The DOI matches its Crossref record; 28 of the 28 references it cites were found in a registry or an index.
Primary care management of non-specific low back pain: key messages from recent clinical guidelines
Abstract
Introduction: Research in the past decade supports some major changes to the primary care management of non-specific low back pain (LBP). The present article summarises recommendations from recently published United Kingdom, Danish, Belgian and United States guidelines to alert readers to the important changes in recommendations for management, and the recommendations from previous guidelines that remain unchanged. Main recommendations: Use a clinical assessment to triage patients with LBP. Further diagnostic workup is only required for the small number of patients with suspected serious pathology. For many patients with non-specific LBP, simple first line care (advice, reassurance and self-management) and a review at 1–2 weeks is all that is required. If patients need second line care, non-pharmacological treatments (eg, physical and psychological therapies) should be tried before pharmacological therapies. If pharmacological therapies are used, they should be used at the lowest effective dose and for the shortest period of time possible. Exercise and/or cognitive behavioural therapy, with multidisciplinary treatment for more complex presentations, are recommended for patients with chronic LBP. Electrotherapy, traction, orthoses, bed rest, surgery, injections and denervation procedures are not recommended for patients with non-specific LBP. Changes in management as a result of the guidelines: The major changes include: emphasising simple first line care with early follow-up; encouraging non-pharmacological treatments over pharmacological treatments; and recommending against the use of surgery, injections and denervation procedures.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Internationally, clinical practice guidelines on LBP consistently recommend non-pharmacological and non-surgical approaches as the first line of treatment.6–8”
In the citing paper
“For chronic back pain, recommendations are education, exercise and psychological therapies.6–9”
Citations
Cites
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305
Vos, T., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abdulkader, R. S., Abdulle, A. M., Abebo, T. A., Abera, S. F., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)32154-2 · Cited by 13,220
Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & for the Clinical Guidelines Committee of the American College of Physicians* (2017) · Annals of Internal Medicine · doi:10.7326/m16-2367 · Cited by 3,234
Hill, J. C., Whitehurst, D. G., Lewis, M., Bryan, S., Dunn, K. M., Foster, N. E., Konstantinou, K., Main, C. J., Mason, E., Somerville, S., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60937-9 · Cited by 1,306
Stochkendahl, M. J., Kjær, P., Hartvigsen, J., Kongsted, A., Aaboe, J., Andersen, M., Andersen, M. Ø., Fournier, G. L., Højgaard, B., Jensen, M. B., et al. (2017) · European Spine Journal · doi:10.1007/s00586-017-5099-2 · Cited by 705
The prognosis of acute and persistent low-back pain: a meta-analysis
Costa, L. D. C. M., Maher, C. G., Hancock, M. J., McAuley, J. H., Herbert, R., & Costa, L. O. P. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.111271 · Cited by 631
Self-citationDeyo, R. A., Korff, M. V., & Duhrkoop, D. (2015) · BMJ · doi:10.1136/bmj.g6380 · Cited by 535
Prognosis for patients with chronic low back pain: Inception cohort study
Costa, L. D. C. M., Maher, C. G., McAuley, J. H., Hancock, M. J., Herbert, R. D., Refshauge, K. M., & Henschke, N. (2009) · BMJ · doi:10.1136/bmj.b3829 · Cited by 430
Self-citationDevelopment of a short form of the orebro musculoskeletal pain screening questionnaire
Linton, S. J., Nicholas, M., & MacDonald, S. (2011) · Spine · doi:10.1097/brs.0b013e3181f8f775 · Cited by 358
Low back pain and sciatica in over 16s: assessment and management NICE guideline [NG59].
