WHO releases guidelines on chronic low back pain

WHO releases guidelines on chronic low back pain


The World Health Organization (WHO) is releasing its first-ever guidelines on managing chronic 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.

The personal and community impacts and costs associated with LBP are particularly high for people who experience persisting symptoms. 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 is issuing guidelines on chronic primary LBP.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” said Dr Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course. “Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care.”

With the guidelines, 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 (i.e. pulling on part of the body);
  • and some medicines, such as opioid pain killers, which can be associated with overdose and dependence.

LBP is a common condition experienced by most people at some point in their life. In 2020, LBP accounted for 8.1% of all-cause years lived with disability globally. Yet clinical management guidelines have been developed predominately in high-income countries. For people who experience persisting pain, their ability to participate in family, social, and work activities is often reduced, which can negatively affect their mental health and bring substantial costs to families, communities, and health systems.

Countries may need to strengthen and transform their health systems and services to make the recommended interventions available, accessible and acceptable through universal health coverage, while discontinuing the routine delivery of certain interventions. Successful implementation of the guidance will rely on public health messaging around the appropriate care for LBP, building workforce capacity to address chronic low back pain care, adapting care standards and strengthening primary health care, including referral systems.

“Addressing chronic low back pain requires an integrated, person-centred approach. This means considering each person’s unique situation and the factors that might influence their pain experience,” said Dr Anshu Banerjee, WHO Director for Maternal, Newborn, Child, Adolescent Health and Ageing. “We are using this guideline as a tool to support a holistic approach to chronic low back pain care and to improve the quality, safety and availability of care.”

LBP affects life quality and is associated with comorbidities and higher mortality risks. Individuals experiencing chronic LBP, especially older persons, are more likely to experience poverty, prematurely exit the workforce, and accumulate less wealth for retirement. At the same time, older people are more likely to experience adverse events from interventions, reinforcing the importance of tailoring care to the needs of each person. Addressing chronic LBP among older populations can facilitate healthy ageing, so older persons have the functional ability to maintain their own well-being.

5 Responses

  1. We should leave pain treatment to be an individualized issue. Define pain as mild, moderate, severe, chronic, and intractable. Pain should be treated by pain doctors, not addiction specialists. The doctor-patient relationship is in the toilet and it needs to be restored. If and I mean if we need addiction therapy, well reach out, until then stay in your lane. Why are you punishing 999 people for 1 addiction? Btw, addicted people have traumas and diseases too. They should suffer bc of addiction? No, you developed individual treatment plans so they do not suffer. We must do better!

  2. i wonder JMO,,,who paid off the WHO??? i wonder how much $$$$$ addictionist gave to the WHO for a donations??Even scarey,,,the international WHO,, is literally right across the street from the U.N,,,,maryw

  3. It’s incredibly aggravating that they don’t distinguish between the plethora of differing causes of “chronic low back pain”. While many people have back pain from causes such as natural degeneration from aging and arthritis, which can be very painful without a doubt, other people have diseases and other issues that frequently produce significant, life altering pain.

    According to my pain doc, I’ve had the back of a 60yr old since I was in my 20’s due to injuries that I sustained in a serious accident that nearly killed me. There were pieces of my vertebrae that were snapped off and several were fractured. I have had significant osteoarthritis and degenerative disc disease, as well as having serious problems with the muscles in my back since they were also damaged in the accident. I experience sciatica, terrible muscle spasms, and wake up feeling like my entire torso is clamped down in a vice.

    As a matter of fact, the torso issue is one of the top 3 reasons that I can’t sleep. Pain meds are the only thing that afford me actual rest and the ability to lay down for any length of time. Yet, my low back pain is lumped in with people who have mild-moderate arthritis. Again, not that it isn’t painful, but some distinction should be made.

    I wonder how soon after Medicaid gets wind of the change that they’re going to craft policies denying people with a diagnosis of chronic low back pain any pain relief in the form of pain medications because WHO said so? It could potentially have the same type of impact as the CDC’s guidelines did, with people interpreting them as law. Perhaps that’s what they intend.

    It’s mind-blowing how they can point out the fact that chronic low back pain is a leading cause of disability, but then still dissuade the prescription of pain medications to treat the pain that is inarguably a heavily contributing factor toward chronic low back pain being a leading cause of disability.

    I have tried TENS, PT, chiropractic, NSAIDS, facet injections, massage, hot packs, cold packs, stretches, core strengthening, creams, patches, ointments, rubs, you name it and I have likely given it a try. The only one of those things that has provided ANY noticeable relief are Rx NSAIDS, in the form of Toradol. Which I can only take 5 days a month, and even then, they only really ever worked for me as an adjunct to pain meds.

    This news is seriously troubling to me. It’s like saying that you treat “skin conditions” the same way. Whether it’s a bacterial issue, a fungal infection, or an allergic reaction. That’s just piss-poor medicine, please excuse my “french”.

    • I’ve experienced the same. Only difference is I was finally after a lifetime of suffering diagnosed with a rare genetic bone disease with no cure. Only thing is my doctor has never heard of it and knows nothing about so he’s not giving me the only medication that actually helps. Opioids. I’ve done and tried everything that doctors have made me try with no relief. Only relief is from oxycodone an FDA approved medication that works. No medication made can cause addiction.if the directions are followed there should be no problems with overdosing and addiction!! I wish you the best of health!

      • I am so very sorry to hear that. It’s devastating when you’ve done all that’s been asked of you, only to be told there’s no further help for you. I also very much agree with you that no medication “causes” addiction, especially when used as directed and as a tool to reduce pain, rather than to achieve euphoria. Thank you, sir! I wish the best of health to you as well!

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