6,590 (Q1 $2,710, Q3 $13,922) in the first year, almost doubling the baseline cost; costs were highest for patients with Medicare Supplemental insurance, reaching $10,156 (Q1 $5,481, Q3 $18,570). 33,664 (60.2%) patients engaged physical therapy, 28,016 (50.1%) engaged chiropractors, and 14,488 (25.9%) had steroid injections. 36,729 (65.7%) patients used prescription pain medications, most commonly opioids (N = 31,628, 56.5%) and muscle relaxants (N = 21,267, 38.0%). CONCLUSION This study is one of the first to investigate the HCRU of a large, longitudinal US cohort of patients with CRLBP. These patients experience substantial healthcare costs. Contrary to LBP management guidelines, most patients used opioids, and several non-pharmacologic therapies were used by only a few patients. LEVEL OF EVIDENCE 3.