<p>Back pain syndrome is one of the most prevalent disorders of the 21st century, frequently diagnosed by physicians across various medical specialties. A key clinical priority is to identify the underlying cause and establish an accurate diagnosis. A common etiological factor is the overload of soft tissues due to improper posture or movement, resulting in congestion, reduced mobility, and pain. Spinal mesotherapy, a minimally invasive injection technique, has gained attention for its ability to improve microcirculation, relax tense tissues, enhance range of motion, and, most importantly, alleviate pain. Increasingly, this treatment is being incorporated into a structured “three-step approach” to chronic back pain: risk factor assessment, medical intervention (such as spinal mesotherapy), and subsequent targeted physiotherapy. This narrative review analyzes nine studies involving more than 800 patients with chronic back pain syndrome. Across all included studies, mesotherapy demonstrated a consistent positive impact on both pain reduction and functional improvement, without reports of serious adverse events. The purpose of this review is to assess the current evidence on the efficacy and safety of spinal mesotherapy and to highlight its role within a multimodal treatment strategy for chronic back pain.</p>