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

This World Health Organization guideline covers non-surgical care in primary and community settings for adults, including older people, with chronic primary low back pain: pain lasting more than three months that cannot be reliably traced to a specific disease or structural lesion. WHO says no earlier guideline had looked at chronic low back pain in adults from a global public health perspective.

It is written for health workers of every discipline, and it names chiropractors, physiotherapists and occupational therapists among them. An external guideline group used GRADE to judge the evidence on 37 interventions in five classes: education, physical interventions, psychological therapies, medicines and multicomponent care. The recommendations are conditional, and the certainty of evidence behind them was mostly low or very low.

It conditionally supports structured education, structured exercise, needling therapies including dry needling, spinal manipulative therapy, massage, operant therapy, cognitive behavioral therapy, NSAIDs and multidisciplinary biopsychosocial care. It advises against routine use of traction, therapeutic ultrasound, TENS, opioids and several other medicines. It describes the recommended options as a menu to combine and tailor to each person, not single treatments used alone.

Summarized from the published abstract; the full text was not open to us.