WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings

The purpose of the guideline is to provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP (CPLBP) in adults, including older people, that can be delivered in primary and community care settings to improve CPLBP-related health and well-being outcomes. For this reason, the guideline does not consider interventions typically delivered in secondary or tertiary care settings (e.g. surgical or other invasive procedures) or workplace interventions. The target audience is health workers of all disciplines working in the primary and community care settings. In this context, the guideline is intended to be discipline neutral. The guidelines will be of use to clinical staff including medical doctors, nurses, allied health workers including chiropractors, occupational therapists, physiotherapists, pharmacists, psychologists and community health workers, as well as public health programme and system managers

Patient-centered consultations for persons with musculoskeletal conditions

Consultations between practitioners and patients are more than a hypothesis-chasing exploration, especially when uncertainty about etiology and prognosis are high. In this article we describe a single individual's account of their lived experience of pain and long journey of consultations. This personal account includes challenges as well as opportunities, and ultimately led to self-awareness, clarity, and living well with pain. We follow each section of this narrative with a short description of the emerging scientific evidence informing on specific aspects of the consultation. Using this novel structure, we portray a framework for understanding consultations for persistent musculoskeletal pain from a position of patient-centered research to inform practice.</p

Beyond the study of pain: the evolving role of the International Association for the Study of Pain in global advocacy

Although founded on the basis of the study of pain, the International Association for the Study of Pain (IASP) has actively advocated for improving pain relief and access to pain management in a variety of ways. The Global Year was launched in 2004 and has continued with a different theme each year, and "Pain Awareness Month" is held every September. The Declaration of Montreal (2010) emphasized that access to pain management is a fundamental human right as a result from the IASP-hosted International Pain Summit. The IASP has continued to publish timely statements related to pain and pain management. The work of IASP on the 11th version of the International Classification of Disease has ensured that chronic pain is recognized as a disease in its own right, and the establishment of the Global Alliance of Partners for Pain Advocacy Task Force recognizes the importance of engaging people with lived experience of pain in accomplishing IASP's mission. The Working Group on Global Advocacy now spearheads IASP's global efforts in capacity building to ensure that pain advocacy activities will continue to grow.</p

Effect of diagnostic labelling on management intentions for non-specific low back pain: a randomised scenario-based experiment

BACKGROUND: Diagnostic labels may influence treatment intentions. We examined the effect of labelling low back pain (LBP) on beliefs about imaging, surgery, second opinion, seriousness, recovery, work, and physical activities. METHODS: Six‐arm online randomized experiment with blinded participants with and without LBP. Participants received one of six labels: ‘ disc bulge’, ‘ degeneration’, ‘ arthritis’, ‘ lumbar sprain’, ‘ non‐specific LBP’, ‘ episode of back pain’. The primary outcome was the belief about the need for imaging. RESULTS: A total of 1375 participants (mean [SD] age, 41.7 years [18.4 years]; 748 women [54.4%]) were included. The need for imaging was rated lower with the labels ‘ episode of back pain’ (4.2 [2.9]), ‘ lumbar sprain’ (4.2 [2.9]) and ‘ non‐specific LBP’ (4.4 [3.0]) compared to the labels ‘ arthritis’ (6.0 [2.9]), ‘ degeneration’ (5.7 [3.2]) and ‘ disc bulge’ (5.7 [3.1]). The same labels led to higher recovery expectations and lower ratings of need for a second opinion, surgery and perceived seriousness compared to ‘ disc bulge’, ‘ degeneration’ and ‘ arthritis’. Differences were larger amongst participants with current LBP who had a history of seeking care. No differences were found in beliefs about physical activity and work between the six labels. CONCLUSIONS: ‘ Episode of back pain’, ‘ lumbar sprain’ and ‘ non‐specific LBP’ reduced need for imaging, surgery and second opinion compared to ‘ arthritis’, ‘ degeneration’ and ‘ disc bulge’ amongst public and patients with LBP as well as reducing the perceived seriousness of LBP and enhancing recovery expectations. The impact of labels appears most relevant amongst those at risk of poor outcomes (participants with current LBP who had a history of seeking care)

One step at a time. Shaping consensus on research priorities and terminology in telehealth in musculoskeletal pain: an international modified e-Delphi study

Abstract Background Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. Methods In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. Results We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. Conclusion An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. Register Open Science Framework ( https://osf.io/tqmz2/ )