- Back pain
- Low back pain
- Clinical guidelines
Low back pain: causes, warning signs and what the WHO recommends
Low back pain is the leading cause of disability worldwide. We explain its causes, when to see a doctor, and which treatments the first WHO guideline supports.
PainManagement ER Published 3 min read
If your lower back hurts, you are far from alone. The World Health Organization (WHO) estimates that 619 million people had low back pain worldwide in 2020, and that the number will reach about 843 million by 2050, mainly because the population is growing and aging.[1] It is also the leading cause of disability worldwide.[1]
People with low back pain worldwide (millions)
- 2020 (estimate)
- 2050 (projection)
When is it acute, and when is it chronic?
The WHO classifies low back pain by how long it lasts:[1]
| Type | Duration |
|---|---|
| Acute | Less than 6 weeks |
| Subacute | 6 to 12 weeks |
| Chronic | More than 12 weeks |
Source: WHO (2023).[1]
It can start at any age, even in children and teenagers. The highest number of cases occurs between ages 50 and 55, and women are affected more often than men.[1]
Most common causes
According to the U.S. National Institutes of Health (NIAMS), back pain can come from several sources, which sometimes overlap:[4]
- Mechanical or structural: sprains and strains, degenerative disc disease, herniated discs, spondylolisthesis, spinal stenosis, vertebral fractures, scoliosis or myofascial pain.
- Inflammatory: such as ankylosing spondylitis and other inflammatory arthritis of the spine.
- Other conditions: osteoporosis, fibromyalgia, kidney stones or infections, endometriosis, spinal infections, (rare) tumors, or pregnancy.
In many cases no specific cause is found; this is called non-specific low back pain.[1]
Risk factors
NIAMS lists, among others: low fitness or weak core muscles, overexertion after a period of inactivity, weight gain, physically demanding jobs, desk work with poor posture, chronic poor sleep, depression or anxiety, age (especially after 45), and heredity.[4]
Warning signs: when to see a doctor
NIAMS recommends seeing a doctor if:[4]
- The pain doesn’t improve after a few weeks.
- You have numbness or tingling.
- The pain is severe and doesn’t improve with medication.
- It started after a fall or an injury.
- It comes with trouble urinating, weakness or numbness in the legs, fever, or unexplained weight loss.
Those last symptoms call for prompt medical care.
What the WHO recommends for chronic low back pain
In December 2023 the WHO published its first guideline on the non-surgical management of chronic primary low back pain in adults.[2] As summarized by UN News, the guideline:[3]
| Recommends | Advises against |
|---|---|
| Structured exercise programs | Opioid painkillers |
| Patient education on options and self-care | Physical therapies such as traction |
| Psychological support, such as cognitive behavioral therapy | Lumbar braces and belts |
| Spinal manipulative therapy and massage | |
| Non-steroidal anti-inflammatory drugs (NSAIDs) |
Sources: WHO (2023)[2]; UN News (2023).[3] The guideline covers non-surgical treatments in primary and community care; it does not assess surgery or invasive procedures.
The WHO also stresses that care should be tailored to each person’s mix of factors.[3] Its fact sheet adds that painkillers should not be the first-line treatment and, when used, are best combined with other measures: physical therapy, psychological and social support, reducing strain during physical work, and habits such as more physical activity, a healthy diet and good sleep.[1]
The bottom line
- Low back pain is very common, but once it lasts more than 12 weeks it is chronic and deserves a plan, not just painkillers.
- Exercise, education and psychological support are the foundation of what the WHO recommends.
- If you notice warning signs, don’t wait: see a professional.
An assessment looks for the source of your pain so you and your care team can decide which combination of treatments makes sense for you.
Sources
- Low back pain (fact sheet) . World Health Organization (WHO) , June 19, 2023.
- WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings . World Health Organization (WHO) , December 7, 2023.
- Do's and don'ts for tackling chronic back pain . UN News , December 7, 2023.
- Back Pain . National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH , reviewed February 2023.
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