An Updated Overview of Clinical Guidelines for the Management of Non-specific Low Back Pain in Primary Care
Written by Editor   
Thursday, November 24, 2016 12:00 AM

News Bite: Evidence-based clinical guidelines for low back pain have been issued in many countries.  This review  of national and international guidelines points out the disparities between guidelines.  However, the comparison of international clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations are generally similar.

Consistently, guidelines recommended the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial factors as risk factors for chronicity.  For chronic low back pain, supervised exercises, cognitive behavioral therapy and multidisciplinary treatment. There are some discrepancies, however, for recommendations regarding spinal manipulation and drug treatment for acute and chronic low back pain. 


Low back pain remains a condition with a relatively high incidence and prevalence. Following a new episode, the pain typically improves substantially but does not resolve completely during the first 4–6 weeks. In most people the pain and associated disability persist for months; however, only a small proportion remains severely disabled. For those whose pain does resolve completely, recurrence during the next 12 months is not uncommon.

There is a wide acceptance that the management of low back pain should begin in primary care. The challenge for primary care clinicians is that back pain is but one of many conditions that they manage. For example while back pain, in absolute numbers, is the eighth most common condition managed by Australian GPs, it only accounts for 1.8% of their case load. To assist primary care practitioners to provide care that is aligned with the best evidence, clinical practice guidelines have been produced in many countries around the world.

The first low back pain guideline was published in 1987 by the Quebec Task Force with authors pointing to the absence of high-quality evidence to guide decision making. Since that time there has been a strong growth in research addressing diagnosis and prognosis but especially research on therapy.

This review of national and international guidelines points out the disparities between guidelines with respect to spinal manipulation and the use of drugs for both chronic and acute low back pain. The aim of this study was to present and compare the content of (inter)national clinical guidelines for the management of low back pain. To rationalize the management of low back pain, evidence-based clinical guidelines have been issued in many countries. This study updated a previous review that included clinical guidelines published up to and including the year 2000.

Only one guideline per country was included–the one most recently published. This updated review includes national clinical guidelines from 13 countries and 2 international clinical guidelines from Europe published from 2000 until 2008. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. 

Consistent features for acute low back pain were the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial factors as risk factors for chronicity.

For chronic low back pain, consistent features included supervised exercises, cognitive behavioural therapy and multidisciplinary treatment. There are some discrepancies, however, for recommendations regarding spinal manipulation and drug treatment for acute and chronic low back pain. 
The comparison of international clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations are generally similar.