Transforming chronic low back pain management in Bangladesh: implications for rehabilitation in low- and middle-income countries

Chronic low back pain (CLBP) is the leading cause of disability worldwide and represents a growing public health challenge in low- and middle-income countries. In Bangladesh, CLBP affects a substantial proportion of the adult population and contributes significantly to disability, reduced productivity, and healthcare utilization. Despite the high burden of disease, current management approaches frequently rely on pharmacological treatment and passive physiotherapy modalities that may not fully address the complex biopsychosocial nature of chronic pain. Sociocultural beliefs, limited patient awareness, and workforce constraints further influence care-seeking behavior and treatment practices. Contemporary clinical guidelines increasingly recommend biopsychosocial management strategies that emphasize active rehabilitation, patient education, and individualized care. The Specific Treatment of Problems of the Spine approach represents one such framework designed to deliver individualized physiotherapy for low back pain. This perspective highlights current challenges in CLBP management in Bangladesh and discusses how adopting individualized biopsychosocial physiotherapy models could improve outcomes. Strengthening rehabilitation capacity and integrating evidence-based physiotherapy into healthcare systems may provide a pragmatic pathway for improving CLBP care in Bangladesh and similar resource-limited settings.