By Sylvia Chebet
The World Health Organization (WHO) has released guidelines on managing chronic low back pain (LBP) which lists interventions for health workers - those to be used and those not to be used during routine care.
The guidance argues against the use of opioid painkillers which could lead to dependence or overdose. It also discourages some physical therapies, such as traction - the pulling on part of the body - and use of lumbar braces and belts.
These are among some 14 interventions that WHO says could be potentially more harmful than beneficial and should not be offered routinely.
Instead, healthcare professionals are advised to help patients educate themselves on the options and self-care strategies available and provide psychological support.
WHO also finds non-surgical interventions including exercise and physical therapies such as spinal manipulative therapy and massage more effective.
Holistic approach
“Addressing chronic low back pain requires an integrated, person-centred approach. This means considering each person’s unique situation and the factors that might influence their pain experience,” Dr Anshu Banerjee, WHO Director for Maternal, Newborn, Child, Adolescent Health and Ageing says.
“We are using this guideline as a tool to support a holistic approach to chronic low back pain care and to improve the quality, safety and availability of care.”
The new “WHO guidelines are a day late but better late than never,” Dr. Hamisi Kote Ali, a chiropractor and physiotherapist tells TRT Afrika.
“The modern doctor has abandoned the traditional basics of medicine; first to be a teacher to their patient and secondly, performing detailed physical examination beyond the day’s signs and symptoms,” Dr. Hamisi rues.
He emphasises that it is critical to thoroughly probe a patient’s history, all the way to their childhood, to get to the root cause of the pain. This would guide medics in developing suitable management plans for their patients.
The WHO guidelines emphasise that care should be tailored towards addressing the mix of factors (physical, psychological, and social) that may influence a patient’s chronic primary LBP experience.
“A suite of interventions may be needed to holistically address a person’s chronic primary LBP, instead of single interventions used in isolation,” WHO says.
Leading cause of disability
Low back pain is a common condition experienced by most people at some point in their life and a leading cause of disability globally.
Data from WHO indicates that in 2020, approximately one in 13 people, equating to 619 million people, experienced LBP. This is a 60% increase from 1990.
LBP affects life quality and is associated with other illnesses and higher mortality risks. Persistent pain reduces an individual’s ability to participate in family, social, and work activities.
This can negatively affect their mental health and bring substantial costs to families, communities, and health systems.
Those experiencing chronic LBP, especially older persons, are more likely to experience poverty, premature exit from the workforce, and may have less savings for retirement.
WHO notes that addressing chronic LBP among older populations can facilitate healthy ageing, so older persons have the functional ability to maintain their own well-being.
Pain that cannot be ignored
Chronic primary low back pain refers to pain that lasts for more than 3 months that is not due to an underlying disease or other condition.
WHO says it accounts for at least 90% of the chronic LBP presentation in primary care and for these reasons, has issued guidelines for its management.
The new guidelines require countries to strengthen and transform their health systems and services to make the recommended interventions available, accessible and acceptable through universal health coverage.
“To achieve universal health coverage, the issue of low back pain cannot be ignored, as it is the leading cause of disability globally,” Bruce Aylward, WHO Assistant Director-General for Universal Health Coverage says.
“Countries can address this ubiquitous but often-overlooked challenge by incorporating key, achievable interventions, as they strengthen their approaches to primary health care,” Dr. Aylward, who is also a physician, added.
Discontinuing the routine delivery of interventions that are not effective is also critical in accordance with the guidelines.
“If we do this, we will be able to work and play when we are in our sunset years because we will still be having our mobility and cognitive function intact,” Dr. Hamisi tells TRT Afrika.
