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Applauding WHO's Endorsement Of Evidence-Informed, People-Centred Approach To Musculoskeletal Healthcare

Healthcare

The World Health Organization (WHO) has unveiled its new Guideline for the Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings. According to the NZCA, New Zealand’s peak body for chiropractors, the new guideline is a notable endorsement of the chiropractic profession and the broader musculoskeletal (MSK) community,

NZCA spokesperson, Dr Jenna Duehr, chiropractor explains: `This groundbreaking guideline presents evidence-informed recommendations on non-surgical interventions for chronic primary low back pain (CPLBP), aiming to enhance CPLBP-related health and wellbeing outcomes. It clearly supports the use of chiropractic techniques.’

According to ACC in New Zealand during 2009–2020, there were 3.3 million ACC claims for LBP with a total cost of NZ$4 billion.

The WHO Guideline Development Group, which included chiropractors, relied on evidence commissioned by WHO from reputable sources, including Dr Sidney Rubinstein, Chair of the World Federation of Chiropractic’s Research Committee. Dr Rubinstein led three systematic reviews that significantly contributed to the guideline recommendations.

Key recommendations from the guideline include:

  1. Spinal Manipulation: Acknowledged as one of the recommended physical therapies for all patients, alongside interventions such as dry needling, structured exercise programs, and massage.
  2. Education and Advice: Emphasising structured and standardised education and advice as fundamental components of effective management, complemented by cognitive-behavioural therapy.
  3. Non-Value Interventions: Dismissing the effectiveness of interventions such as TENS, therapeutic ultrasound, traction, and lumbar braces/supports, with explicit recommendations against their use.
  4. Pharmacological Caution: Expressing scepticism towards commonly used pharmacological interventions, with conditional approval only for non-steroidal anti-inflammatory medication. Opioids, benzodiazepines, antidepressants, anticonvulsants, muscle relaxants, cannabis-related preparations, and paracetamol (acetaminophen) received explicit recommendations against use.
  5. Biopsychosocial Approaches: Endorsing multicomponent biopsychosocial interventions, reinforcing the value of shared decision-making and the importance of acknowledging patient needs, preferences, and context.
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Acknowledging the importance of non-pharmaceutical interventions Dr Jenna Duehr says: ‘these new guidelines endorse our EPIC (evidence-based, people-centred, interprofessional, and collaborative) approach to primary health care.’

For patients with acute episodes of low back pain, the first point of entry to the health care system is associated with utilisation and total cost of care in the following year. Although the latest clinical practice guidelines recommend nonpharmacologic and nonsurgical treatments, patients are often prescribed opioid pain medications or referred to specialists for procedures — including surgery, imaging or steroid injections — that do not address the root causes of their pain.

Dr Jenna Duehr explains: `An estimated one billion people suffer with spinal pain with 540 million people at any one time. Low back pain remains the leading cause of years lived with disability on the planet. Spinal pain and disability are more prevalent than cancer, stroke, heart disease, diabetes, and Alzheimer’s Disease combined.’

Dr Jenna Duehr adds: ‘The evidence is clear that chiropractors can play an important role in evidence-informed, people-centred, interprofessional and collaborative care for spinal health. As New Zealand grapples with developing a health service fit for the 21st century we need to focus on the vital role of allied health professionals in keeping people out of the hospitals and enjoying a healthy and active life.’

New Zealand’s chiropractors have launched a public website (https://chiropracticnz.org), taking the lead to inform, educate and inspire people to enhance their overall health and prevent pain and disability by improving their posture, addressing spinal problems and engaging in physical activity.

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