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Low back pain is the leading cause of disability globally. Most prevalence data for low back pain come from high-income countries. Data from low-and middle-income countries such as Nepal are currently lacking. This study aimed to estimate one-month prevalence of low back pain in Nepal using a nationally representative sample and present the prevalence estimates by socio-demographic characteristics. We used national population-based survey data from the World Health Organisation (WHO) STEPwise Approach to Non-communicable Disease Risk Factor Surveillance (STEPS) survey conducted in Nepal from February to May 2019 with people aged 15 to 69 years. We reported the age-standardised low back pain prevalence (95% CI). We used univariate and multivariable logistic regression to assess the associations between sociodemographic variables and the presence of low back pain and results were presented as odds ratios. A total of 5593 people aged 15 to 69 years participated in the survey. The response rate was 86.4%. The age-standardised prevalence of activity limiting low back pain was 23.2% (95% CI: 21.9% to 24.5%). Older people were more likely to have low back pain than younger people. For example, people aged 55–69 years had over 4 times higher odds of having low back pain than people aged 15–24 years [odds ratio: 4.06 (95%CI= 2.57 to 6.42)]. Females had 1.74 times higher odds of having low back pain than males [odds ratio: 1.74 (95%CI= 1.45 to 2.09)]. The results of our study show that a quarter of adults are affected by low back pain in Nepal; with women and older people more likely to experience low back pain.

We used a scoping review design to map the available evidence describing the use of reassurance in clinical practice, interventions to increase the delivery of reassurance, and reassurance-related outcome measures. We searched CINAHL, MEDLINE, EMBASE and Cochrane Central from inception to October 2024. Publications were included if they described the use of reassurance or reassurance-related outcome measures in patients with non-specific low back pain (LBP) presenting to primary care. We did not exclude publications on the basis of study design. Data were extracted and charted in accordance with study aims. We included 88 publications describing 66 primary studies. Twenty-one papers described how clinicians used reassurance in primary care, including: information provided (n=16), frequency of use (n=6), challenges providing reassurance (n=7), and importance of individualising reassurance (n=11). Reassurance interventions were investigated in 46 trials. Reassurance interventions were delivered verbally by clinicians to individuals (n=29) or groups (n=14), or via educational materials (n=18). Only one trial measured how reassured the patient felt after the intervention using a single-item non-validated question. Thirty-six trials used indirect measurements of reassurance success, including reductions in: fear-avoidance (n=23), worry (n=8), anxiety (n=8), pain catastrophising (n=10), and further healthcare utilisation (n=12). Relatively few papers have described how clinicians use reassurance in primary care. Reassurance interventions were investigated in 46 trials; however, reassurance was rarely the primary component of the intervention and was often delivered as part of an education intervention. There are no validated measures to directly assess how reassured a patient feels after an intervention.

•Facilitators/barriers to target the altered nervous system in chronic low back pain.•Effective pain communication creates positive attitudes and empowerment.•Some approaches increase while others interfere with intervention coherence.•Face-to-face and online components increase confidence in performing the treatment.•People outside the treatment team also impact the acceptability of the treatment.

•Mediation analyses can help identify key treatment targets of interventions.•Adapting interventions to best influence treatment targets can improve outcomes.•Patient education targeting self-efficacy and back beliefs may reduce disability in acute low back pain.•The role of pain catastrophizing in acute low back pain is unclear.