de Campos, T. F. (2017) · Journal of physiotherapy · doi:10.1016/j.jphys.2017.02.012 · Cited by 338
Flagged first, then by citations
Research works printed but not linked: 3
- 2017, Australian Institute of Health and Welfare
- Van Wambeke P, 2017, Summary: Low back pain and radicular pain: assessment and management. KCE report 287Cs
- NSW Agency for Clinical Innovation, 2016, Management of people with acute low back pain: model of care
Cited by
Sorted by citations
Items 101–174 of 174
Primary care management of non‐specific low back pain: key messages from recent clinical guidelines
Lin, I. B., Mak, D. B., Coffin, J., & O’Sullivan, P. (2018) · The Medical Journal of Australia · doi:10.5694/mja18.00408 · Cited by 4
Ramadanti, F. Y., Setiadi, A. P., Aditama, L., Brata, C., Wibowo, Y. I., Setiawan, E., & Halim, S. V. (2021) · Jurnal Sains Farmasi & Klinis · doi:10.25077/jsfk.8.2.190-199.2021 · Cited by 4
What do the general public believe about back pain? A scoping review of population-based studies
Chang, J. R., Maher, C. G., Sharma, S., Altinger, G., van Wyk, A., Wong, A. Y. L., Buchbinder, R., Bailly, F., Jenkins, H. J., & Traeger, A. C. (2026) · BMC Public Health · doi:10.1186/s12889-026-26879-3 · Cited by 3
Self-citationSalsbury, S. A., & Maiers, M. (2021) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2022.02.003 · Cited by 3
Acute back pain – Role of injection techniques and surgery: WFNS spine committee recommendations
Peev, N. A., Zygourakis, C. C., Sippl, C., Grasso, G., Oertel, J., & Sharif, S. Y. (2024) · World Neurosurgery X · doi:10.1016/j.wnsx.2024.100315 · Cited by 3
Sima, S., Sial, A. W., Sharma, S., Ananthakrishnan, D., Kuan, J., & Diwan, A. D. (2025) · JOR Spine · doi:10.1002/jsp2.70056 · Cited by 3
Ko, D. H. (2022) · The Korean Journal of Sports Medicine · doi:10.5763/kjsm.2022.40.3.170 · Cited by 3
ARAUJO, W. J. D., BASTOS, M. S., & Bonvino, M. A. S. (2022) · Coluna/Columna · doi:10.1590/s1808-185120222103257247 · Cited by 3
Doğancalı, U., Çil, E. T., & Subaşı, F. (2023) · International Journal of Disabilities Sports & Health Sciences · doi:10.33438/ijdshs.1224969 · Cited by 4
Graded activity for chronic low back pain
de Oliveira, L. A., Gross, A., Carlesso, L. C., Hanna, S., Bakaa, N., Silva, D. A. S., Hayden, J. A., & Macedo, L. G. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015507 · Cited by 3
Alyousef, B., Kazemi, Z., Cicuttini, F., Heritier, S. R., Wang, Y., & Urquhart, D. M. (2023) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2023.102768 · Cited by 3
Incorporating evidence-based practice as standard of care
Ganesh, G. S. (2020) · European Journal of Physiotherapy · doi:10.1080/21679169.2020.1786163 · Cited by 3
Tripodi, N., Garrett, A., Savic, D., Sadrani, K., Robertson, L., Volarich, S., & Sirgiovanni, T. (2020) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2020.08.002 · Cited by 3
Evidenzbasiertes und individualisiertes Training für Schmerzpatient*innen
Zebisch, J., & Diemer, F. (2022) · Schmerz Therapie · doi:10.1055/a-1756-8998 · Cited by 2
Fu, Y., Madsen, S. D., Shaheed, C. A., de Zoete, A., Chiarotto, A., & Koes, B. W. (2024) · MethodsX · doi:10.1016/j.mex.2024.102713 · Cited by 2
Mullen, N., Ashby, S., Haskins, R., & Osmotherly, P. G. (2024) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2024.103241 · Cited by 2
Zhou, T. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2553216 · Cited by 2
Nayel, N., Ezzat, H., Ahmed, S., & Saleh, H. (2025) · Scientific Reports · doi:10.1038/s41598-025-28313-x · Cited by 2
