Background: Chronic low back pain (CLBP) beliefs are important psychosocial risk-factors affecting the occurrence and progression of CLBP. To address pain beliefs and implement recommended biopsychosocial approaches for CLBP management, an understanding of patients' and healthcare professionals' (HCPs') beliefs, as well as CLBP management practices, is necessary. A narrative review was conducted to explore CLBP beliefs and practices in African countries.Methods: Two systematic searches were conducted using seven databases (MEDLINE, Embase, PsychInfo, CINAHL Plus, AMED, PubMed and Web of Science) with combined variations of the terms, "Management", "Guidelines", "CLBP", "Beliefs", "Patients", "Healthcare Professionals", "Africa", .Results: Five studies and one standard treatment guideline document were included. No systematically developed African CLBP treatment guideline was found, however CLBP practices were identified in two African countries. CLBP management in African countries appears to be biomedically oriented. Only three research articles investigated patients' CLBP beliefs in Africa, with none assessing HCPs' beliefs. Unhelpful CLBP beliefs (catastrophizing and fear-avoidance) and biomedical thoughts about the causes of CLBP were identified. Unhelpful CLBP beliefs were associated with increased disability. Conclusion:Management practices for CLBP in African countries appear to contradict recommended biopsychosocial management guidelines by developed countries and are not sufficiently documented. Research on CLBP beliefs and CLBP management practices in Africa is deficient. To enhance the uptake of biopsychosocial approach in Africa, research around CLBP beliefs in African CLBP patients and HCPs is required.

Background Chronic musculoskeletal pain is a major health concern. The biopsychosocial approach is an evidence‐based approach recommended for managing chronic musculoskeletal pain. However, the evidence for this approach is largely reported from high‐income countries; therefore, it is important to ascertain how biopsychosocial approaches are operationalised in low‐ and middle‐income countries to inform practice. Aim To examine the evidence for the operationalization of biopsychosocial interventions in managing patients with chronic musculoskeletal pain in low‐and middle‐income countries. Methods The search included studies published in English from 2008 to September 2019 in: Cochrane library, OVID, CINAHL, Scopus, PUBMED, Web of Science, and SportDiscus. Randomised and non‐randomised trials using a biopsychosocial intervention were considered. The review team developed a search strategy; two independent reviewers screened and assessed results for quality. Results Sixteen studies were included (n = 996) with mainly low back pain populations (n = 11 studies). Others were osteoarthritis (n = 1) and other musculoskeletal pain (n = 4). The majority (n = 12) of studies attained fair to poor quality, three had good quality, one scored excellent quality. Interventions applied biopsychosocial principles such as cognitive functional therapy, and graded activity, delivered by healthcare professionals such as physiotherapists and doctors. However, most results provided insufficient information regarding healthcare professionals' capacity to deliver interventions, lack of information regarding intervention delivery and training of healthcare professionals. Conclusions The results highlight the potential for delivering biopsychosocial interventions in low‐ and middle‐income countries; however, future research should consider robust methodological approaches with clear details to achieve high‐quality trials.

IntroductionChronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear.ObjectivesTo explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management/coping and to identify the mechanisms influencing them.DesignQualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy.ParticipantsThirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana.ResultsParticipants suggested dominant biomedical/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients’ themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana.ConclusionParticipants’ narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP/sociocultural beliefs and equip patients with management options for CLBP could be beneficial.

IntroductionChronic low back pain (CLBP) is a global health concern associated with multidimensional/biopsychosocial levels of affectation in developed countries, with holistic management requiring consideration of these factors. There has been minimal research exploring the psychosocial impact of CLBP, and the factors influencing it, in African contexts, with none in Ghana.ObjectivesTo explore the psychosocial impact of CLBP among patients with CLBP in Ghana.DesignQualitative study using individual semistructured face-to-face interviews, underpinned by Straussian grounded theory principles and critical realist philosophy.ParticipantsThirty patients with CLBP attending physiotherapy at two hospitals in Ghana.ResultsFive categories: loss of self and roles, emotional distress, fear, stigmatisation and marginalisation, financial burden, and social support and three mechanisms: acquired biomedical/mechanical beliefs from healthcare professionals (HCPs), sociocultural beliefs and the socioeconomic impact of CLBP were derived.ConclusionCLBP adversely affects multidimensional/biopsychosocial aspects of individuals experiencing CLBP in Ghana. This delineates the need for a biopsychosocial approach to care. There is the need for HCPs in Ghana to reassess current CLBP management strategies to address the influence of adverse HCPs biomedical inclinations on patients’ psychosocial consequences. Population-based education strategies and consideration of formal support systems for persons with disabling CLBP may also be beneficial.