Current guidelines for chronic spinal pain mainly recommend conservative, non-pharmacological care. Yet one dimension is largely missing: the environmental impact of how this care is delivered.
Our international modified Delphi study asked physiotherapists from different world regions how environmental sustainability could be integrated into chronic spinal pain management. Starting from existing clinical guidelines and sustainability literature, the Delphi resulted in 49 consensus recommendations across clinical practice, education, research and innovation, community engagement, and advocacy and policy.
The resulting framework, considered across micro, meso and macro levels, provides a starting point rather than a finished solution. It can help guide future clinical guidelines, education and research, while encouraging the profession to consider environmental responsibility alongside high-quality, evidence-based care.
The full article, published open access in August 2026 in the European Journal of Pain, presents the recommendations in detail, including areas of strong consensus and those where uncertainty remains.
This blog post is based on:
Opsommer, E., Korogod, N., & Melo Pereira, A. M. (2026). Environmental physiotherapy for chronic spinal pain management: An international modified Delphi study. European Journal of Pain, 30(7), e70354. https://doi.org/10.1002/ejp.70354
Emmanuelle Opsommer (PhD)
Full professor at HESAV School of Health Sciences—Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
Emmanuelle Opsommer has been a professor at HESAV since 2008 and served as dean of the physiotherapy department from 2015 to 2024. Her research focuses on pain and its transition to chronicity, using non-invasive approaches and combining quantitative and qualitative methodologies, with a particular emphasis on environmental considerations. She is also a member of the Executive Committee of the Swiss Pain Society.