Do’s and don’ts for tackling chronic back pain

Notably, the guidance includes both recommendations and warnings for long-term sufferers, arguing against the use of opioid painkillers; physical therapies, such as traction; and lumbar braces and belts.

Instead, healthcare professionals are advised to develop exercise programmes; help patients educate themselves on the options and self-care strategies; and provide psychological support, such as cognitive behavioural therapy.

Some physical therapies, such as spinal manipulation therapy (chiropractic or osteopathy treatment), massage and medicines - such as non-steroidal anti-inflammatory medicines (NSAIDs) - are also recommended.

“Care should be tailored to address the mix of factors – physical, psychological and social – that may influence their chronic primary low back pain (LBP) experience,” WHO said.

“A suite of interventions may be needed to holistically address a person’s chronic primary LBP, instead of single interventions used in isolation,” the agency added.

Leading cause of disability

Low back pain (LBP) is a common condition experienced by most people at some point in their life, however, it is also the leading cause of disability globally, said WHO.

For people who experience persistent pain, their ability to participate in family, social, and work activities is often reduced, which can negatively affect their mental health at substantial cost to families, communities, and health systems.

In 2020, approximately 1 in 13 people – equating to 619 million people – experienced LBP, a 60 per cent increase from 1990.

Figures shooting up

LBP cases are expected to rise to an estimated 843 million by 2050, with the greatest growth anticipated in Africa and Asia, where populations are rising and people are living longer.

Personal and community impacts, and costs associated with LBP are particularly high for people who experience persisting symptoms.

Those experiencing chronic LBP, especially older persons, are more likely to experience poverty, prematurely exit the workforce, and be cash-strapped in retirement.

Addressing chronic LBP among older populations can facilitate healthy ageing, so older persons have the functional ability to maintain their own well-being, WHO noted.

Problem cannot be ignored

Bruce Aylward, WHO Assistant Director-General for Universal Health Coverage, emphasized the need to tackle low back pain, especially in the light of global health targets.

“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” Dr. Aylward, who is also a physician, said.

“Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care,” he added.

Tailor-made approach

WHO also stressed the need for an integrated, person-centred approach.

It said that countries may need to strengthen and transform their health systems and services to make the recommended interventions available, accessible and acceptable through universal health coverage, while discontinuing the routine delivery of interventions that are not effective.

Successful implementation of the guidance will rely on public health messaging around the appropriate care for LBP, building workforce capacity to address chronic low back pain care, adapting care standards and strengthening primary healthcare, including referral systems, WHO added.