German Institute for Quality and Efficiency in Health Care publish report on chronic back pain guidelines


The German Institute for Quality and Efficiency in Health Care (IQWiG) has published the results of a search for evidence-based guidelines on the treatment of people with chronic back pain. The aim of the report is to identify those recommendations from current guidelines of high methodological quality that may be relevant for the potential new disease management programme (DMP) “Chronic back pain”.


According to the results of the report, the recommendations cover all important health care aspects and are largely consistent.

The 6 sets of guidelines that the IQWiG analysed cover all important aspects of diagnosis, treatment, and relapse prevention.

In the diagnosis of patients with back pain, it is primarily important to identify those risk factors that could lead to chronic disease. The guidelines address the standardised documentation of symptoms and psychosocial risk factors, as well as imaging procedures, blood tests, and the use of diagnostic nerve blocks.

Besides drug and invasive therapy (e.g. injections in joints), many non-drug interventions are mentioned. In addition to massages, manual therapy, physical activity, physiotherapy, and yoga, these also include behavioural therapy. The guideline authors commonly advise against certain interventions. This concerns, for example, massages, bed rest, transcutaneous electrical nerve stimulation (TENS) or therapeutic ultrasound.

The recommendations are largely consistent. Inconsistencies only exist with regard to drug therapy (with paracetamol and phytotherapeutics), acupuncture, and discography.

Finally, the guidelines also contain specific recommendations for several subgroups of patients, such as patients with radiculopathy, disc-related back pain, spinal canal stenosis, post-nucleotomy syndrome, lumbar facet joint pain or sacroiliac joint pain.

The standards for guidelines stipulate that it should be clear what evidence the recommendations are based on. However, this is not always the case for the analysed guidelines on chronic back pain. This particularly applies to many non-drug interventions and the recommendations on rehabilitation measures.