OBJECTIVES: Low back pain (LBP), with or without radiant pain, has been estimated as one of the most common reasons for using healthcare resources and being on sick leave. The objective of this study was to develop a treatment pathway simulation model to estimate the societal life-time burden of LBP in Sweden. METHODS: An individual state transition simulation model was constructed to follow patients from their first healthcare visit in primary care related to their LBP-condition and over the LBP treatment pathway until death. Data on transition probabilities, costs and quality of life were derived from a research database including data from six national and regional registers on all healthcare resource and sickness insurance use of patients who had sought care due to LBP during 2008–­2012. A control group for comparison with the LBP patient group was derived from publicly available aggregated data on costs in the general population. RESULTS: Most LBP patients started their treatment pathway receiving non-invasive care (93%), and for most, LBP symptoms had resolved within 12 months (90%). Within one year after the first registered visit to a caregiver, 1.2% percent had undergone surgery. Ten years after the first visit in primary care, 92% were asymptomatic. Mean total life-time cost per patient was €47,452, where indirect costs represented 57%. QALYs lost due to LBP was estimated at 2.7/patient. For patients visiting primary care for a LBP problem in one year in the whole Swedish population (9.6M inhabitants), the total life-time burden was €8.8 billion. By adding the intangible value of lost QALYs, the total societal burden amounts to €44.1 billion. CONCLUSIONS: Using a unique pathway model including data from national and regional registers in Sweden, LBP was found to cause a major strain to the society, mainly due to the high indirect costs and reduced quality of life.