NICE Guidelines for Treatment of Back Pain

The NICE guidelines are a set of recommendations from England’s National Institute for Health and Care Excellence. Through its merger with the Health Development Agency in 2005, their mandate became to aid in developing public health guidance to help prevent ill health and promote healthier lifestyles. It is composed of a series of independent committees made-up of concerned stakeholders for whichever issue is being addressed. The committees include academics, clinicians, and members of the public who look at the available scientific evidence in order to develop their recommendations. NICE GuidelinesMost recently, in November 2016, their recommendations for low back pain with or without sciatica were published based upon the latest evidence-based research. Of interest to chiropractors, and their patients, was that it was recommended that manual therapy combined with exercise, provided the best results, and are therefore recommended for these conditions over all other methods. Also of interest, in this time of so much press given to the prescription and use of opioid drugs such as oxycontin, are not recommended for neither acute low back pain nor chronic low back pain. They also noted the judicious use of imaging:

1.1.4 Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica.

1.1.5 Explain to people with low back pain with or without sciatica that if they are being referred for specialist opinion, they may not need imaging.

1.1.6 Consider imaging in specialist settings of care (for example, a musculoskeletal interface clinic or hospital) for people with low back pain with or without sciatica only if the result is likely to change management.

The recommendations as described are essentially what chiropractors have been saying for decades: restore mobility to the spine and coupled with exercise, will effect a cure. Modalities such as spinal decompression tables (traction), ultrasound or TENS are unproven and ineffective, therefore were not recommended.

Following are some of the key recommendations:

Orthotics

1.2.3 Do not offer belts or corsets for managing low back pain with or without sciatica.

1.2.4 Do not offer foot orthotics for managing low back pain with or without sciatica.

1.2.5 Do not offer rocker sole shoes for managing low back pain with or without sciatica.

Manual therapies

1.2.6 Do not offer traction for managing low back pain with or without sciatica.

1.2.7 Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.

Acupuncture

1.2.8 Do not offer acupuncture for managing low back pain with or without sciatica.

Electrotherapies

1.2.9 Do not offer ultrasound for managing low back pain with or without sciatica.

1.2.10 Do not offer percutaneous electrical nerve simulation (PENS) for managing low back pain with or without sciatica.

1.2.11 Do not offer transcutaneous electrical nerve simulation (TENS) for managing low back pain with or without sciatica.

1.2.12 Do not offer interferential therapy for managing low back pain with or without sciatica.

Hopefully the NICE Guidelines will be considered when other governments and third-party payers (such as insurance companies) establish their own regulations for standards of care and who should provide it.

Dr. Mark Strudwick is a third-generation chiropractor in Victoria, B.C.

 

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