Recent clinical practice guidelines for the management of low back pain: a global comparison.
Study Goal
The researchers aimed to compare clinical practice guidelines (CPGs) for managing low back pain (LBP) globally, including the role of acupuncture in chronic LBP treatment.
Results Summary
The study found that acupuncture was recommended in CPGs for chronic LBP, alongside therapeutic exercise, NSAIDs, and spinal manipulation, though guidelines exhibited heterogeneity in recommendations.
Population
Adults with non-specific low back pain (acute, subacute, and chronic stages).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
non-steroidal anti-inflammatory drugs (NSAIDs) | no change | acute low back pain | patients with low back pain | - | recommended | #1 |
therapeutic exercise | no change | acute low back pain | patients with low back pain | - | recommended | #2 |
staying active | no change | acute low back pain | patients with low back pain | - | recommended | #3 |
spinal manipulation | no change | acute low back pain | patients with low back pain | - | recommended | #4 |
non-steroidal anti-inflammatory drugs (NSAIDs) | no change | subacute low back pain | patients with low back pain | - | recommended | #5 |
therapeutic exercise | no change | subacute low back pain | patients with low back pain | - | recommended | #6 |
staying active | no change | subacute low back pain | patients with low back pain | - | recommended | #7 |
spinal manipulation | no change | subacute low back pain | patients with low back pain | - | recommended | #8 |
therapeutic exercise | no change | chronic low back pain | patients with low back pain | - | recommended | #9 |
non-steroidal anti-inflammatory drugs (NSAIDs) | no change | chronic low back pain | patients with low back pain | - | recommended | #10 |
spinal manipulation | no change | chronic low back pain | patients with low back pain | - | recommended | #11 |
acupuncture | no change | chronic low back pain | patients with low back pain | - | recommended | #12 |
BACKGROUND: Low back pain (LBP) is a significant health problem worldwide, with a lifetime prevalence of 84% in the general adult population. To rationalise the management of LBP, clinical practice guidelines (CPGs) have been issued in various countries around the world. This study aims to identify and compare the recommendations of recent CPGs for the management of LBP across the world. METHODS: MEDLINE, EMBASE, CINAHL, PEDro, and major guideline databases were searched from 2017 to 2022 to identify CPGs. CPGs focusing on information regarding the management and/or treatment of non-specific LBP were considered eligible. The quality of included guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS: Our analysis identified a total of 22 CPGs that met the inclusion criteria, and were of middle and high methodological quality as assessed by the AGREE II tool. The guidelines exhibited heterogeneity in their recommendations, particularly in the approach to different stages of LBP. For acute LBP, the guidelines recommended the use of non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic exercise, staying active, and spinal manipulation. For subacute LBP, the guidelines recommended the use of NSAIDs, therapeutic exercise, staying active, and spinal manipulation. For chronic LBP, the guidelines recommended therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture. CONCLUSIONS: Current CPGs provide recommendations for almost all major aspects of the management of LBP, but there is marked heterogeneity between them. Some recommendations lack clarity and overlap with other treatments within the guidelines.