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Exercise better for back pain than acupuncture say experts

NICE says acupuncture is no better than ‘sham’ treatment

Adrian O'Dowd

Thursday, 24 March 2016

People with low back pain should take part in exercise in all its forms as the first step to managing their problem, according to NICE draft guidance published today.

The draft guidance is an update to NICE’s 2009 guidance on the early management of low back pain and its recommendations are open for public consultation.

In the UK, it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in women and the total cost of low back pain to the UK economy is reckoned to be over £12 billion per year while treating all types of back pain costs the NHS more than £1bn per year.

The draft guideline recommends exercise, such as stretching, strengthening, aerobic or yoga and says that 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.

It no longer recommends acupuncture for treating low back pain because evidence shows it is no better than “sham treatment”, says NICE. People with this pain should also be encouraged to continue with normal activities as far as possible.

Paracetamol on its own is no longer the first option for managing low back pain, and instead, the draft 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 have failed to work or are not suitable.

Within the guidance, NICE recommends combined physical and psychological treatments (talking therapies) for people who have not seen an improvement in their pain on previous treatments or who have significant psychological and social barriers to recovery.

The updated draft guideline has been expanded to include people with sciatica.

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.”

Musculoskeletal physician and GP Dr Ian Bernstein, who is on the group developing the guideline, said: “The diagnosis of back pain includes a variety of patterns of symptoms. This means that one approach to treatment doesn’t fit all.

“Therefore the draft guidance promotes combinations of treatments such as exercise with manual therapy or combining physical and psychological treatments. The draft guideline also promotes flexibility about the content and duration of treatments, and the choices made should take into account people’s preferences as well as clinical considerations.”

The consultation runs until 5 May and final guidance is due to be published in September.

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