NICE offers new guidelines on low back pain treatment
Back pain is an unavoidable part of a physiotherapist‘s day, be it in the clinic or advice for a friend. But, do most treatment recommendations are up-to-date?
The treatment guidelines are crucial for understanding evidence based recommendations for care provision and treatment. National Institute for Health and Care Excellence has been supplimenting guidance for clinicians since 1999, covering a wide variety of topics. They periodically update the guidance when new evidence is accessible. The guidance is purely is based on systematic reviews and expert panels.
The latest of the guidelines to be updated was for low back pain. Estimation, non-invasive and invasive management has been put under the spotlight. The main highlight of intervention should be around self-management rather than in terms of non-invasive treatment, which is most relevant to physiotherapy. This can be done successfully via education, excercise before anything else. The treatment should not comprise traction, acupuncture, electrotherapy (TENS, PENS or Ultrasound) or manual therapy without excercise. For those with recurrent back pain, CBT or talking therapy can also be included alongwith exercise.
The involvement of a return to work programme should also be a part of treatment programmes focused at complimenting the self help philosophy which should be the centerpiece of management. This is complimentary with the move away from using the terminology of acute, sub-acute and chronic and the adjustment to thinking of low back pain with respct to the risk of poor outcomes.
All in all, the recommendation to move away from passive treatments is a step in the right direction for enabling those with long standing issues. In the future, it will be interesting to see if other guidance follows this message as well.