This clinical trial checks if a new medicine, PIPE-791, is safe and helps with pain from chronic osteoarthritis (joint disease causing pain) or chronic low back pain (long-lasting back pain). Participants will stop current pain medicines and take either PIPE-791 or a placebo (a pill with no medicine) for 4 weeks, then switch for another 4 weeks. They'll keep a daily diary about their pain and visit the clinic for tests and checkups.

• Study Length: About 16 weeks total, including screening, treatment, and follow-up.
• Participation Requirements: Must stop current medications and attend regular clinic visits.
• Eligibility: Ages 18-70 with specific chronic pain conditions, willing to follow study guidelines.

This study will include clinic visits and phone check-ins to ensure safety and track progress. Participants will receive instructions on how to record their experiences using an electronic diary.