World Health Organization Releases Guidelines on Lower Back Pain Management

back pain old woman

Lower back pain is one of the leading causes of disability both in the United States and worldwide. The cost of lower back pain isn’t just financial. Chronic lower back pain can lead to lowered quality of life, making it difficult to conduct even basic tasks like walking, sitting, standing, and engage in physical exercise. Improving functionality is one of the key objectives of treatment for chronic lower back pain.

The World Health Organization (WHO) recognizes the burden that lower back pain places on individuals and society as a whole. In response, they have released new guidelines on how to (and how not to) manage LBP. These guidelines use evidence-based treatment recommendations to improve the lives of those living with chronic lower back pain.

Who Can Use These Guidelines?

The WHO’s guidelines for non-surgical management of lower back pain are intended to educate and inform healthcare providers on the best practices of treating LBP. Healthcare providers can include anyone from:

  • Occupational therapists
  • Chiropractors
  • Primary care physicians
  • Physiotherapists
  • Nurses

Even if you’re not a healthcare provider, knowing the latest recommendations can help you advocate for yourself and create a treatment plan with your provider if you suffer from lower back pain. These are the first guidelines ever to be released by the WHO for LBP treatment in primary and community care settings. Now is the perfect time to take advantage of these recommendations and discuss them with your healthcare provider.

Key Recommendations from the Guidelines

The WHO’s new guidelines provider recommendations for treating chronic lower back pain. More importantly, they also provided updated information on what things to avoid when managing LBP. Keep in mind that in creating these guidelines, the contributors must use research-based evidence and reasoning. That being said, if you notice you’ve been using a certain treatment for your LBP but it contradicts the WHO’s recommendations, you should consult with your healthcare provider about making changes as soon as possible.

So, what are some of the key recommendations from the guidelines? Here are a few highlights.

Recommendations For

There were 37 total types of treatment that the WHO considered when creating its guidelines. Of these 37, only a handful were selected by the WHO and fall under their key recommendations. Some of these treatments include:

  • Structured exercise therapies/ programmes
  • Structured and standardized education and/or advice
  • Needling therapies
  • Spinal manipulative therapy
  • Massages
  • NSAIDs
  • Psychological therapy, including Cognitive-behavioral therapy, or CBT

One of the most surprising findings was the use of topical cayenne pepper in the treatment of chronic lower back pain. This recommendation comes from Cayenne pepper’s ability to mute the nerve signals that generate pain. It does so through Capsaicin, which is the chemical responsible for its spicy kick!

Massages, cognitive-behavioral therapy to help reduce negative thoughts around back pain, and even needling therapies are some other alternative treatments that have been recommended by the WHO.  These broad treatments can be a great way for patients to experience a full-body approach to healing.

Other findings have already been strongly recommended by other health organizations. For instance, the Department of Veterans Affairs’ Clinical Guidelines for lower back pain also recommend the use of spinal manipulation and an exercise routine.

It’s important to note that spinal manipulation is not the same as traction therapy, which the guidelines are now recommending against. If you’re interested in alternative treatments, it’s important to work with a chiropractor or other treatment specialist who understands the differences between these two approaches.

Recommendations Against

In addition to recommendations on what treatments to try, the WHO guidelines also provide important advice on what treatments should be avoided. These include:

  • Traction therapy
  • Assistive products like lumbar braces
  • Medications like Tricyclic antidepressants and Skeletal muscle relaxants
  • Other herbs like Devil’s Claw and White Willow
  • Weight management through pharmacological weight loss

Perhaps the most significant recommendation against is the use of opioids as a treatment for lower back pain. This is due to the high risk of addiction and overdose associated with these medications.

It’s important for patients to carefully consider any potential treatments, especially if they involve medications or invasive procedures. Ultimately, these treatments are not only ineffective but possibly cause more harm than good.

Key Takeaways

These guidelines are just that – guidelines to help you form your treatment plan and guide you and your provider to make informed decisions. It’s important to keep in mind that every individual may respond differently to different treatments. In addition, treatments are ever-changing, and what worked in the past, such as traction therapy, might not work for you now. Living with chronic back pain might be a lifelong process, but guidelines like those of the WHO and collaborating with a knowledgeable healthcare professional go a long way in managing symptoms and improving your quality of life.

Article edited and fact checked by our editorial team.


  1. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.
  2. Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1.
  3. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, van Tulder M, Koes BW. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803. doi: 10.1007/s00586-018-5673-2.
  4. Cashin AG, Wand BM, O’Connell NE, Lee H, Rizzo RR, Bagg MK, O’Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2023 Apr 4;4(4):CD013815. doi: 10.1002/14651858.CD013815.pub2.