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NICE updates advice on treating low back pain

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Exercise should be the first step to help manage low back pain and sciatica, according to updated advice from the National Institute for Health and Care Excellence (NICE).

The new guidelines, published in December, say that all forms of exercise — for example stretching, strengthening, aerobics and yoga — can reduce the impact of low back pain and sciatica on people’s lives.

NICE also recommends encouraging people to continue with normal activities as far as possible.

However, the guidelines state that massage and manipulation should only be used with exercise because there is not enough evidence to show they are of benefit when used alone. Similarly, acupuncture for treating low back pain is not recommended because evidence shows it is no better than sham treatment.

When it comes to pain-relieving drugs, NICE says that paracetamol on its own is no longer the first option for managing low back pain. Instead, the guidelines recommend 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 are not suitable.

Professor Mark Baker, clinical practice director for NICE, said: “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.”

Low back pain is estimated to cost the UK economy over £12bn per year. It is responsible for around 37% of all chronic pain in men and 44% in women.

Sciatica is also a relatively common condition, affecting up to 40% of people at some point in their lives.

https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain