Lower back pain – the National Institute for Health and Care Excellence (NICE) new draft guidelines

In the UK it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in women.  The total cost of this to the UK economy is reckoned to be over £12 billion per year!  A recent study found that lower back pain caused more disability than any other condition.  It affects 1 in 10 people and is also becoming more common with increasing population age.  Additionally, sciatica is also commonly associated with low-back pain.  It is estimated that as many as 40% of us will experience sciatica at some point in our lives.

lower back painNICE is now updating its 2009 guidance on the early management of low back pain.  It has published draft recommendations for public consultation.  The aim of this draft guideline is to clarify the most clinical and cost effective ways to treat low-back pain and sciatica based on the best available evidence.  The previous guideline only covered the management of low back pain that had lasted between 6 weeks and 12 months.  This updated guideline covers people with low back pain or sciatica irrespective of how long they have had the condition.

The draft guideline:

The draft guideline recommends exercise, in all its forms (such as stretching, strengthening, aerobic or yoga), as the first step in managing low-back pain.  The guideline states:

1 1.2.7 Consider manipulation, mobilisation or soft tissue techniques 2 (for example, massage) for managing non-specific low back 3 pain with or without sciatica, but only as part of multi-modal 4 treatment packages.

(But, interestingly, the commentary says:

Massage and manipulation by a physiotherapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone.

which seems to say more than the actual guideline).  Perhaps they will develop this a bit further once it is published in full.

The draft guideline also recommends encouraging people to continue with normal activities as far as possible.  All of which we have been doing for years!

Really pleasing is that the guideline says that Paracetamol on its own is no longer the first option for managing low back pain.  Instead, the guideline recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first.  Weak opioids, such as codeine, are now only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable.


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