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European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain in Primary Care

European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain in Primary Care

The Chiro.Org Blog


You will enjoy these recent European evidence-based guidelines for the management of acute and chronic low back pain.

Both the Acute Back Pain Guideline and the
Chronic Back Pain Guideline recommend spinal manipulation
as an effective conservative treatment.


Interestingly, MOST of what’s considered “standard medical treatment” are listed as
Invasive treatments, that should NOT be recommended for non-specific CLBP.

Non-recommended medical treatments include:

  • Bed rest,
  • Acupuncture,
  • intradiscal injections,
  • epidural corticosteroid injections,
  • intra-articular (facet) steroid injections,
  • local facet nerve blocks,
  • trigger point injections,
  • prolotherapy,
  • botulinum toxin,
  • radiofrequency facet denervation,
  • intradiscal radiofrequency lesioning,
  • intradiscal electrothermal therapy,
  • radiofrequency lesioning of the dorsal root ganglion,
  • and spinal cord stimulation

Percutaneous electrical nerve stimulation (PENS) and neuroreflexotherapy may be considered where available.


Their Conclusion:

Surgery for non-specific CLBP cannot be recommended unless 2 years of all other recommended conservative treatments — including multidisciplinary approaches with combined programs of cognitive intervention and exercises — have failed, or such combined programs are not available, and only then in carefully selected patients with maximum 2-level degenerative disc disease.

Explore the complete Back Pain Europe website.

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