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.

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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