Towards global clinical practice guidelines for the management of non-specific low back pain in primary care: a review of current guideline recommendations and how they have changed over the last 30 years

Low back pain has an enormous impact on individuals and health systems. The large majority of individuals with low back pain have non-specific low back pain (also recently called primary low back pain by WHO), where the cause cannot be attributed to a specific pathology. Developing and implementing evidence-based guidelines to manage non-specific low back pain in primary care is essential to reducing the burden on individuals and health systems. Since 2001, periodic overviews of clinical practice guidelines for the management of patients with non-specific low back pain in primary care have been conducted. Since the last overview in 2018, new clinical practice guidelines for the management of low back pain have been published. This Review summarises management recommendations across international low back pain clinical practice guidelines for primary care and explores the changes in recommendations over time in guidelines published between 1994 and 2026.