Which needle angle wins for back pain? trial tests two techniques Head-to-Head

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * aged \> 40, capable of understanding and providing consent in English, capable of complying with the outcome instruments used, capable of attending all planned follow up visits * unilateral or bilateral low back pain of at least 4/10 on Numeric Pain Rating Scale (NPRS) present for at least 2 months that has failed to adequately respond to at least 6 weeks of physical therapy and oral pain medication * at least 80% improvement on two consecutive lumbar medial branch blocks of no more than a total of 4 lumbar facet joints * beyond the above stated criteria, the decision to initiate the process of a first medial branch block is based on clinical decision making of the treating physician * Patient consents to treatment in a shared decision-making process with the treating physician. Exclusion Criteria: * Those whose primary complain is lumbar radiculopathy * Those receiving remuneration for their pain treatment (e.g., disability, worker's compensation). * Those involved in active litigation relevant to their pain. * Those unable to read English and complete the assessment instruments. * Those unable to attend follow up appointments * The patient is incarcerated. * History of prior lumbar fusion * Progressive motor deficit, and/or clinical signs of cauda equina or polyradiculopathy * History of lumbar steroid injection (epidural steroid injection, sacroiliac joint steroid injection, lumbar facet steroid injection) within the prior 3 months. * Possible pregnancy or other reason that precludes the use of fluoroscopy. * Allergy to contrast media or local anesthetics. * BMI\>40. * Active Systemic inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis, lupus). * Active infection or treatment of infection with antibiotics within the past 7 days. * Medical conditions causing significant functional disability (e.g., stroke, COPD) * Chronic widespread pain or somatoform disorder (e.g. fibromyalgia). * Addictive behavior, severe clinical depression, or psychotic features.