Low back pain (LBP) is a prevalent condition with substantial global and national burden, particularly within the scope of Primary Health Care (PHC). Evidence-based education and counseling are recommended strategies for LBP management; however, their implementation remains suboptimal. Identifying the frequency of these practices and the themes explored may contribute to understanding whether key messages recommended for LBP education and counseling are being addressed in primary care.

This study aimed to investigate the frequency of education and/or counseling in the management of LBP in PHC and to identify the content provided to patients, assessing adherence to the recommended key messages.

A cross-sectional observational study was conducted with physicians and nurses working in PHC in Fortaleza, Brazil. Data were collected through in-person and online surveys using a RedCap-based form. Participants responded to two simulated clinical cases—one acute and one chronic — based on validated cases. The participant was asked about LBP management. If the response included education and counseling, the participant would respond about the themes covered from the options. Sociodemographic and professional data were collected. The survey also described adherence to recommended key messages and barriers to implementing education and/or counseling.

A total of 140 professionals participated, with 74.29% being female and 59.29% being physicians. The mean age was 39.90 (±11.27) years, and the mean time since graduation was 13.45 (±10.88) years. Regarding qualifications, 51.43% held a specialization. Most professionals (51.43%) worked within the Family Health Strategy, and 42.86% had over 10 years of experience in PHC. Counseling was provided in 81.44% of cases, with a frequency of 84.62% in chronic LBP and 78.36% in acute LBP. Recommended key messages, such as guidance on exercise (65.26%) and home-based measures (72.77%), were frequently addressed. However, non-recommended messages, such as education about joint wear (56.81%) and limitation of household activities (40.38%), were also prevalent. The most frequently reported barriers included insufficient training (23.81%) and a limited perception of the educational role (23.81%).

Although educational and counseling were frequently employed in PHC, the content covered still includes many themes not recommended in evidence-based key messages. Implementing training programs for healthcare professionals could enhance alignment with scientific recommendations, ultimately improving LBP management within PHC settings.

These findings highlight the need for targeted interventions to enhance education and/or counseling in LBP management within PHC. Strengthening professional training in educational strategies and addressing identified barriers could improve a more effective and evidence-based approach to LBP management in PHC.