•Known or suspected allergy to trial medication(s), excipients, or related products
•Contraindications to study medication(s), worded specifically as stated in the product's Prescribing Information
•Previous randomization in this trial
•Pregnant, breastfeeding, or the intention of becoming pregnant or not using adequate contraceptive measures
•Low back pain related to infection, trauma, or malignancy
•Plans to undergo new back pain interventions within 3 months.
•Considering or have been offered surgery to treat structural disease believed to cause their low back pain, including infection, severe degeneration adjacent to a prior fusion, mobile spondylolisthesis, severe central lumbar stenosis, coronal or sagittal deformity, or other severe structural pathology diagnosed by a board-certified spine surgeon. Ambiguous cases will be adjudicated by a board-certified spine surgeon.
•Another source of pain that is more severe than their low back pain (e.g., headache or radiculopathy)
•History of or plans to undergo bariatric weight loss surgery
•History of a major abdominal or stomach surgery that might affect drug absorption
•Decrease in body weight of > 5 kg within 3 months of screening
•History of diabetes mellitus, with HbA1c > 7 or requiring medical treatment (i.e., insulin or other diabetes medication other than Metformin).
•Uncontrolled hypertension, defined as a systolic blood pressure (BP) > 155 mmHg or a diastolic BP > 100 mmHg
•Clinically significant congestive heart failure, defined as New York Heart Association Class IV, or active symptoms related to heart failure, or exacerbation requiring hospitalization within 90 days of screening.
•Any of the following: myocardial infarction, stroke, hospitalization for unstable angina pectoris, or transient ischemic attack within 90 days of screening.
•Other medical conditions that could impact their treatment, similar to prior published reports
•Treatment with oral or injectable glucagon-like peptide-1 (GLP-1) receptor agonists within 3 months before screening
•Active acute or chronic pancreatitis diagnosed within 180 days or history of unprovoked pancreatitis within the past year.
•Stage 3 or worse chronic kidney disease (i.e., eGFR < 60).
•Known active gallstone disease, other than disease previously treated with cholecystectomy.
•Newly diagnosed or worsening chronic liver disease.
•Active malignancy
•Major neurological disease, such as multiple sclerosis or Parkinson's Disease
•Major psychiatric disease, such as psychosis or schizophrenia, or a psychiatric disease requiring hospitalization in the preceding 12 months
•History of a suicide attempt or any reported suicidal behavior reported within 30 days of screening.
•Personal history of MEN2
•Personal or family history of medullary thyroid cancer
•Impaired sensorium due to alcohol or drug use.