Heatwrap and exercise in acute low back pain: a multi-arm randomised controlled trial
Côté‐Picard, C., Tittley, J., Mailloux, C., Desgagnés, A., Perreault, K., Mercier, C., Dionne, C. E., Roy, J., & Massé‐Alarie, H. (2026) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2026.103587 · Cited by 2
Alimán, J. F. (2020) · Fisioterapia · doi:10.1016/j.ft.2020.10.004 · Cited by 2
Malik, A., Ramsha, M., & Samad, A. (2022) · doi:10.58398/0002.000002 · Cited by 2
Environmental Risk Assessment of Low Back Pain in ICU Nurses: An Instrument Development Study
Zhang, L., Liu, Y., & Yuan, S. (2023) · Journal of Nursing Management · doi:10.1155/2023/3649293 · Cited by 2
Schell, M. S., de Araujo, F. X., & Silva, M. F. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2202419 · Cited by 2
Lumbar lordotic change and its fulcrum in low back pain disorders: Radiographic evaluation
Okpala, F. O. (2020) · Nigerian Journal of Clinical Practice · doi:10.4103/njcp.njcp_522_19 · Cited by 2
Mishriky, J., Stupans, I., & Chan, V. (2021) · International Journal of Pharmacy Practice · doi:10.1093/ijpp/riab022 · Cited by 2
Patterson, T., Turner, J. P., Gnjidic, D., Mintzes, B. J., Baysari, M. T., Bennett, C., Bywaters, L., Clavisi, O., Ferreira, M. L., Beckenkamp, P. R., et al. (2021) · International Journal of Clinical Trials · doi:10.18203/2349-3259.ijct20214108 · Cited by 2
Amorin-Woods, L., Cascioli, V., Losco, B. E., & Parkin-Smith, G. F. (2025) · Journal of Patient Safety · doi:10.1097/pts.0000000000001339 · Cited by 1
Nasreen, A., Majeed, Z., Awan, M. A. H., Maqbool, S., Asghar, H. M. U., Tahir, H., Butt, K., & Zaheer, B. (2022) · Pakistan BioMedical Journal · doi:10.54393/pbmj.v5i7.639 · Cited by 1
Rozbroj, T., Reed, B., O’Connor, D. A., Gelber, N. D., Bourne, A., Maher, C. G., & Buchbinder, R. (2025) · Musculoskeletal Care · doi:10.1002/msc.70099 · Cited by 1
Self-citationVanderstraeten, R., Fourré, A., Demoulin, C., Westerweel, A., Meuleman, E. M., Anthierens, S., Michielsen, J., Darlow, B. J. S., Roussel, N. A., & Hutting, N. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2487562 · Cited by 1
Jarrett, M., Beard, M., & Kumar, S. (2025) · Healthcare · doi:10.3390/healthcare13172185 · Cited by 1
Vanderstraeten, R., Fourré, A., Demoulin, C., Michielsen, J., Bastiaens, H., Roussel, N. A., & Anthierens, S. (2025) · BMC Family Practice · doi:10.1186/s12875-025-03032-4 · Cited by 1
Fizyoterapistlerin bel ağrısına yaklaşımları
Bahçacı, U., Çolak, T. K., & Acar, G. (2021) · Journal of Exercise Therapy and Rehabilitation · doi:10.15437/jetr.602789 · Cited by 1
Baroni, M. P., Bomfim, R. A., Gallon, B. C., Bim, C. R., Hespanhol, L., & Saragiotto, B. T. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-15372-7 · Cited by 1
Self-citationAcute back pain: minimizing the risks of therapy as the basis for effective treatment
Kasatkin, D. S. (2019) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro201911911180 · Cited by 1
Agarwal, V., Schenk, R., & Ross, M. D. (2020) · Journal of Public Health · doi:10.1007/s10389-020-01386-w · Cited by 1
Dal, Ç. N., & Ekinci, B. (2021) · Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi · doi:10.31609/jpmrs.2020-80286 · Cited by 1
Buttigieg, D., Efthimiou, N., & Sim, A. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-89843-0.00003-9 · Cited by 1
Chronic Pain: Perspective on the Second Wave
Adams, L. M., & Turk, D. C. (2022) · Springer eBooks · doi:10.1007/978-3-031-11677-3_29 · Cited by 1
