The UK’s National Institute for Health and Care Excellence (NICE) has updated its advice on the treatment of low back pain in those over 16, recommending exercise in all forms as the best way to begin management. The guidelines now refer to treatment for sciatica as well as back pain.
As well as increasing exercise—such as yoga, aerobics, stretching and strengthening—the guidelines advise the continuation of day-to-day activities wherever possible.
Manual manipulation is only recommended in conjunction with exercise, with the guidelines citing a lack of evidence showing massage to be effective by itself.
According to the guidelines, treatment by acupuncture has failed to demonstrate superior results for back pain than sham treatment, and so it is not recommended by NICE.
In a press release, Mark Baker, clinical practice director for NICE, says: “Millions of people are affected every year by these often debilitating and distressing conditions. For most their symptoms improve in days or weeks. However for some, the pain can be distressing and persist for a long time.
“Regrettably there is a lack of convincing evidence of effectiveness for some widely used treatments. For example acupuncture is no longer recommended for managing low back pain with or without sciatica. This is because there is not enough evidence to show that it is more effective than sham treatment.”
Non-steroidal anti-inflammatory drugs are recommended above paracetamol as first medical treatment for back pain. Acute back pain can be treated with weak opioids, but only when initial NSAID treatment has failed, or is unsuitable, the guidelines state.
For those individuals whose other treatments have failed, or who face “significant psychological or social barriers to recovery”, the press release states, a combination of physical and psychological treatments should be offered.
Baker adds, “It is possible to reduce the impact that low back pain and sciatica can have on people’s lives. The guideline continues to recommend a stepped care approach and means people whose pain or function are not improving despite initial treatment should have access to a choice of further therapies.
“Our aim with this guideline is to give clarity and set out the most clinical and cost effective ways to treat low back pain and sciatica based on the best available evidence.”