The World Health Organization (WHO) has unveiled its inaugural guidelines aimed at addressing the global challenge of chronic low back pain (LBP) in primary and community care settings. With low back pain standing as the leading cause of disability worldwide, affecting 619 million people in 2020 alone, the guidelines are positioned as a crucial resource for healthcare providers and systems grappling with the escalating burden of this condition.
The prevalence of LBP has surged by 60% since 1990, and projections estimate that cases will soar to 843 million by 2050. The most substantial growth is anticipated in Africa and Asia, underscoring the urgent need for a comprehensive, globally applicable approach to managing chronic LBP.
Dr Bruce Aylward, WHO Assistant Director-General, Universal Health Coverage, Life Course, emphasized the imperative of addressing low back pain for achieving universal health coverage. He stated, “To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally.”
The guidelines specifically focus on chronic primary LBP, defined as pain persisting for more than three months without an underlying disease or condition. Representing approximately 90% of chronic LBP cases in primary care, the guidelines highlight the necessity of tailored interventions for this prevalent and often overlooked health challenge.
WHO’s recommendations for non-surgical interventions include education programs, exercise programs, specific physical therapies like spinal manipulative therapy and massage, psychological therapies such as cognitive-behavioral therapy, and selected medicines like non-steroidal anti-inflammatory drugs.
The guidelines stress the importance of a holistic, person-centered, equitable, non-stigmatizing, non-discriminatory, integrated, and coordinated approach to care. Acknowledging the multifactorial nature of chronic primary LBP, the guidelines advocate for a suite of interventions rather than isolated measures.
Conversely, WHO identifies 14 interventions that should not be routinely offered due to potential harms outweighing benefits. These include lumbar braces, belts, supports, certain physical therapies like traction, and specific medicines such as opioid painkillers, which can be associated with overdose and dependence.
Dr Anshu Banerjee, WHO Director for Maternal, Newborn, Child, Adolescent Health and Ageing, stressed the importance of an integrated, person-centered approach in addressing chronic low back pain. “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.”
The guidelines highlight the need for countries to strengthen their health systems to make recommended interventions universally accessible while discontinuing routine delivery of certain ineffective interventions. Successful implementation will depend on public health messaging, workforce capacity building, adapting care standards, and strengthening primary health care, including referral systems.
Chronic low back pain not only affects quality of life but is also associated with comorbidities and higher mortality risks. Addressing this issue is particularly crucial for older populations, as chronic LBP can lead to poverty, premature workforce exit, and reduced wealth accumulation for retirement. Tailoring care to individual needs is emphasized, reflecting the WHO’s commitment to fostering healthy ageing and preserving functional ability among older persons.
