Chronic low back pain beliefs and management practices in Africa: Time for a rethink?

Chronic low back pain (CLBP) beliefs are important psychosocial risk factors affecting the occurrence and progression of CLBP. To address pain beliefs and implement recommended biopsychosocial approaches for CLBP management, an understanding of the beliefs of patients and healthcare professionals (HCPs), and also CLBP management practices, is necessary. A narrative review was conducted to explore CLBP beliefs and practices in African countries.

Two systematic searches were conducted using seven databases (MEDLINE, Embase, PsychInfo, CINAHL Plus, AMED, PubMed and Web of Science) with combined variations of the terms "Management", "Guidelines", "Chronic Low Back Pain", "Beliefs", "Patients", "Healthcare Professionals" and "Africa".

Five studies and one standard treatment guideline document were included. No systematically developed African CLBP treatment guideline was found, although CLBP practices were identified in two African countries. CLBP management in African countries appears to be biomedically orientated. Only three research articles investigated the CLBP beliefs of patients in Africa, with none assessing HCP beliefs. Unhelpful CLBP beliefs (catastrophizing and fear avoidance) and biomedical thoughts about the causes of CLBP were identified. Unhelpful CLBP beliefs were associated with increased disability.

Management practices for CLBP in African countries appear to contradict recommended biopsychosocial management guidelines by developed countries and are not sufficiently documented. Research on CLBP beliefs and CLBP management practices in Africa is lacking. To enhance the uptake of biopsychosocial approach in Africa, research around CLBP beliefs in African CLBP patients and HCPs is required.