Chronic low back pain: what the World Health Organization recommends

How common it is

According to the WHO, low back pain is the single leading cause of disability worldwide. In 2020 it affected 619 million people, about 1 in 13, and the number is expected to reach 843 million by 2050.

In about 90% of cases there is no specific disease or injury that explains the pain. This is called non-specific low back pain.

What chronic primary low back pain means

It is back pain that has lasted more than 3 months and is not caused by another condition. The WHO guideline covers this pain in adults and older people. It does not cover recent back pain or surgery.

What may be offered

The WHO suggests these may be offered:

• Structured education and advice
• Exercise therapy or exercise programmes
• Spinal manipulation and massage
• Acupuncture
• Cognitive behavioural therapy
• Anti-inflammatory painkillers (NSAIDs), for a limited time
• Combined care from a team of health professionals

Most recommendations rest on low-certainty evidence. That is why the WHO talks about options that may be offered depending on the person, rather than one treatment that works for everyone.

What is not recommended routinely

The WHO advises against routinely using traction, therapeutic ultrasound, TENS, back belts and braces, opioid painkillers, muscle relaxants and several other medicines for chronic low back pain.

This does not mean they are dangerous for everyone. It means that, on current evidence, they should not be the main treatment.

What you can do

The WHO says painkillers should not be the first-line treatment and that rehabilitation matters at every stage. It helps to stay active, keep a healthy weight, not smoke, sleep well, and keep up work and social life as much as you can.

In physiotherapy, exercise and education are the foundation. Hands-on techniques can help you move more comfortably so you can do your exercises.