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Low back pain and sciatica – New Guidelines

The National Institute of Clinical Excellence sets standards for medical assessment and treatment excellence in the UK.  NICE regularly reviews treatments for a wide variety of conditions and provides guidance for all healthcare professionals which should be followed unless otherwise justified. They recently released treatment guidance and a summary for back pain with or without sciatica in people over the age of 16.  The full guidance is available at the link however it is nearly 800 pages long!

Please note this guidance is for mechanical types of back pain with or without sciatica (as opposed to inflammatory rheumatic conditions).  My mini-summary is below.

Treatments given a GREEN LIGHTTreatments given a RED LIGHT
(this means that these are highly evidenced approaches and healthcare providers should be using them within our abilities and training)(this means we have to justify more heavily doing these things and ensure that a large group of others use them and have had sound justification and also would agree with our use of these techniques)
Objective assessments of psychosocial risk factors associated with low back painBelts, braces, orthotics, shoes with rocking soles
Exercise prescriptionTraction (manual and presumably inversion)
Certain medications (see your GP, who must also be informed by this guidance)Certain medications (see your GP, who also must be informed by this guidance)
Manual therapy alongside exercise (but not on its own)Acupuncture, ultrasound, TENS machines
Combined support including both manual therapy as well as psychological supports such as CBTSpinal injections, fusions (in some cases), disc replacements
Support in getting back to work and doing daily activitiesDisc replacement
Injection/Surgical interventions for people who aren’t respondingRoutine imaging


What does this mean for your back pain treatment from an osteopath ?

Previous guidelines suggested certain professions for back pain treatment, however NICE recognised that professionals with varying credentials are often qualified to perform approved treatments.  This is reflected in the newest guidance which is focussed exclusively on treatments that help and those that do not.  Within one’s remit of training, clinicians should offer ‘green light’ treatments and should not offer ‘red light’ treatments without justification and peer support.

Osteopathy is a profession which focusses on the whole person in treatment, and so this guidance is welcome news to patients of osteopaths. Assessment of psychosocial risk factors using quick tools like the START BACK tool, tailored exercise, manual therapy, referrals to CBT as well as daily living and return-to-work advice can be offered.

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