Updated guidelines on the management of Low Back Pain – A Global Review

May 1, 2018

New research, published in the Lancet and which included chiropractors as contributing authors, shows movement and physical activity is the best treatment for back pain.

The British Chiropractic Association says ‘The publication of the Lancet’s series on low back pain which suggests that in the West, we are over medicalising low back pain has been well received by those specialising in spinal care. With the global burden of low back pain forecast to increase in coming decades, ensuring that there are options available to patients who are experiencing this is paramount. Chiropractors provide the safe and effective hands on care which has been suggested within the first steps for the treatment of low back pain. This involves a package of care including education and advice to stay active, such as the Straighten Up UK exercises available for free from the BCA, spinal manipulation, massage and exercise therapy. Chiropractors are well positioned to provide this care.

This series comes at an important time. With the recent attention given to the use of opioid prescriptions for non-cancer pain becoming a complex public health crisis, chiropractors are able to provide non-pharmaceutical care options in the management of back pain, neck pain and other joint and muscle problems for which opioids are often prescribed. This paper recognises the use of medication in limited circumstances but also advises caution.

The chiropractors at the Lansdown clinic place great importance on providing evidence based, patient centred care.  It is fantastic to see that the knowledge that underpins our treatments and advice is congruent with the following key messages that are provided by the Lancet series.

Low back pain is an extremely common symptom in populations worldwide and occurs in all age groups, from children to the elderly population

  • Most episodes of low back pain are short-lasting with little or no consequence, but recurrent episodes are common and low back pain is increasingly understood as a long-lasting condition with a variable course rather than episodes of unrelated occurrences
  • Low back pain is a complex condition with multiple contributors to both the pain and associated disability, including psychological factors, social factors, biophysical factors, comorbidities, and pain-processing mechanisms
  • For the vast majority of people with low back pain, it is currently not possible to accurately identify the specific source of symptoms.
  • Lifestyle factors, such as smoking, obesity, and low levels of physical activity, that relate to poorer general health, are also associated with occurrence of low back pain episodes

Imaging has a questionable place for aiding diagnosis as many findings are identified equally in symptomatic and non-symptomatic patients

In summary, low back pain is increasing across the population.  It remains a condition not fully understood by the medical community and there is now an acknowledgement that medications, surgery and imaging are of limited efficacy in the majority of cases.  The guidelines for low back pain recommend self-management, physical and psychological therapies and place less emphasis on pharmacological and surgical treatments.  Routine use of imaging and investigations is not recommended.

The recent recommendations advocate the role of chiropractors in the treatment of low back pain, re enforcing what we at the Lansdown clinic have known for a long time- we are great at what we do! The package of care provided by chiropractors serves to encourage and enable exercise through physical therapy and self-management strategies, whilst also understanding that the thoughts you have about your back pain are equally influential on your recovery and therefore providing supportive approaches for this in tandem.

You can trust us to do the best we possibly can for you, actively involving you from the start of your care.

We really do ‘have your back’!