Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

Oliveira, Crystian B.; Maher, Chris G.; Pinto, Rafael Z.; Traeger, Adrian C.; Lin, Chung-Wei Christine; Chenot, Jean-François; van Tulder, Maurits; Koes, Bart W.

doi:10.1007/s00586-018-5673-2

Cited by 1,584Musculoskeletal pain and rehabilitationClinical practice guidelines implementationSpine and Intervertebral Disc Pathology

Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

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Oliveira, Crystian B., Maher, Chris G., Pinto, Rafael Z., Traeger, Adrian C., Lin, Chung-Wei Christine, Chenot, Jean-François, van Tulder, Maurits, Koes, Bart W.·2018·European Spine Journal

DOI 10.1007/s00586-018-5673-2

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Abstract

OBJECTIVE: The aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pain in primary care. We also aimed to examine how recommendations have changed since our last overview in 2010. METHOD: The searches for clinical practice guidelines were performed for the period from 2008 to 2017 in electronic databases. Guidelines including information regarding either the diagnosis or treatment of non-specific low back pain, and targeted at a multidisciplinary audience in the primary care setting, were considered eligible. We extracted data regarding recommendations for diagnosis and treatment, and methods for development of guidelines. RESULTS: We identified 15 clinical practice guidelines for the management of low back pain in primary care. For diagnosis of patients with non-specific low back pain, the clinical practice guidelines recommend history taking and physical examination to identify red flags, neurological testing to identify radicular syndrome, use of imaging if serious pathology is suspected (but discourage routine use), and assessment of psychosocial factors. For treatment of patients with acute low back pain, the guidelines recommend reassurance on the favourable prognosis and advice on returning to normal activities, avoiding bed rest, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods. For treatment of patients with chronic low back pain, the guidelines recommend the use of NSAIDs and antidepressants, exercise therapy, and psychosocial interventions. In addition, referral to a specialist is recommended in case of suspicion of specific pathologies or radiculopathy or if there is no improvement after 4 weeks. While there were a few discrepancies across the current clinical practice guidelines, a substantial proportion of recommendations was consistently endorsed. In the current review, we identified some differences compared to the previous overview regarding the recommendations for assessment of psychosocial factors, the use of some medications (e.g., paracetamol) as well as an increasing amount of information regarding the types of exercise, mode of delivery, acupuncture, herbal medicines, and invasive treatments. These slides can be retrieved under Electronic Supplementary Material.

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Most clinical practice guidelines endorse the use of psychological treatments for chronic low back pain.
“Most clinical practice guidelines endorse the use of psychological treatments for chronic LBP.16”
From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [16]
Existing guidelines typically provide generic or incomplete recommendations for psychological treatments for chronic low back pain.
“However, existing guidelines typically provide generic or incomplete recommendations.”
From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [16]
Existing guidelines consistently endorse that exercise and psychosocial therapies should be prescribed for management of chronic low back pain.
“Existing guidelines consistently endorse that exercise and psychosocial therapies should be prescribed for management of chronic LBP.16”
From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [16]

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DOI 10.1007/s00586-010-1502-y REVIEW ARTICLE An updated overview of clinical guidelines for the management of non-specific low back pain in primary care
Christine, C.-W., Luciana, L., Macedo, G., Mcauley, J., & Maher, C. G. (2013)
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Authors: Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C.-W. C., Chenot, J.-F., van Tulder, M., & Koes, B. W.
Affiliations: Universidade Estadual Paulista (Unesp) (BR)
Universidade Federal de Minas Gerais (BR)
The University of Sydney (AU)
Universitätsmedizin Greifswald (DE)
University of Southern Denmark (DK)
Corresponding author: Koes, Bart W.
ORCID: Oliveira, Crystian B.
Maher, Chris G.
Pinto, Rafael Z.
Traeger, Adrian C.
Lin, Chung-Wei Christine
Chenot, Jean-François
Koes, Bart W.
Venue: European Spine Journal
Publisher: Springer Science and Business Media LLC
Published: 2018-07-03
Volume: 27
Issue: 11
Pages: 2791-2803
ISSN: 0940-6719 (ISSN-L)
1432-0932
DOI: 10.1007/s00586-018-5673-2
OpenAlex: W2811473826
Cited by: 1,584
References: 31
Citations by year: 2026: 140 · 2025: 212 · 2024: 275 · 2023: 235 · 2022: 241 · 2021: 241 · 2020: 149 · 2019: 74 · 2018: 13 · 2015: 1
FWCI: 13.89
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (tdm)
Locations: European Spine Journal (publishedVersion, cc-by)
PubMed (publishedVersion)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
VU Research Portal (publishedVersion, other-oa)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
Americanae (AECID Library) (submittedVersion, other-oa)
University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (88881.134663/2016-01)
National Health and Medical Research Council (APP1103022, APP1144026, APP1061400)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Keywords: non-specific low back pain, primary care, diagnosis, treatment, acute low back pain, chronic low back pain, red flags, radiculopathy, imaging, psychosocial factors, nonsteroidal anti-inflammatory drugs, antidepressants, exercise therapy, specialist referral, guideline recommendations
MeSH terms: Humans, Primary Health Care, Low Back Pain, Practice Guidelines as Topic

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Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

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