Introduction —
This topic includes links to society and government-sponsored guidelines from selected countries and regions around the world. We will update these links periodically; newer versions of some guidelines may be available on each society's website. Some societies may require users to log in to access their guidelines.
The recommendations in the following guidelines may vary from those that appear in UpToDate topic reviews. Readers who are looking for UpToDate topic reviews should use the UpToDate search box to find the relevant content.
Links to related guidelines are provided separately:
●(See "Society guideline links: Spondylolysis and spondylolisthesis".)
●(See "Society guideline links: Chronic pain management".)
●(See "Society guideline links: Radiculopathy".)
●(See "Society guideline links: Thoracic and lumbar spine injury in adults".)
International
●World Health Organization (WHO): Guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings (2023)
●International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT): Position statement – International framework for red flags for potential serious spinal pathologies (2020)
●American Society of Regional Anesthesia and Pain Medicine (ASRA), European Society of Regional Anaesthesia and Pain Therapy (ESRA), American Academy of Pain Medicine (AAPM), International Neuromodulation Society (INS), North American Neuromodulation Society (NANS), and World Institute of Pain (WIP): Guidelines on interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications, second edition (2018)
Canada
●Choosing Wisely Canada: Don't do imaging for lower-back pain unless red flags are present (2024)
●Choosing Wisely Canada: Don't initiate opioids long-term for chronic pain. Recommend and help support physical activity as the foundation for managing osteo-arthritis and chronic low back pain (2024)
●Choosing Wisely Canada: Canadian Spine Society (CSS) – Eight tests and treatments to question (2021)
●Choosing Wisely Canada: Don't order lumbosacral (low back) spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators (2021)
●American Society of Regional Anesthesia and Pain Medicine (ASRA), European Society of Regional Anaesthesia and Pain Therapy (ESRA), American Academy of Pain Medicine (AAPM), International Neuromodulation Society (INS), North American Neuromodulation Society (NANS), and World Institute of Pain (WIP): Guidelines on interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications, second edition (2018)
United States
●North American Spine Society (NASS): Clinical guidelines
●American College of Radiology (ACR): ACR Appropriateness Criteria on back pain– Child (2024)
●American Society of Pain and Neuroscience (ASPN): Evidence-based clinical guideline of interventional treatments for low back pain (2022)
●US Department of Veterans Affairs/Department of Defense (VA/DoD): Clinical practice guideline for the diagnosis and treatment of low back pain (2022)
●American College of Occupational and Environmental Medicine (ACOEM): Guidelines for invasive treatments for low back disorders (2021)
●ACR: ACR Appropriateness Criteria on inflammatory back pain – Known or suspected axial spondyloarthritis (2021)
●ACR: ACR Appropriateness Criteria on low back pain (2021)
●American Physical Therapy Association (APTA): Clinical practice guidelines for interventions for the management of acute and chronic low back pain, revision (2021)
●ACOEM: Guidelines on non-invasive and minimally invasive management of low back disorders (2020)
●ACOEM: Practice guideline on diagnostic tests for low back disorders (2019)
●American Society of Regional Anesthesia and Pain Medicine (ASRA), European Society of Regional Anaesthesia and Pain Therapy (ESRA), American Academy of Pain Medicine (AAPM), International Neuromodulation Society (INS), North American Neuromodulation Society (NANS), and World Institute of Pain (WIP): Guidelines on interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications, second edition (2018)
●American Society of Interventional Pain Physicians (ASIPP): Comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain, update (2013)
Europe
●American Society of Regional Anesthesia and Pain Medicine (ASRA), European Society of Regional Anaesthesia and Pain Therapy (ESRA), American Academy of Pain Medicine (AAPM), International Neuromodulation Society (INS), North American Neuromodulation Society (NANS), and World Institute of Pain (WIP): Guidelines on interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications, second edition (2018)
United Kingdom
●National Institute for Health and Care Excellence (NICE): Guideline on low back pain and sciatica in over 16s – Assessment and management (2016, updated 2020)
●NICE: Quality standard on low back pain and sciatica in over 16s (2017)
Australia–New Zealand
●Choosing Wisely Australia: Do not prescribe benzodiazepines for low back pain (2018)
●Choosing Wisely Australia: Do not prescribe spinal orthotics or bed rest for patients with non-specific low back pain (2018)
●Choosing Wisely Australia: Do not refer axial lower lumbar back pain for spinal fusion surgery (2018)
●Choosing Wisely Australia: Do not undertake imaging for low back pain in patients without indications of a serious underlying condition (2018)
●Choosing Wisely Australia: Do not order X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology (2017)
●Choosing Wisely Australia: Do not use imaging for diagnosing non-specific acute low back pain in the absence of red flags (2017)
●Choosing Wisely Australia: Avoid using electrotherapy modalities in the management of patients with low back pain (2016)
●Choosing Wisely Australia: Don't request imaging for patients with non-specific low back pain and no indicators of a serious cause for low back pain (2016)
●Choosing Wisely Australia: Don't perform imaging for patients with non-specific acute low back pain and no indicators of a serious cause for low back pain (2015)
Japan
●[In Japanese] Japanese Orthopaedic Association (JOA) and Japanese Society for Spine Surgery and Related Research (JSSR): Clinical practice guideline on lumbar disc herniation, 3rd edition (2021)
●[In Japanese] JOA and JSSR: Lumbar spinal stenosis treatment, 2nd edition (2021)
●[In Japanese] JOA: Low back pain treatment guidelines, 2nd edition (2019)
●[In Japanese] Choosing Wisely Japan: Treatment of low back pain – What is the period of proper bed rest? (2016)
