Lightning Presentation Sydney Spinal Symposium 2026

What are the current recommendations of primary care guidelines for low back pain and how have they changed over the last 30 years? (#136)

Crystian Bitencourt Oliveira 1 , Bart Koes 2 , Rafael Pinto 3 , Adrian Traeger 1 , Gustavo Machado 1 , Christine Lin 1 , Jill Hayden 4 , Jan Hartvingsen 5 , Caitlin Jones 1 , Qiuzhe Chen 1 , Alessandro Chiarotto 2 , Christopher Maher 1
  1. Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
  2. Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
  3. Discipline of Physiotherapy, University of Technology Sydney, Sydney, NSW, Australia
  4. Department of Community Health and Epidemiology, Dalhousie University, Halifax,, NS, Canada
  5. Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

Aims: To investigate current recommendations of primary care guidelines for low back pain (LBP) and explore how they have changed over the last 30 years.

Methods: Searches were conducted in MEDLINE and Embase via OVID, PEDro, WHO Guidelines, International Guideline Library, and National Institute for Health and Clinical Excellence (NICE). We also conducted supplemental searches on Google, Web of Science Citation index and asked experts in the field. Guidelines including information regarding the diagnosis, prognosis, treatment or prevention of non-specific LBP (also called primary LBP) and targeting healthcare professionals working in primary care settings were considered eligible. Two independent authors performed the screening of the records retrieved in the searches and data extraction. Guideline development methods and management recommendations were narratively described and displayed in tables.

Results/Conclusion: Thirty-two LBP guidelines from 15 countries/multinationals were included in this review. For diagnosis, most guidelines recommended history taking (including checking for red flags) and physical examination, psychological evaluation, considering individual psychological factors or risk stratification tools, and against the routine use of imaging for those patients without any suspicion of serious pathologies. For acute LBP, self-management, heat therapy, spinal manipulation and NSAIDs were recommended. For chronic LBP, psychological interventions, exercise therapy, multidisciplinary treatment, acupuncture, spinal manipulation (mainly as part of a treatment package) and NSAIDs were recommended. Some guidelines recommended against the use of epidural injections. Most guidelines recommend regular physical activity for prevention, as well as assessment of psychological factors and providing information about the clinical course of the condition for prognosis. There were a few changes over time in the recommendations for diagnosis (i.e., diagnosis triage and risk stratification tools), non-pharmacological & non-surgical treatments (i.e., heat therapy for acute LBP and acupuncture for chronic LBP) and pharmacological treatments (i.e., paracetamol and opioids).