The National Institute for Health and Care Excellence (NICE) has published its updated guidelines on low back pain and sciatica.

NICE guidelines make recommendations on a wide range of topics, including preventing and managing specific conditions, to promote integrated care where appropriate.

We’re pleased to report that the updated guidelines still recommend manual therapies and make a specific mention to :

‘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’ (1.2.7. NG59).

In addition, mind-body approaches also form part of the recommendations:

‘Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.’

Sadly, however, acupuncture is no longer recommended in the guidelines, despite objections from a number of registered stakeholders, including the FHT, who highlighted during the consultation period that:

• a number of data errors were present in the draft guidelines and appendices in relation to the acupuncture studies included in the review;
• a large and potentially significant acupuncture study was not included in the review;
• sham acupuncture is not a ‘best comparator’ to prove whether acupuncture has treatment-specific effects, as sham acupuncture can produce similar physiological and therapeutic outcomes as acupuncture;
• it is disappointing that NICE stated in the draft guideline that ‘cost-effectiveness was not considered relevant’ as ‘there was insufficient evidence of an overall treatment-specific effect to support a recommendation for acupuncture’.

For more information and to view the guidelines visit https://www.nice.org.uk/guidance/NG59