WHO releases lower back pain guideline

Jolyon Attwooll

24/01/2024 1:08:17 PM

The document, the first of its kind to be released by the WHO, considers 37 different interventions for the management of chronic lower back pain.

Woman with back pain
Lower back pain is one of the most widespread conditions affecting patients around the world.

A new World Health Organization (WHO) guideline for managing chronic lower back pain conditionally supports the use of structured exercise therapy but advises against the use of opioids.
The Guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings also concludes that nonsteroidal anti-inflammatory drugs (NSAIDs) may be offered to patients with moderate certainty in favour of their use.
Cognitive behavioural therapy is another intervention that gets the green light from WHO experts, although they acknowledge the ‘very low certainty’ evidence.
Overall, the resource, which was compiled by 25 members of a clinical guideline group including three clinicians based in Australia, considers 37 interventions and makes 24 recommendations, along with one statement of good practice.
There were 12 interventions for which no recommendation was made, with the available information deemed either too equivocal or providing insufficient evidence.
According to its authors, lower back pain is a leading cause of disability across all ages and both sexes, with one in 13 people around the world experiencing it in 2020 – the equivalent of around 619 million people.
They note that estimates of the condition’s prevalence are ‘consistently higher’ in females and older people.
‘No guideline has been produced that considers management of chronic lower back pain in adults, and in particular for older people, from a global public health perspective that takes into account universal health coverage (UHC) and the different levels of economic development across countries,’ they wrote.
The guideline was put together to fill that gap, they state.
A Low Back Pain Clinical Care Standard published by the Australian Commission on Safety and Quality in Health Care (ACSQHC) previously outlined evidence for a more active approach for Australians with lower back pain.
The standard, which was released in 2022, was the first of its kind to be produced in Australia.
When it was published, Associate Professor Liz Marles, a GP and Clinical Director at the ACSQHC, warned against unnecessary investigations.
‘The good news is that most people who have a single episode of low back pain – 75% of patients – will improve rapidly and their pain will resolve within six weeks,’ she told newsGP at the time.
Similarly, the WHO guideline notes that most patients who experience acute lower back pain have ‘time-limited, low-to-moderate levels of disability’ as well as a ‘favourable clinical course’.
An Australian-led study published this month in the Canadian Medical Association Journal also found patients with acute and subacute low back pain had substantial improvements in their level of pain and disability within six weeks.
However, it noted that study participants who had persistent low back pain had ‘minimal improvements’ over time.
‘Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain,’ its authors wrote.
The WHO guideline reports a 60% increase in lower back pain cases since 1990, while the most recent Australian Institute of Health and Welfare (AIHW) estimate suggests four million people in Australia had back problems in 2017–18.
The Handbook of Non-Drug Interventions (HANDI), which includes details on a number of recommendations for patients with low back pain, is published on the RACGP website.
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