From The Times

May 27, 2009

Millions of patients with chronic back pain should be offered a choice of complementary therapies on the NHS despite conflicting evidence about their effectiveness, the health watchdog says today.

The National Institute for Health and Clinical Excellence (NICE) recommends that people with lower back pain should be prescribed a course of acupuncture, exercise classes or some form of manual therapy or massage if their symptoms persist for six weeks or more.

It is the first time that the institute has officially recommended complementary therapies for use on the NHS in England and Wales.

Experts criticised the guidance and said that evidence showed the therapies were no more effective than a “theatrical placebo”. In studies patients have reported that their back pain diminished when they had a “dummy” form of acupuncture carried out with toothpicks on their skin.

Peter Littlejohns, the institute’s clinical and public health director, said that the beneficial effect of the therapies was “sufficiently robust” to recommend them over less cost-effective procedures such as X-rays or injections into the spine. “As with many interventions the underlying process of how acupuncture works is still not completely clear, but I think the evidence still shows that on balance patients do better,” he said.

More than 2.5 million people consult their GPs about back pain and related disability each year and the NHS spends more than £1.6 billion treating the condition. Of this, roughly a third is related to the use of private therapists such as osteopaths.

NICE said that implementation of the guidance will cost the NHS only £77,000 a year, in part owing to savings that could be made by dropping tests and treatments that have no proven clinical benefit.

Backache is the cause of one in six days off work and about one in three Britons will suffer from it during their lifetime. The guidance relates to people suffering from persistent non-specific lower back pain — defined as having symptoms for at least six weeks but less than a year. Where suitable, patients should be eligible for up to 12 weeks of tailored exercise, nine sessions of spinal manipulation or ten sessions of acupuncture. X-rays, ultrasounds and MRI scans should not be used to investigate causes of back pain except in certain circumstances, the guidance states.

It also recommends ending the use of electrical machines such as TENS units to relieve back pain and the use of therapeutic substances injected into the back.

Martin Underwood, a GP in Coventry and chairman of the committee that drew up the NICE guidance, said that the advice marked a “sea change” in the way that back pain was managed by the NHS but admitted that access to complementary therapies was “patchy”.

Steve Field, chairman of the Royal College of GPs, said that there was a shortage of qualified physiotherapists who could offer prompt treatment. “GPs see patients with backache every day of the week, many of whom would benefit and avoid long-term pain if treated quickly enough. It’s nice to be able to offer patients an alternative to strong painkillers.”