Background

WHO recognises the global burden of disease associated with low back pain (LBP) and other musculoskeletal conditions,¹ the need for rehabilitation services,² and the need to respond with global guidelines to improve outcomes on health and well-being and health system performance, especially in primary and community care settings. As such, WHO has developed a standard clinical guideline for the non-surgical management of chronic primary LBP in adults in primary and community care settings. The Guideline is targeted towards health workers in primary and community care settings.

Scope

The Guideline addresses the key question:

“What are the benefits and harms of non-surgical interventions in the clinical management of community-dwelling adults, including older adults aged 60 years and over, with chronic primary LBP (with or without spine-related leg pain) in primary or community care settings compared with placebo, no intervention, or usual care?”

The Guideline provides evidence-based recommendations for non-surgical interventions for chronic primary LBP in adults, including older adults, in primary and community care settings. Interventions considered include: structured and standardized education interventions; physical interventions; psychological interventions; medicines; and multicomponent interventions.

Development process

The Guideline was developed by a Guideline Development Group according to WHO standards and overseen by an internal WHO Steering Group representing all WHO Regional Offices and relevant technical units at WHO Headquarters.

Recommendations

The Guideline makes conditional recommendations for interventions that should be offered as part of care to adults, including older people (where appropriate), with chronic primary LBP, in most contexts. The Guideline also recommends interventions that should not be used as part of routine care for adults, including older people, with chronic primary low back pain.

The Guideline outlines 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. Care should be tailored to address the mix of factors (physical, psychological, and/or social) that may influence a person’s chronic primary LBP experience. A suite of interventions may be needed to holistically address a person’s chronic primary LBP experience, instead of single interventions used in isolation.            

Links

• Department news
  
• Executive Summary (EN)
• Guideline (EN)
• Web Annex A
  
• Web Annex B
  
• Web Annex C
  
• Web Annex D 
• Web Annex E 
• Quick reference guide

Complementing other WHO work

The Guideline complements other WHO work in health system strengthening for musculoskeletal conditions such as the Package of interventions for rehabilitation of musculoskeletal conditions and the WHO Integrated Care for Older People (ICOPE) approach; one of action areas of  UN Decade of Healthy Ageing (2021-2030). From a lifecourse perspective, this Guideline on adults will support the   WHO Guidelines on the management of chronic pain in children.

Disclaimer

Guideline Development Groups provide technical and/or normative advice and recommendations to WHO. Participation in a Guideline Development Group convened by WHO does not necessarily mean that the views expressed by the expert concerned are shared by WHO and/or represent the decisions or stated policy of WHO.