Chronic low back pain beliefs and management practices in Africa: Time for a rethink?

Abstract

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.

Cross-cultural adaptation and psychometric evaluation of the Yoruba version of the Back beliefs questionnaire among patients with chronic low-back pain

“…For instance, beliefs about LBP may be under-reported in the African settings due to cultural or religious reasons. Although, patient beliefs and other psychosocial factors influences LBP in comparable ways both in the developed and developing countries [38], culture can mediate how these beliefs and psychosocial factors are expressed. Thus, the difference in the factor structures of the different versions of the BBQ may be adduced to the differences in culture.…”

The Lancet Series call to action to reduce low value care for low back pain: an update

“…A 2019 systematic review (6 studies) found that management pathways in African countries typically favour treatment approaches with ineffective passive treatment modalities. 1 The authors identify a need for culturally sensitive and context-specific biopsychosocial interventions. A 2020 survey of physiotherapists in Nigeria found that although 79% were aware of clinical practice guidelines for treatment of low back pain, just 28% reported adhering to these when treating people with low back pain.…”

Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study

“…All healthcare professionals reported providing predominantly biomedically orientated care, a finding found in other low-and middleincome countries (Ahenkorah et al, 2019;Mousavi et al, 2011).…”