The National Institute for Health and Care Excellence (NICE) has published updated guidance on low back pain and sciatica, including recommending manipulation and massage with exercise in all its forms such as: stretching, strengthening, aerobics and yoga .
The guidelines also recommend encouraging people to continue with normal activities as far as possible.
Acupuncture for treating low back pain is not recommended, as current research has not shown this to be effective, however massage and manipulation with exercise is recommended.
In regards to medication, 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.
Combined physical treatments (such as Chiropractic) and psychological or 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: “Millions of people are affected every year by these often debilitating and distressing conditions. For most their symptoms improve in days or weeks. However for some, the pain can be distressing and persist for a long time.
Low back pain causes more disability than any other condition, affecting 1 in 10 people and becoming more common with increasing age.
In the UK it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in women and 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% of people will experience it at some point in their lives.
Professor Baker added: “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.”
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