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Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines.

Corp, N; Mansell, G; Stynes, S; Wynne-Jones, G; Morsø, L; Hill, J; Van Der Windt, D


G Mansell

L Morsø


Background and objective: This systematic review synthesised evidence from European neck and low back pain (NLBP) clinical practice guidelines (CPGs) to identify recommended treatment options for use across Europe. Databases and Data Treatment: Comprehensive searches of thirteen databases were conducted, from 1st January 2013 to 4th May 2020 to identify up-to-date evidence-based European CPGs for primary care management of NLBP, issued by professional bodies/organisations. Data extracted included; aim and target population, methods for development and implementation, and treatment recommendations. The AGREE II checklist was used to critically appraise guidelines. Criteria were devised to summarise and synthesise the direction and strength of recommendations across guidelines. Results: Seventeen CPGs (11 low back; 5 neck; 1 both) from eight European countries were identified, of which seven were high-quality. For neck pain, there was consistent weak or moderate strength recommendations for: reassurance, advice and education, manual therapy, referral for exercise therapy/programme, oral analgesics and topical medications, plus psychological therapies or multidisciplinary treatment for specific subgroups. Notable recommendation differences between back and neck pain included, i) analgesics for neck pain (not for back pain); ii) options for back painspecific subgroups - work-based interventions, return to work advice/programmes, and surgical interventions (but not for neck pain), and iii) a greater strength of recommendations (generally moderate or strong) for back pain than those for neck pain. Conclusions: This review of European CPGs identified a range of mainly non-pharmacological recommended treatment options for NLBP that have broad consensus for use across Europe.


Corp, N., Mansell, G., Stynes, S., Wynne-Jones, G., Morsø, L., Hill, J., & Van Der Windt, D. (2021). Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. European Journal of Pain, 25(2),

Journal Article Type Article
Acceptance Date Oct 5, 2020
Online Publication Date Oct 16, 2020
Publication Date 2021-02
Publicly Available Date Jun 26, 2023
Journal European Journal of Pain
Print ISSN 1090-3801
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 25
Issue 2
Publisher URL
PMID 33064878


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