Chronic low back pain: what the WHO guideline recommends

Low back pain is the leading cause of disability in the world, and on December 7, 2023 the World Health Organization published a guideline on how to treat its chronic form in primary care. The central recommendation is to treat the whole person: education, exercise, physical and psychological therapies, together. And the list of what to avoid includes opioids, lumbar belts and traction.

What happened

The guideline deals with chronic primary low back pain, the kind that lasts more than three months without an underlying disease to explain it. According to the WHO, in 2020 about 619 million people lived with low back pain, one in 13 people on the planet, 60% more than in 1990. The projection for 2050 is 843 million.

What the WHO recommends, as part of the care of adults, including older people:

• education programs that teach self-care strategies;
• structured exercise programs;
• physical therapies, such as spinal manipulation and massage, and needling therapies, such as acupuncture;
• psychological therapies, such as cognitive behavioral therapy;
• non-steroidal anti-inflammatory drugs.

And what it advises against: 14 interventions, among them lumbar belts and supports, traction and opioid painkillers, because of the risk of overdose and dependence. According to RTP, the WHO considered that, in these cases, the potential harms probably outweigh the benefits. The Portuguese broadcaster also reported that the organization did not find enough evidence to recommend or advise against some approaches, among them mindfulness, paracetamol, benzodiazepines and cannabis-based treatments.

Why it matters

In Brazil, chronic pain is a public health problem. A systematic review published in BrJP in 2021, covering 35 Brazilian studies, found an average prevalence of chronic pain of 45.59% across the studies analyzed, ranging from 23% to 76% and weighing more heavily on women. The lower back appears among the most frequently cited areas.

The guideline shifts the focus from medication alone to a set of care measures, and this is in line with recent research. In September 2026, Extra reported on a review by researchers at Adelaide University, covering more than 150 studies and 221,000 participants, according to which exercise reduced pain by more than one point on average on a 0-to-10 scale, with good results for light activities such as yoga, Pilates and tai chi.

For those who live with pain every day, the message is twofold. There are evidence-based paths, and they call for ongoing follow-up, not a single solution. And the first step is still a health professional.

In Bairo's view

Bairo Leandro Gonzalez Martinez says he found his foundation in pain, but he makes a point of separating the kinds of pain. The pain of the soul, that of failure, loss and emptiness, he tells in the pages on pain, faith and reconnection. The pain of the body, for him, starts in a doctor's office. The personal path he lived with the plant is in the plant that reconnected him, told as a personal account, never as a recommendation. And when everyday pain also weighs on the mind, he recalls that CVV (Brazil's emotional support service) answers free of charge at 188.

In his reading, those with chronic pain also suffer from the back-and-forth: telling the same story to each professional, forgetting half of what changed since the last consultation, not knowing whether what they feel today is a reason to seek help. That is where Bairo sees a place for the clinical assistant. At Hospital Triage, the proposal is to accompany the person day to day and call a professional, who validates and decides, when something changes. At Xperienc Global Labs, a clinical second opinion from a specialist in another country can broaden the view of the doctor who follows the case.

Where this meets the ecosystem

Hospital Triage provides, for chronic conditions, a daily question in simple language and a signal to the professional when the answers depart from that person's usual pattern. It is a signal for someone to take a look, not a conclusion. The system is at the prototype stage.

Xperienc Global Labs combines teleconsultation, the Global Language translator and biotechnology research, including medical cannabis. Faced with a guideline that says evidence is lacking for cannabis-based treatments for low back pain, Xperienc's place is that of research and of an honest grading of what is known, with no promise of results.

Sources

• World Health Organization, "WHO releases guidelines on chronic low back pain", 12/7/2023: who.int
• RTP, "OMS emite orientações sobre o que funciona no tratamento da dor nas costas" (WHO issues guidance on what works in treating back pain), 2024: rtp.pt
• Aguiar DP et al., "Prevalência de dor crônica no Brasil: revisão sistemática" (Prevalence of chronic pain in Brazil: systematic review), BrJP, 2021;4(3):257-67: scielo.br
• Extra, "Exercício leve alivia dor crônica tanto quanto remédios, aponta revisão de 157 estudos" (Light exercise relieves chronic pain as much as medication, says review of 157 studies), 9/25/2026: extra.globo.com

Read also

• The plant and science
• How pain can become purpose
• When to seek professional help