The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities.
Study Goal
The researchers aimed to develop recommendations for managing spinal disorders, including the role of massage as a conservative treatment for chronic low back and neck pain.
Results Summary
Massage was identified as a primary treatment option for chronic low back and neck pain without serious pathology, alongside other non-pharmacological therapies like exercise and yoga. The study did not provide specific efficacy metrics for massage but included it as a recommended intervention based on synthesized guidelines.
Population
Patients with chronic low back and neck pain without serious pathology, particularly in low-income communities and medically underserved areas.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
education and reassurance | neutral | - | patients with spinal disorders in low-income communities | - | should provide | #1 |
advice to remain active | neutral | - | patients with spinal disorders in low-income communities | - | should advise | #2 |
information about self-care options | neutral | - | patients with spinal disorders in low-income communities | - | should provide | #3 |
exercise | neutral | acute low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary conservative treatment option | #4 |
manual therapy | neutral | acute low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary conservative treatment option | #5 |
superficial heat | neutral | acute low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary conservative treatment option | #6 |
nonsteroidal anti-inflammatory drugs (NSAIDs) | neutral | acute low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary conservative treatment option | #7 |
exercise | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #8 |
yoga | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #9 |
cognitive behavioral therapies | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #10 |
acupuncture | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #11 |
biofeedback | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #12 |
progressive relaxation | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #13 |
massage | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #14 |
manual therapy | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #15 |
interdisciplinary rehabilitation | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #16 |
NSAIDs | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #17 |
acetaminophen | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #18 |
antidepressants | neutral | chronic low back and neck pain without serious pathology | patients with spinal disorders in low-income communities | - | primary treatment option | #19 |
exercise | neutral | spinal pain with radiculopathy | patients with spinal disorders in low-income communities | - | may consider | #20 |
spinal manipulation | neutral | spinal pain with radiculopathy | patients with spinal disorders in low-income communities | - | may consider | #21 |
NSAIDs | neutral | spinal pain with radiculopathy | patients with spinal disorders in low-income communities | - | may consider | #22 |
benzodiazepines | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #23 |
botulinum toxin injection | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #24 |
systemic corticosteroids | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #25 |
cervical collar | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #26 |
electrical muscle stimulation | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #27 |
short-wave diathermy | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #28 |
transcutaneous electrical nerve stimulation | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #29 |
traction | no change | spinal pain | patients with spinal disorders in low-income communities | not effective | should not offer | #30 |
PURPOSE: The purpose of this review was to develop recommendations for the management of spinal disorders in low-income communities, with a focus on non-invasive pharmacological and non-pharmacological therapies for non-specific low back and neck pain. METHODS: We synthesized two evidence-based clinical practice guidelines for the management of low back and neck pain. Our recommendations considered benefits, harms, quality of evidence, and costs, with attention to feasibility in medically underserved areas and low- and middle-income countries. RESULTS: Clinicians should provide education and reassurance, advise patients to remain active, and provide information about self-care options. For acute low back and neck pain without serious pathology, primary conservative treatment options are exercise, manual therapy, superficial heat, and nonsteroidal anti-inflammatory drugs (NSAIDs). For patients with chronic low back and neck pain without serious pathology, primary treatment options are exercise, yoga, cognitive behavioral therapies, acupuncture, biofeedback, progressive relaxation, massage, manual therapy, interdisciplinary rehabilitation, NSAIDs, acetaminophen, and antidepressants. For patients with spinal pain with radiculopathy, clinicians may consider exercise, spinal manipulation, or NSAIDs; use of other interventions requires extrapolation from evidence regarding effectiveness for non-radicular spinal pain. Clinicians should not offer treatments that are not effective, including benzodiazepines, botulinum toxin injection, systemic corticosteroids, cervical collar, electrical muscle stimulation, short-wave diathermy, transcutaneous electrical nerve stimulation, and traction. CONCLUSION: Guidelines developed for high-income settings were adapted to inform a care pathway and model of care for medically underserved areas and low- and middle-income countries by considering factors such as costs and feasibility, in addition to benefits, harms, and the quality of underlying evidence. The selection of recommended conservative treatments must be finalized through discussion with the involved community and based on a biopsychosocial approach. Decision determinants for selecting recommended treatments include costs, availability of interventions, and cultural and patient preferences. These slides can be retrieved under Electronic Supplementary Material.