What is the best pain med to help with severe chronic back pain when all other options have failed? have tried trig point inject, phys therapy

Time to see: An interventional pain physician for more sophisticated and effective treatment options.

Pain killers: The best pain killer for the chronic pain is the one that relieves your pain. It can be over the counter medication like Ibuprofen or tylenol, (acetaminophen) or prescription medication.

All other options?: If you mean just trigger point injections and physical therapy, you're far from having tried all the options. Chronic medication use is not the best answer/solution. If a spine specialist can find the true source of the pain (facet joints, pinched nerves, ligaments, muscles, etc) than it can either be "fixed" or at least maybe just require an injection/procedure now and then.

Try osteopathic tx: Why not try osteopathic medical treatment by a trained do, or osteopathic doctor, who can do a complete musculoskeletal diagnosis of your condition, and also take into consideration past and recent traumas, medical conditions, etc.? This could be affecting the fatigue from your chronic pain. Go to the aoa.Org website, and look up a doctor in your town, and get a second opinion and treatment.