Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings
Publication Date: December 7, 2023
Last Updated: December 12, 2023
Education
Structured and standardized education and/or advice
Structured and standardized education and/or advice interventions may be offered as part of care to adults, including older people, with CPLBP. (C, VL )
620
Physical interventions
Structured exercise therapies or programmes
A structured exercise therapy or programme may be offered as part of care to adults, including older people, with CPLBP. (C, L )
620
Needling therapies
Needling therapies such as acupuncture may be offered as part of care to adults, including older people, with CPLBP. (C, L )
620
Spinal manipulative therapy
Spinal manipulative therapy may be offered as part of care to adults, including older people, with CPLBP. (C, VL )
620
Massage
Massage may be offered as part of care to adults, including older people, with CPLBP. (C, VL )
620
Traction
Traction should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Therapeutic ultrasound
Therapeutic ultrasound should not be used as part of routine care for adults, including older people, with CPLBP. (C, L )
620
Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Lumbar braces, belts and/or supports
Lumbar braces, belts and/or supports should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Mobility assistive products
Quality, affordable mobility assistive products should be offered to adults, including older people, with CPLBP, based on a personcentred assessment. (U, CC)
620
Psychosocial Interventions
Operant therapy
Operant therapy may be offered as part of care to adults, including older people, with CPLBP. (C, VL )
620
Respondent therapy
The balance between the benefits and harms for respondent therapy in managing CPLBP in adults, including older people, is so equivocal that a recommendation cannot be made. (U, VL )
620
Cognitive therapy
The balance between the benefits and harms for cognitive therapy in managing CPLBP in adults, including older people, is so equivocal that a recommendation cannot be made. (U, VL )
620
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) may be offered as part of care to adults, including older people, with CPLBP. (C, VL )
620
Mindfulnessbased stress reduction therapy
The balance between the benefits and harms for mindfulnessbased stress reduction therapy in managing CPLBP in adults, including older people, is so equivocal that a recommendation cannot be made. (U, L )
620
Systemic pharmacotherapies
Opioid analgesics
Opioid analgesics should not be used as part of routine care for adults, including older people, with CPLBP. (C, M )
620
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDS may be offered as part of care to adults with CPLBP. (C, M )
620
Serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressants
SNRI antidepressants should not be used as part of routine care for adults, including older people, with CPLBP. (C, L )
620
Tricyclic antidepressants
Tricyclic antidepressants should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Anticonvulsants
Anticonvulsants should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Skeletal muscle relaxants
Skeletal muscle relaxants should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Glucocorticoids
Glucocorticoids should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Paracetamol (acetaminophen)
No recommendation. There were no trials identified that evaluated the benefits or harms of paracetamol (acetaminophen) in the management of CPLBP in adults. (U, U)
620
Benzodiazepines
No recommendation. There were no trials identified that evaluated the benefits or harms of benzodiazepines in the management of CPLBP in adults. (U, U)
620
Cannabisrelated pharmaceutical preparations for therapeutic use
No recommendation. There were no trials identified that evaluated the benefits or harms of cannabis-related pharmaceutical preparations for therapeutic use in the management of CPLBP in adults. (U, U)
620
Injectable local anaesthetics
Injectable local anaesthetics should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Herbal medicines
Topical Cayenne pepper (Capsicum frutescens)
Topical Cayenne pepper (Capsicum frutescens) may be offered as part of care to adults with CPLBP, including older people. (C, L )
620
Devil’s claw (Harpagophytum procumbens)
Devil’s claw (Harpagophytum procumbens) should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
White willow (Salix spp.)
White willow (Salix spp.) should not be used as part of routine care for adults, including older people, with CPLBP. (C, L )
620
Topical Brazilian arnica (Solidago chilensis)
No recommendation. The evidence regarding the benefits and harms of topical Brazilian arnica (Solidago chilensis) in managing CPLBP in adults is insufficient to formulate a recommendation. (U, VL )
620
Ginger (Zingiber officinale Roscoe)
No recommendation. The evidence regarding the benefits and harms of Ginger (Zingiber officinale Roscoe) in managing CPLBP in adults is insufficient to formulate a recommendation. (U, VL )
620
Topical white lily (Lilium candidum)
No recommendation. The evidence regarding the benefits and harms of topical white lily (Lilium candidum) in managing CPLBP in adults is insufficient to formulate a recommendation. (U, VL )
620
Topical combination herbal compress
No recommendation. The evidence regarding the benefits and harms of a topical combination herbal compress in managing CPLBP in adults is insufficient to formulate a recommendation. (U, VL )
620
Topical combination herbal transdermal diffusional patch
No recommendation. The evidence regarding the benefits and harms of a topical combination herbal transdermal patch in managing CPLBP in adults is insufficient to formulate a recommendation. (U, VL )
620
Multicomponent Interventions
Weight management: pharmacological weight loss
Pharmacological weight loss should not be used as part of routine care for adults, including older people, with CPLBP. (C, VL )
620
Weight management: nonpharmacological weight loss
No recommendation. The balance between the benefits and harms for non-pharmacological weight loss in managing CPLBP in adults, including older people, is so equivocal that a recommendation cannot be made. (U, VL )
620
Multicomponent biopsychosocial care
Multicomponent biopsychosocial care delivered by a multidisciplinary team may be offered as part of care for adults, including older people, with CPLBP. (C, L )
620
Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings
Authoring Organization
World Health Organization
Publication Month/Year
December 7, 2023
Last Updated Month/Year
February 16, 2024
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
Global
Document Objectives
The purpose of the guideline is to provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP (CPLBP) in adults, including older people, that can be delivered in primary and community care settings to improve CPLBP-related health and well-being outcomes. For this reason, the guideline does not consider interventions typically delivered in secondary or tertiary care settings (e.g. surgical or other invasive procedures) or workplace interventions.
Target Patient Population
Adult patients with chronic low back pain
Target Provider Population
Health workers of all disciplines working in the primary and community care settings
Health Care Settings
Ambulatory, Long term care
Intended Users
Chiropractor, nurse, nurse practitioner, physical therapist, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D017116 - Low Back Pain
Keywords
low back pain, chronic low back pain, non-surgical
Source Citation
WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.