Exercise and NSAIDs first in low back pain, says NICE

EXERCISE along with the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be first-line treatments in managing low back pain and sciatica, according to new updated guidance by NICE.

Weak opioids, such as codeine, are only recommended for acute back pain when NSAIDs have not worked or are not suitable. Paracetamol on its own is no longer the first option for managing low back pain. NSAIDs should be used at the "lowest effective dose and for the shortest possible time".

NICE recommends exercise in all its forms - for example stretching, strengthening, aerobics or yoga - as the first step in managing the condition. The guideline also recommends encouraging people to continue with normal activities as far as possible, but massage and manipulation should only be used with exercise because there is not enough evidence to show benefit when used alone.

Acupuncture for treating low back pain is not recommended as there is not enough evidence to show it is any more effective than “sham treatment”.

Combined physical and psychological treatments (talking therapies) are recommended for people who have not seen an improvement in their pain on previous treatments or who have significant psychological and social barriers to recovery.

Low back pain causes more disability than any other condition, affecting 1 in 10 people, and is more common with increasing age. It is estimated that in the UK low back pain is responsible for 37 per cent of all chronic pain in men and 44 per cent in women. The total cost of low back pain to the UK economy is reckoned to be over £12 billion per year.

Sciatica is also a relatively common condition, with estimates suggesting that as many as 40 per cent of people will experience it at some point in their lives.

Professor Mark Baker, clinical practice director for NICE, said: "It is possible to reduce the impact that low back pain and sciatica can have on people’s lives. The guideline continues to recommend a stepped care approach and means people whose pain or function are not improving despite initial treatment should have access to a choice of further therapies.

"Our aim with this guideline is to give clarity and set out the most clinical and cost-effective ways to treat low back pain and sciatica based on the best available evidence."

Link: Low back pain and sciatica in over 16s: assessment and management

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