WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings

The World Health Organization (WHO) released on 7 December 2023 its first-ever guidelines (click here) on managing chronic primary low back pain (LBP) in primary and community care settings, listing interventions for health workers to use and also to not use during routine care.

Low back pain is the leading cause of disability globally. In 2020, approximately 1 in 13 people, equating to 619 million people, experienced LBP, a 60% increase from 1990. Cases of LBP are expected to rise to an estimated 843 million by 2050, with the greatest growth anticipated in Africa and Asia, where populations are getting larger and people are living longer.

Chronic primary LBP referring to pain that lasts for more than 3 months that is not due to an underlying disease or other condition accounts for the vast majority of chronic LBP presentation in primary care, commonly estimated to represent at least 90% of cases. For these reasons, WHO issued guidelines on chronic primary LBP.

WHO recommends non-surgical interventions to help people experiencing chronic primary LBP. These interventions include:

•  education programs that support knowledge and self-care strategies;
•  exercise programs;
•  some physical therapies, such as spinal manipulative therapy and massage;
•  psychological therapies, such as cognitive behavioural therapy; and
•  medicines, such as non-steroidal anti-inflammatory medicines.

The guidelines outline key principles of care for adults with chronic primary LBP, recommending that it should be holistic, person-centred, equitable, non-stigmatizing, non-discriminatory, integrated and coordinated. Care should be tailored to address the mix of factors (physical, psychological, and social) that may influence their chronic primary LBP experience. A suite of interventions may be needed to holistically address a person’s chronic primary LBP, instead of single interventions used in isolation.

The guidelines also outline 14 interventions that are not recommended for most people in most contexts. These interventions should not be routinely offered, as WHO evaluation of the available evidence indicate that potential harms likely outweigh the benefits. WHO advises against interventions such as:

•  lumbar braces, belts and/or supports;
•  some physical therapies, such as traction;
•  and some medicines, such as opioid pain killers, which can be associated with overdose and dependence.

The Guideline and its associated resources ARE AVAILABLE HERE.