WHO Releases Groundbreaking Guidelines for Managing Chronic Low Back Pain in Primary Care

The World Health Organization (WHO) unveils its inaugural guidelines to address chronic low back pain, offering recommendations for health workers in primary and community care settings.

Chronic low back pain (LBP), a global leader in disability cases, prompted WHO to release guidelines aimed at improving care and mitigating the escalating prevalence. In 2020, 619 million people, or 1 in 13 individuals, encountered LBP, marking a 60% surge since 1990. With projections estimating a rise to 843 million cases by 2050, particularly in Africa and Asia, where populations are growing, the impact on personal, community, and economic levels is substantial.

Chronic primary LBP, characterized by pain lasting more than three months without an underlying disease, comprises over 90% of cases in primary care. Dr. Bruce Aylward, WHO Assistant Director-General for Universal Health Coverage, emphasizes the significance of addressing LBP for achieving universal health coverage globally.

The guidelines advocate non-surgical interventions for chronic primary LBP, endorsing education programs, exercise regimens, selected physical therapies, psychological interventions like cognitive behavioral therapy, and specific medications such as non-steroidal anti-inflammatory medicines.

Key principles underscore a holistic, person-centered, and equitable approach to care. Tailoring interventions to address the diverse factors influencing chronic primary LBP is emphasized, discouraging isolated interventions. WHO advises against 14 interventions, including lumbar braces, traction therapies, and opioid pain killers, citing potential harms outweighing benefits.

While LBP accounted for 8.1% of global disability in 2020, clinical management guidelines have primarily originated from high-income countries. The guidelines emphasize the need for an integrated, person-centered approach to care. Dr. Anshu Banerjee, WHO Director for Maternal, Newborn, Child, Adolescent Health, and Ageing, emphasizes the importance of addressing chronic LBP holistically to enhance care quality, safety, and availability.

Chronic LBP not only impacts the quality of life but is associated with comorbidities and higher mortality risks. Addressing chronic LBP is crucial for healthy aging, preventing adverse events from interventions, and tailoring care to individual needs. The successful implementation of these guidelines relies on public health messaging, workforce capacity building, and strengthening primary health care, including referral systems.