European wide Neck and Low Back Pain Treatment Recommendations 2020

Brief Summary

In clinic, osteopathic treatment together with reassurance, exercises and specific advice for physical activity are the keys to helping your patients with low back pain and neck pain. 

However, electrotherapy, shortwave, laser and more than a couple of days bed rest are not recommended.

Summary of European-wide, evidence-based National and professional Guidelines 2020.

Key words

Low back pain, neck pain, evidence based, European Guidelines.


Back pain causes the highest rate of years lived with disability globally out of 354 conditions, with neck pain ranked in the top 15 (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018).

In this evidence based and European wide systematic review thirteen databases were searched for National and Professional Guidelines for the clinical management of low back pain and neck pain. The guidelines were issued between 2013-2020. Inclusion criteria: the guidelines were evidence-based, European and issued by professional bodies and organisations; the guidelines were for an adult population over 18; Treatment needed to be deliverable within primary care; treatments were included that aimed to reduce pain, improve function, and support return to work. 

National and Professional Guidelines from Belgium, Denmark, France, Germany, Italy, The Netherlands, Poland and UK were included.

Seventeen guidelines were systematically identified, synthesised and graded using the AGREE II reporting checklist. Of these seven were identified to be of high quality, two guidelines for neck pain and five for low back pain. 3,941 unique citations were identified and analysed. The degree of evidence for or against a treatment was ranked as strong, moderate, weak, inconsistent/consistent or inconclusive.

The Results of the study found that:

Back Pain -there is evidence (both strong and weak) for: 

reassurance, advice, education with specific advice for physical activity, manual therapy combined with exercise, exercise programme and work, group exercise programmes, work-based rehabilitation, and return to work programmes. 

Back pain -there is evidence (strong) against: 

electrotherapy, shortwave, laser, more than a couple of days bed rest, use of paracetamol, anti-depressants, anticonvulsants, muscle relaxants, spinal injections for non-specific low back pain, traction, and orthoses.

Referral for imaging is only recommended for those with red flags -Risk of fracture, infection, metastatic cancer, neurological emergencies including cauda equina, aortic aneurysm or systemic inflammatory arthritis, or deterioration of symptoms.

Psychological therapies are mainly recommended for subgroups of patients with psychosocial risk, complex mood problems or persistent back pain. Surgery is only recommended where there is a specific pathology.

There is inconsistent or inconclusive evidence for: manual therapy without additional active treatment, traction, NSAID’s, opioids, steroid injections, acupuncture, postural therapies. The guidelines recommend entirely non-pharmacological treatments for low back pain. 

Neck Pain -there is evidence (moderate or weak) for: reassurance, advice, education, manual therapy combined with exercise, exercise programme, oral analgesics, topical medications, and psychological therapies. Multidisciplinary treatment for those with psychosocial risk or persistent neck pain or disability. 

Neck Pain– there is inconsistent or inconclusive evidence for manual therapy without additional active treatment, traction, electrotherapies, thermotherapies, cervical orthoses, acupuncture/dry needling and referral for imaging.

This paper gives an up-to-date European wide analysis of National and Professional Guidelines for the treatment of neck and low back pain. It provides highly relevant informative evidence-based recommendations which osteopaths should apply in clinic.


Corp N. 2020 Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. European Journal of Pain Vol 25 (2) 275-295

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789-1858. doi: 10.1016/S0140-6736(18)32279-7. Epub 2018 Nov 8. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. PMID: 30496104; PMCID: PMC6227754.


Caroline Frost

Juni 2021

Caroline är utbildad som D.O. på British College of Osteopathic Medicine, London, 1989-1993 och blev legitimerad Osteopat i UK 1999. Osteopatiutbildningen bestod av fyra års heltidsstudier. Hon har genomfört en masters i osteopati (MSc) genom Osteopathie Schule Deutschland/ Dresden International University.

Hon är också KBT-terapeut (kognitiv beteendeterapeut) efter att ha genomfört Steg 1 (grundutbldning) i KBT-kognitiv beteendeterapi år 2012. KBT-utbildningen är godkänd av Socialstyrelsen och motsvarar den av ”Svenska föreningen för kognitiva och beteendeinriktade terapier” fastställda normen för grundutbildningen. Jag har även en fil.kand. i biologi.

I England jobbade Caroline på ett hälsocenter i Bethnal Green, London, tillsammans med andra osteopater. Hon samarbetade också med den lokala vårdcentralen där hon erbjöd osteopatiska behandlingar via motsvarigheten till landstinget i Storbritannien. Hon arbetade också som volontär på OCC (osteopathic centre for children) under en tid. År 2004 flyttade Caroline till Sverige från Storbritannien och hennes osteopati- och kbt-mottagning är baserad i centrala Stockholm.