PATIENTS with lower back pain should qualify for acupuncture and chiropractic manipulation, a health watchdog has said.
The National Institute for Health and Clinical Excellence (Nice) published new advice for those working in the NHS, but admitted access to the therapies varied across the UK. Treatments recommended in the guidelines include a tailored exercise prog
ramme for up to 12 weeks.
Alternative choices suggested are manual therapy, including spinal manipulation, for a maximum of nine sessions over 12 weeks, acupuncture for a maximum of ten sessions up to 12 weeks and a programme of physical and psychological treatment for people suffering serious disability or significant psychological distress.
Nice said a raft of other treatments and tests – including X-rays, ultrasound and MRI scans – should not be used except in certain circumstances.
It also recommended dropping the use of electrical machines, such as "Tens" units, to relieve back pain and the use of therapeutic substances injected into the back.
Experts from Nice said there should be no early surgical intervention or the use of psychological therapy on its own.
All the guidance relates to people suffering from persistent non-specific lower back pain – defined as having had back pain for six weeks or longer but for less than a year.
Professor Martin Underwood, who chaired the committee,
said back pain was the second commonest complaint after the common cold at his surgery.
The guideline provided a "consistent message" on what patients could expect from their GP, he said.
But he admitted that although the recommended treatments were currently in use across the NHS, availability was "variable".
Prof He said the guidance marked a "sea change" in the way back pain was treated on the NHS, but it would take time to implement.
Professor Peter Littlejohns, clinical and public health director of Nice, backed acupuncture in the guidance, saying
the evidence was "sufficiently robust".
Professor Edzard Ernst, of the department of complementary medicine at Peninsula Medical School, said of the guideline: "This is very over-optimistic, as far as chiropractic is concerned.
"The panel included three pro-manipulation experts. They overestimated the benefit and underestimated the risks of chiropractic spinal manipulation, in my view."
Stuart Derbyshire, senior lecturer in psychology at the University of Birmingham, said: "I'd be less inclined to offer manipulations and acupuncture even though clinical trials have been successful. These things are hard to do in a proper fashion.
"But anything that encourages back-pain patients to stay active, not go for scans and stay out of the hands of surgeons is generally a good thing."
Nice estimates it will cost the NHS roughly £77,000 to implement the guideline.
This cost is comparatively low due to the savings made by dropping treatments that have no proven clinical benefit.
Figures from 1998 suggest the healthcare costs of back pain are £1.63 million a year, of which about a third is due to the use of private therapists such as osteopaths. Professor Ann Moore, research lead at the Chartered Society of Physiotherapy, said: "Patient-centred care, supported by evidence-based information, is key to delivering quality services."
