Geneva, Switzerland – The World Health Organization (WHO) has unveiled its inaugural guidelines on managing chronic low back pain (LBP) in primary and community care settings. These guidelines provide health workers with recommendations for interventions to use and avoid during routine care.
As the leading cause of global disability, low back pain affected approximately 619 million people in 2020, marking a 60% increase from 1990. Projections estimate that cases will surge to 843 million by 2050, with Africa and Asia expected to witness the most significant growth due to expanding populations and longer life expectancies.
Chronic primary LBP, lasting over three months without an underlying disease or condition, constitutes many cases in primary care, accounting for at least 90%. Recognizing the significant personal, community, and economic impacts, WHO is issuing guidelines specifically addressing 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.”
The guidelines recommend non-surgical interventions for chronic primary LBP, including education programs, exercise, specific physical therapies, psychological therapies, and selected medications such as non-steroidal anti-inflammatory drugs.
Key principles of care outlined in the guidelines emphasize a holistic, person-centered, equitable, non-stigmatizing, non-discriminatory, integrated, and coordinated approach. Care should address the mix of physical, psychological, and social factors influencing chronic primary LBP. Instead of isolated interventions, a suite of strategies may be needed for a comprehensive approach.
The guidelines also caution against 14 interventions not recommended for most people in most contexts due to potential harms outweighing benefits. These include lumbar braces, belts, supports, traction, and certain medicines like opioid painkillers associated with overdose and dependence.
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Chronic low back pain can lead to reduced participation in daily activities, negatively affecting mental health and imposing substantial costs on families, communities, and health systems. The guidelines advocate for public health messaging, workforce capacity building, adaptation of care standards, and strengthening primary health care to successfully implement the recommended interventions.
“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.”
