The World Health Organization (WHO) released its first-ever guidelines on managing chronic low back pain (LBP) in primary and community care settings. It lists interventions for health workers to use and avoid during routine care.
According to WHO, 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.
WHO states that the personal and community impacts and costs associated with LBP are particularly high for people who experience persisting symptoms. Chronic primary LBP refers to pain that lasts for more than 3 months and is not due to an underlying disease or other condition.
The health organisation said they issued the guidelines on the accounts for the vast majority of chronic LBP presentations in primary care, commonly estimated to represent at least 90% of cases.
Dr. Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course, said “To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally. Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care.”
WHO’s chronic primary LBP guidelines included interventions that recommend non-surgical interventions that 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.
- Medicines, such as non-steroidal anti-inflammatory medicines.
According to WHO, the guidelines outlined 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.
The guidelines also outline 14 interventions that are not recommended based on WHO’s evaluation of the available evidence indicating that potential harms likely outweigh the benefits. WHO advises that these interventions should not be routinely offered for most people in most contexts. They include:
- Lumbar braces, belts and/or supports.
- Some physical therapies, such as traction (i.e. pulling on part of the body).
- Some medicines, such as opioid painkillers, which can be associated with overdose and dependence.
WHO records that LBP is a common condition experienced by most people at some point in their lives. 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.
Dr. Anshu Banerjee, WHO Director for Maternal, Newborn, Child, Adolescent Health and Ageing said “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.
“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.”
The global organisation states that 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 well-being.
WHO urged Countries 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.
