The World Health Organization has published a paper in its Bulletin that warns of the risks of over-medicalizing the management of low back pain, instead advocating care that chiropractors are highly qualified to provide.

The paper (1), authored by leading experts from Australia and the UK, proposes non-drug, non-surgical approaches as the first line treatments for low back pain. They include advice, education and reassurance with manual therapies including spinal manipulation for patients at risk of developing chronicity.

The paper's authors were particularly critical of the overuse of spinal surgery, hospitalization, injections, complex pharmaceuticals and diagnostic imaging. This mirrored the strong evidence cited in a series of articles on low back pain published last year in The Lancet.

The WHO Bulletin paper found that despite international recommendations, it was conservatively estimated that 32% of care provided for low back pain in the USA was inconsistent with clinical guidelines, including a rise of 62% in elective spinal fusion surgery (2004-2015) in the USA, despite no good evidence of benefit over non-surgical care.

"As spine care specialists, chiropractors are perfectly positioned to provide evidence-based, people-centered care for low back pain," said WFC President Dr Vivian Kil. "All of the top guidelines published in the past few years are telling us that non-surgical, non-drug care is the preferred approach. Spinal manipulation is increasingly being seen as the treatment of choice. Chiropractors are highly skilled in this technique but can also deliver many of the other recommended interventions, such as patient education, soft tissue techniques and self-management advice."

For chronic persistent low back pain, the guidelines recommend a multidisciplinary approach. As part of its #BeEPIC campaign, the WFC recommends interprofessional and collaborative care and increasingly chiropractors are engaging positively with spine care professionals from other disciplines.

WFC Secretary-General Richard Brown commented: "As well as meeting demand in high-income countries, more chiropractors are needed around the world to deliver evidence-based care to underserved communities. We know that in low- and middle-income countries many people have no access to health care, let alone spine care. Chiropractors have all the skills to make a real difference to the lives of those suffering from spinal pain and disability."

The WHO Bulletin paper criticizes the persistent use of opiate painkillers for chronic back pain despite research showing limited benefit and the US Center for Disease Control being very clear that they should not be used for chronic, non-cancer pain. Yet many health systems remain non-compliant with guidelines at the expense of patient outcomes and huge costs.

As spine care experts, chiropractors are well-placed to re-educate patients around the many myths and misconceptions surrounding back pain management. Dr Kil continues, "Back pain is one of those conditions where everyone wants to give advice, but the reality is that it is not always grounded in evidence. Staying active and mobile may seem unnatural when you're in pain, but it works and the guidelines support this approach."

Reference

• Traeger AC, Buchbinder R, Eishaug AG, Croft PR, Maher CG. Bulletin of the World Health Organization 2019;97:423-433. doi: http://dx.doi.org/10.2471/BLT.18.226050