NICE updates guidance on older workers and back pain

NICE guidance recommends offering training to older employees if their job role changes

The National Institute for Health and Care Excellence (NICE) has updated workplace guidance about the health and wellbeing of older employees and the treatment of back pain.

In its guidance on older employees, or those aged over 50, NICE has made a number of new recommendations, including the need for employers to:

  • Treat employees on an individual basis, avoiding stereotypes, such as the assumption that an older employee may find learning new tasks difficult or a younger employee is less dependable.
  • Offer and encourage older employees to undertake training if their job role changes, or if they may have received education and training some years ago.
  • Help older employees to access health and screening services, such as cervical screening and eye tests, as well as allowing them time off to attend appointments.
  • Address key life stages or events that may affect an older employee, such as offering carer’s leave or flexible working to care for grandchildren or parents.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “The number of older people in employment is set to increase – people are living longer and will be working well into their 60s and 70s. Protecting their health and wellbeing is essential if we are to maintain a healthy and diversified workforce. Our new recommendations will support older employees and help keep them in employment for longer by providing clarity on their needs.”

When it comes to back pain, NICE has updated its 2009 guidance on the early management of low back pain and has published draft recommendations for public consultation.

The draft guidelines recommend that exercise in all its forms (for example, stretching, strengthening, aerobic or yoga) should be the first step in managing low back pain.

Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone, it has argued. People should also be encouraged to continue with normal activities as far as possible.

In a significant change, the draft guidelines no longer recommend acupuncture for treating low back pain.

Paracetamol on its own should no longer be the first option for managing lower back pain. The guidance recommends 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 draft guidance has been expanded to include people with sciatica. And, unlike the previous guidelines, which only covered the management of low back pain that had lasted between six weeks and 12 months, the updated guidance covers people with low back pain or sciatica irrespective of how long they have had the condition.

Professor Mark Baker, clinical practice director for NICE, said: “Regrettably, there is a lack of convincing evidence of effectiveness for some widely used treatments. For example, acupuncture is no longer recommended for managing low back pain with or without sciatica. This is because there is not enough evidence to show that it is more effective than sham treatment.”

The final guideline on this area is due to be published in September.

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