Primary care management of non-specific low back pain: key messages from recent clinical guidelines

In reply:

We thank Lin and colleagues for their interest in our recent article1 and appreciate the opportunity to reply. We agree with the important points they raise regarding Aboriginal people with musculoskeletal pain conditions.

One of the challenges in providing culturally appropriate care among patients with low back pain is that we lack research to guide our efforts. Most evidence about managing and preventing low back pain comes from studies performed in high income countries that have typically enrolled homogeneous samples of participants who are unrepresentative of the diversity in the population.2 We also lack research investigating the barriers in implementing the available evidence on managing low back pain (and other musculoskeletal conditions) in culturally and linguistically diverse populations such as Aboriginal Australians.

The implementation of clinical practice guideline recommendations in low income countries and culturally diverse populations is far from simple. In high income countries there is often a gap between evidence and practice; and it is likely that gaps will be larger in low income and culturally diverse populations.3 It is necessary to understand the social and economic context of populations, as well as their cultural beliefs and experiences about low back pain, to overcome the challenges of adopting recommendations from guidelines. People in rural and remote regions may lack access to specific treatments endorsed in guidelines (eg, multidisciplinary rehabilitation); language may be a barrier to delivery of psychological therapies, and people from different cultural groups may conceptualise back pain in quite different ways.2

We agree with the authors that appropriate communication is key in managing low back pain well. It is important for patients to receive information about their back pain, as well as advice and reassurance, in a manner that patients can understand. Successful communication is essential to create a positive interaction between patients and health professionals, and consequently for implementing evidence-based care.4

More research about how to effectively implement strategies for managing low back pain in culturally and linguistically diverse populations is needed. The burden of this condition is increasing, overloading the health care and social systems that are already problematical, and Aboriginal Australians are at a disadvantage.