Advice and education for spinal pain
Zadro, J. R., & Elkins, M. R. (2022) · Journal of physiotherapy · doi:10.1016/j.jphys.2022.03.006 · Cited by 1
“Crying in a cupboard”: Five minutes with . . . Sarah Abrams
Mahase, E. (2023) · BMJ · doi:10.1136/bmj.p708 · Cited by 1
The Over-medicalisation of Low Back Pain: An Exigent Caribbean Crisis
Rauseo, C. (2021) · Caribbean Medical Journal · doi:10.48107/cmj.2021.03.002
Red and yellow flags for guiding imaging of lower back pain
Hacking, C., Bell, D. A., & Feger, J. (2019) · Radiopaedia.org · doi:10.53347/rid-65432
Clinical practice guidelines and best practice – A comment
Jull, G. A., & Moore, A. P. (2022) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2022.102585
Chapple, C., McKenna, C., Hill, J., Ellis, R., Reid, D. W., Mani, R., Tumilty, S., & Baxter, D. G. (2022) · New Zealand Journal of Physiotherapy · doi:10.15619/nzjp/50.3.02
Langford, A. V. (2023) · Journal of physiotherapy · doi:10.1016/j.jphys.2023.08.002
Identification and Triage of Emergent Spinal Pathology via Telemedicine: A Case Report
Derian, J. M., Campbell, S. S., Hah, R. J., & Lantz, J. M. (2022) · JOSPT Cases · doi:10.2519/josptcases.2022.10820
Poston, C., Verzosa, J., Brimhall, E. J., & Bricoune, O. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15962-6.00006-0
Gogovor, A., Hunt, M. R., Hovey, R. B., & Ahmed, S. (2025) · Journal of Patient Experience · doi:10.1177/23743735241311752
Nayel, N., Ezzat, H., Ahmed, S., & Saleh, H. (2025) · Research Square · doi:10.21203/rs.3.rs-6612460/v1
Cupping therapy for chronic non-specific low back pain
Saragiotto, B. T., Silva, H. J. D. A., Fandim, J. V., Rios, W. R. C., Barbosa, G. M., Silva, R. S., Jenkins, L. C., & de Souza, M. C. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015269
Self-citationProvenzano, D. A., Abd-Elsayed, A. A., Anițescu, M., Coric, D., Desai, M. J., Khalil, J. G., Kim, P., Petersen, E., & Roper, G. E. (2025) · Pain Practice · doi:10.1111/papr.70069
Caldeira, E. A. D. C., da Silva, S. L. A., Pereira, L. S. M., & Leite, I. C. G. (2025) · European Spine Journal · doi:10.1007/s00586-025-09323-9
Liu, S., Stevens, J., Tran, C., Collins, A., Duff, J. S., Sutherland, J., Oddie, M. D., Naylor, J., Patanwala, A. E., Jauregui, K., et al. (2025) · Pharmacology Research & Perspectives · doi:10.1002/prp2.70172
Saragiotto, B. T., Fioratti, I., dos Reis, F. J. J., Fandim, J. V., Vallio, V., Costa, L. O. P., Maher, C. G., Yamato, T. P., & Miyamoto, G. C. (2025) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2025.13418
Self-citationØverås, C. K., Nilsen, T. I. L., Nicholl, B. I., Rughani, G., Wood, K., Søgaard, K., Mair, F. S., & Hartvigsen, J. (2022) · Figshare · doi:10.6084/m9.figshare.19135999
Jenkins, H. J., French, S. D., Young, A., Moloney, N. A., Maher, C. G., MAGNUSSEN, J. S., Dear, B. F., & Hancock, M. J. (2023) · Figshare · doi:10.6084/m9.figshare.22613644
Self-citationJenkins, H. J., French, S. D., Young, A., Moloney, N. A., Maher, C. G., MAGNUSSEN, J. S., Dear, B. F., & Hancock, M. J. (2023) · Figshare · doi:10.6084/m9.figshare.22613632
Self-citationFerraro, M. C., Bagg, M. K., Wewege, M. A., Cashin, A. G., Leake, H. B., Rizzo, R. R. N., Jones, M. D., Gustin, S. M., Day, R., Loo, C. K. A., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14111264
Jenkins, H. J., French, S. D., Young, A., Moloney, N. A., Maher, C. G., MAGNUSSEN, J. S., Dear, B. F., & Hancock, M. J. (2023) · Figshare · doi:10.6084/m9.figshare.22613641
