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

Roger Chou, Pierre Côté, Kristi Randhawa, Paola Torres, Hainan Yu, Margareta Nordin, Eric L. Hurwitz, Scott Haldeman, Christine Cedraschi

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

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. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalEuropean Spine Journal
DOIs
StateAccepted/In press - Feb 19 2018

Fingerprint

Neck Pain
Back Pain
Low Back Pain
Medically Underserved Area
Spine
Guidelines
Musculoskeletal Manipulations
Anti-Inflammatory Agents
Autogenic Training
Spinal Manipulation
Exercise
Pathology
Yoga
Radio Waves
Diathermy
Transcutaneous Electric Nerve Stimulation
Costs and Cost Analysis
Exercise Therapy
Pain
Radiculopathy

Keywords

  • Conservative treatment
  • Low back pain
  • Medically underserved area
  • Neck pain
  • Spine
  • Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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. / Chou, Roger; Côté, Pierre; Randhawa, Kristi; Torres, Paola; Yu, Hainan; Nordin, Margareta; Hurwitz, Eric L.; Haldeman, Scott; Cedraschi, Christine.

In: European Spine Journal, 19.02.2018, p. 1-10.

Research output: Contribution to journalArticle

Chou, Roger ; Côté, Pierre ; Randhawa, Kristi ; Torres, Paola ; Yu, Hainan ; Nordin, Margareta ; Hurwitz, Eric L. ; Haldeman, Scott ; Cedraschi, Christine. / 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. In: European Spine Journal. 2018 ; pp. 1-10.
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