Evidence‐based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines

Abstract

Background and objective This systematic review synthesized evidence from European neck and low back pain (NLBP) clinical practice guidelines (CPGs) to identify recommended treatment options for use across Europe. Databases and Data Treatment Comprehensive searches of thirteen databases were conducted, from 1st January 2013 to 4th May 2020 to identify up‐to‐date evidence‐based European CPGs for primary care management of NLBP, issued by professional bodies/organizations. Data extracted included; aim and target population, methods for development and implementation and treatment recommendations. The AGREE II checklist was used to critically appraise guidelines. Criteria were devised to summarize and synthesize the direction and strength of recommendations across guidelines. Results Seventeen CPGs (11 low back; 5 neck; 1 both) from eight European countries were identified, of which seven were high quality. For neck pain , there were consistent weak or moderate strength recommendations for: reassurance, advice and education, manual therapy, referral for exercise therapy/programme, oral analgesics and topical medications, plus psychological therapies or multidisciplinary treatment for specific subgroups. Notable recommendation differences between back and neck pain included, i) analgesics for neck pain (not for back pain); ii) options for back pain‐specific subgroups—work‐based interventions, return to work advice/programmes and surgical interventions (but not for neck pain) and iii) a greater strength of recommendations (generally moderate or strong) for back pain than those for neck pain. Conclusions This review of European CPGs identified a range of mainly non‐pharmacological recommended treatment options for NLBP that have broad consensus for use across Europe. Significance Consensus regarding evidence‐based treatment recommendations for patients with neck and low back pain (NLBP) from recent European clinical practice guidelines identifies a wide range of predominantly non‐pharmacological treatment options. This includes options potentially applicable to all patients with NLBP and those applicable to only specific patient subgroups. Future work within our Back‐UP research team will transfer these evidence‐based treatment options to an accessible clinician decision support tool for first contact clinicians.

Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain–Related Disability

“… This support includes providing patients with adequate information, reassurance, and education as well as advice to maintain daily activities and exercise regularly. However, primary care physicians generally lack the time, resources, and training to deliver such support, and adherence to self-management recommendations without feedback or reinforcement is challenging for most patients. Smartphone technology along with knowledge-driven artificial intelligence (AI) can be used to make tailored self-management support available to patients.…”

Authors’ reply to the comment by Zhang et al

“…We thank Zhang et al (2021). for their interest in our work (Corp et al 2021). As the authors point out these are new versions of the AGREE reporting tools and inevitably there will be some delay in their implementation.…”

Validation of a Back Pain Severity Prediction Algorithm: A Cross-Sectional Study with Updated Healthcare Costs for Back Pain Patients Based on the Graded Chronic Pain Scale

“…Structured physical and psychological interventions, as well as education, are recommended for patients whose BP is subacute or chronic and those with current acute pain, but at high risk of becoming chronic BP patients [4,14,15]. There are various approaches that are promising a favourable outcome [13,[16][17][18][19].…”