Self-citationJenkins, H. J., French, S. D., Young, A., Moloney, N. A., Maher, C. G., MAGNUSSEN, J. S., Dear, B. F., & Hancock, M. J. (2023) · Figshare · doi:10.6084/m9.figshare.22613638
Self-citationFerraro, M. C., Bagg, M. K., Wewege, M. A., Cashin, A. G., Leake, H. B., Rizzo, R. R. N., Jones, M. D., Gustin, S. M., Day, R., Loo, C. K. A., et al. (2021) · Figshare · doi:10.6084/m9.figshare.14111267
Jenkins, H. J., French, S. D., Young, A., Moloney, N. A., Maher, C. G., MAGNUSSEN, J. S., Dear, B. F., & Hancock, M. J. (2023) · Figshare · doi:10.6084/m9.figshare.22613635
Self-citationJenkins, H. J., French, S. D., Young, A., Moloney, N. A., Maher, C. G., MAGNUSSEN, J. S., Dear, B. F., & Hancock, M. J. (2023) · Figshare · doi:10.6084/m9.figshare.22613647
Self-citationVanderstraeten, R., Fourré, A., Demeure, I., Bastiaens, H., Demoulin, C., Michielsen, J., Anthierens, S., & Roussel, N. A. (2026) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2026.2640406
Hill, R. A., Maden, M., Duarte, R. V., Eldabe, S. S., Golder, S., Chaplin, M., Shaw, B., Sutcliffe, K., Todd, A., Bresnahan, R., et al. (2024) · Health Technology Assessment · doi:10.3310/gdwp3572
Alichniewicz, K., Fisher, G., Tabinga, A., & Guindalini, C. (2026) · Australian Journal of Psychology · doi:10.1080/00049530.2026.2664166
Fourré, A., Denis, C., Pieter, V., Dankaerts, W., Timmermans, A. A. A., Goossens, N., Severijns, P., Pitance, L., Janssens, L., & Roussel, N. A. (2026) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2026.103588
Motha, S. G., Moyo, M., Naidoo, N., Clerk, C., Musekiwa, A., Kgarosi, K., Basson, A., & Mostert, K. (2026) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2026.08.031
Research hotspots and trends in exercise interventions for chronic nonspecific low back pain
Wang, X., Xiang, H., Liu, Z., Jiang, S., Hongping, P., Liu, X., Zhou, B., Gao, D., & Zhu, C. (2026) · Medicine · doi:10.1097/md.0000000000050593
Scavarelli, N. T., Zerpa, C., Sinden, K. E., & Sanzo, P. (2026) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.1177/10538127261487533
Кожем'яка, М. О., & Soloviuk, O. O. (2026) · Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії · doi:10.31718/2077-1096.26.3.32
Terhorst, S., Jünger, S., & Thiel, C. (2026) · German Journal of Exercise and Sport Research · doi:10.1007/s12662-026-01166-w
Metadata
- Authors
- Almeida, M., Saragiotto, B., Richards, B., & Maher, C. G.
- Affiliations
- Universidade de São Paulo (BR)
- The University of Sydney (AU)
- Royal Prince Alfred Hospital (AU)
- University of Sydney, Sydney, NSW
- Venue
- Medical Journal of Australia
- Publisher
- AMPCo
- Published
- 2018-04
- Volume
- 208
- Issue
- 6
- Pages
- 272-275
- ISSN
- 0025-729X (ISSN-L)
- 1326-5377
- OpenAlex
- W2794567591
- Cited by
- 174
- References
- 28
- Citations by year
- 2026: 9 · 2025: 25 · 2024: 15 · 2023: 25 · 2022: 33 · 2021: 26 · 2020: 16 · 2019: 18 · 2018: 7
- FWCI
- 10.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Medical Journal of Australia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
- Keywords
- non-specific low back pain, primary care management, triage, self-management, non-pharmacological treatment, exercise therapy, cognitive behavioral therapy, multidisciplinary treatment, chronic low back pain, pharmacotherapy, electrotherapy, traction, orthoses, bed rest, spinal injections, denervation
- MeSH terms
- Algorithms, Humans, Primary Health Care, Triage, Low Back Pain, Practice Guidelines as Topic, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review