World Health Organization Releases Chronic Back Pain Care Guidelines

/ Thomas Cohn, MD

back pain hiddenEarlier this week, the World Health Organization (WHO) released its first-ever guidelines for managing chronic low back pain in primary and community care settings. Not only do the guidelines focus on what healthcare workers should be doing to help patients treat their back pain, they also outlined what techniques should be avoided during routine care.

The WHO felt compelled to issue these new guidelines because low back pain is the leading cause of disability in the world. In 2020, roughly 1 in 13 people experienced low back pain, which equates to 619 million people globally. This number also reflects a 60 percent increase from 1990, and cases of low back pain are expected to surge to 843 million by 2050.

“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.”

WHO Chronic Low Back Pain Recommendations

The World Health Organization recommends non-surgical interventions to help patients experiencing chronic low back pain. They grouped their recommendations under different categories, which we’ll explore below:

Education – Patient education should be structured based on the individual needs of the patient and help the patient better understand their condition and some self-help strategies for treatment.

Physical Interventions – Physical intervention recommendations include structured exercise programs, physical therapy, spinal manipulation therapy, massage therapy, needling therapies and assistive devices.

Psychological Interventions – Operant therapy and cognitive behavioral therapy are recommended as treatments to address the psychological effects of chronic low back pain.

Medicines – WHO recommends non-steroidal anti-inflammatory drugs as part of a routine and comprehensive treatment plan for chronic low back pain.

Multi-Component Interventions – Finally, WHO recommends multi-component biopsychosocial care for patients battling chronic low back pain.

Interventions That Should Be Avoided

According to the World Health Organization, the following treatments should not be recommended as part of routine care for chronic low back pain. They may be recommended if specific conditions are met, but they are not currently recommended as part of routine chronic low back pain treatment:

  • Traction
  • Therapeutic ultrasound
  • TENS stimulation
  •  Lumbar braces/Support belts
  • Opioid analgesics
  • SNRI antidepressants
  • Tricyclic antidepressants
  • Anticonvulsants
  • Skeletal muscle relaxants
  • Glucocorticoids
  • Injectable local anesthetics
  • Devil’s claw (Harpagophytum procumbens)
  • While willow (Salix spp.)
  • Pharmacological weight loss products

The recommendations by WHO mirror what we’ve been saying to patients for years. Chronic low back pain is best treated with active interventions like exercise and physical therapy, but it also needs to focus on patient education and the psychological effects of chronic pain. Treatment needs to be multi-faceted to be effective, so it’s nice to see that WHO is confirming the methods we’ve been using to help patients overcome their chronic low back pain for years.

If you need help treating low back pain or another chronic pain issue, reach out to Dr. Cohn and his team today at (952) 738-4580.