NICE updates guidance on low back pain and sciatica

NICE: massage and manipulation should only be used with exercise due to lack of evidence of benefits when used alone.

The National Institute for Health and Care Excellence (NICE) has published updated guidance on low back pain and sciatica, including recommending exercise in all its forms – such as stretching, strengthening, aerobics or yoga – as the first step in managing the condition.

The guidelines also recommend encouraging people to continue with normal activities as far as possible. However, it has emphasised massage and manipulation should only be used with exercise because there is not enough evidence to show they are of benefit when used alone.

Acupuncture for treating low back pain is not recommended, however, because “evidence shows it is not better than sham treatment”, NICE said.

Paracetamol on its own should no longer be the first option for managing low back pain. Instead, 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 not worked or are not suitable, it added.

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.

The updated guidance has been expanded to include people with sciatica, a painful condition typically caused by irritation or compression of the nerves that run from the lower back, through the legs and down to the feet.

Professor Mark Baker, clinical practice director for NICE, said: “Our aim with this guidance is to give clarity, and set out the most clinical, cost-effective ways to treat low back pain and sciatica based on the best available evidence.”

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