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.

Send to Eur Spine J. 2018 Feb 19. doi: 10.1007/s00586-017-5433-8. [Epub ahead of print] Chou R1,2, Côté P3,4, Randhawa K3,4, Torres P5, Yu H3,4, Nordin M6,7, Hurwitz EL8, Haldeman S9,10,11, Cedraschi C12,13. Author information 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA. chour@ohsu.edu. 2 Department of Medicine, Oregon Health and Science University, Portland, OR, USA. chour@ohsu.edu. 3 Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada. 4 UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada. 5 Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile. 6 Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA. 7 World Spine Care Europe, Holmfirth, UK. 8 Office of Public Health Studies, University of Hawaii, Mānoa, HI, USA. 9 Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. 10 Department of Neurology, University of California, Irvine, Irvine, CA, USA. 11 World Spine Care, Santa Ana, CA, USA. 12 Division of General Medical Rehabilitation, University of Geneva, Geneva, Switzerland. 13 Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland. 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. These slides can be retrieved under Electronic Supplementary Material. KEYWORDS: Conservative treatment; Low back pain; Medically underserved area; Neck pain; Spine; Therapeutics PMID: 29460009 DOI: 10.1007/s00586-017-5433-8