Background & Aims

Low back pain is the number one cause of disability globally [1]. Social determinants of health influence low back pain and its outcome [2] particularly for people living in the low- and middle-income countries (LMICs) [3]. The Lancet Series of Low Back Pain highlighted the lack of low back pain data from LMICs [4]. The study aimed to describe (1) what low back pain care is currently delivered in LMICs, and (2) how that care is delivered.

Methods

An online mixed-methods study. A Consortium for low back pain in LMICs (n=65) was developed with an expert panel of leading low back pain researchers (>2 publications on low back pain) and multidisciplinary clinicians and patient partners with five years of clinical/lived low back pain experience in LMICs [3]. Quantitative data were analyzed using descriptive statistics. Two researchers independently analyzed qualitative data using deductive and inductive coding and developed a thematic framework.

Results

Forty-seven of 55 invited panel members (85%) representing 32 LMICs completed the survey (38% women; 62% men). The panel included clinicians (34%), researchers (28%), educators (6%), and patient partners (4%). Pharmacotherapies and electrophysiological agents were the most used low back pain treatments. The Thematic Framework comprised of eight themes: (1) Self-management is ubiquitous; (2) Medicines are the cornerstone; (3) Traditional therapies have a place; (4) Society plays an important role; (5) Imaging use is very common; (6) Reliance on passive approaches; (7) Social determinants influence low back pain care pathway; and (8) Health systems are ill-prepared to address low back pain burden.

Conclusions

Low back pain care in LMICs did not consistently align with the best available evidence. Findings will help research prioritization in LMICs and guide global low back pain clinical guidelines. The establishment of the Consortium will facilitate global collaboration to address the burden of low back pain worldwide especially in the resource-limited countries.

References

1.G. B. D. Low Back Pain Collaborators: Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023, 5(6):e316-e329.
2.Karran EL, Grant AR, Moseley GL: Low back pain and the social determinants of health: a systematic review and narrative synthesis. Pain 2020, 161(11):2476-2493.
3.Sharma S, McAuley JH: Low Back Pain in Low- and Middle-Income Countries, Part 1: The Problem. J Orthop Sports Phys Ther 2022, 52(5):233-235.
4.Buchbinder R, van Tulder M, Oberg B, Costa LM, Woolf A, Schoene M, Croft P, Lancet Low Back Pain Series Working G: Low back pain: a call for action. Lancet 2018, 391(10137):2384-2388.

Presenting Author

Saurab Sharma

Poster Authors

Saurab Sharma

PT

University of New South Wales

Lead Author

Anupa Pathak

PhD

Lead Author

Romy Parker

University of Cape Town

Lead Author

Leonardo Oliveira Pena Costa

PhD

Lead Author

BABITA GHAI,MBBS

MD

Postgraduate Institute of Medical Education and Research Chandigarh

Lead Author

Chinonso Igwesi-Chidobe

PhD

Lead Author

Prawit Janwantanakul

PhD

Lead Author

Fabianna Resende de Jesus Moraleida - PhD

Federal University of Ceara

Lead Author

Mulugeta Bayisa Chala

PhD

Lead Author

Mohammadreza Pourahmadi

PhD

Lead Author

Andrew M. Briggs

PhD

Lead Author

Edward Gorgon

PhD

Lead Author

Clare L. Ardern

PhD

Lead Author

Karim M. Khan

PhD

Lead Author

James H. McAuley

PhD

Lead Author

saurab sharma

Lead Author

Topics

  • Access to Care