Low Back Pain Practice Guidelines: Which are Most Practical?
By Admin | March 21, 2024
The World Health Organization (WHO) has released its first-ever guideline for nonsurgical management of low back pain.1 Published in December 2023, the WHO guideline is timely, as low back pain (LBP) is among the most common, fastest-growing types of pain, affecting 1 in 13 people worldwide.2-6 Despite LBP’s incidence rate, multiple pathologies, and associated economic costs, global guidance on the best ways to manage the condition has been lacking, until now.2,6-8
But clinicians must also consider the recent US Departments of Veterans Affairs (VA) and Defense (DoD) guidelines for the evaluation and management of LBP, published in 2022.9 These recommendations come with distinct acute, subacute, and chronic low back pain timeframes and distinguish interventions for when address pain in these timeframes.
Herein, we provide an overview of new WHO recommendations and compare them to recommendations of the VA/DoD. While both guidelines offer important tools for clinicians working to evaluate and manage low back pain, there are limitations and cautions to consider.
WHO Guideline on Low Back Pain
Overview
The primary purpose of the WHO guideline is to improve treatment outcomes for chronic primary low back pain in primary and community care settings, as well as to discuss the overall benefits and harms of specific interventions. Of note, interventions delivered in secondary and tertiary care settings (eg, surgical, minimally invasive) or in the workplace (eg, posture control) were not addressed.
The WHO guideline defines chronic primary low back pain as a “persistent or recurrent pain experience of more than 3 months that is not reliably attributed to an underlying disease process or structural lesion.”1 More specifically, it involves “pain between the 12th rib and gluteal folds with or without co-existent spine-related leg pain” and may be experienced continuously or intermittently.
Recommendations were developed in accordance with the WHO Handbook for Guideline Development and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to evaluate the certainty of evidence.10
Five classes of interventions for the management of chronic primary LBP in adults were considered:
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standardized/structured patient education
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physical interventions
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psychological interventions
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medicines
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multicomponent interventions
Recommendations
Within these five classes of interventions, the WHO provided 24 recommendations and one good practice statement; another 12 interventions had no recommendations (see Tables I-III for details).
The majority of the WHO recommendations were made with “low” or “very low” certainty evidence. In fact, the only recommendations that were associated with...(More)
For more info please read, Low Back Pain Practice Guidelines: Which are Most Practical?, by MedCentral
