So as I am sure you have no doubt seen in the media and various social media channels the “new guidelines” on low back pain. The media have hyped this up stating that “millions are receiving the wrong care”. Blah Blah Blah. It is important that everyone understands the viewpoint that this advice is coming from.
Download our ebook " 5 Tips to help beat your back pain" Here
So lets get a few things perfectly clear here from the outset… the National Institute for Health and Care Excellence or NICE for short is a government funded organisation that advises the government on health care best practices, based in part by research for the effectiveness of the treatment but also on COST. So we have a an agency working for the government, funded by the government telling the government how its money is best spent on healthcare…. Am I the only one that sees a huge conflict of interest here?
Some of the recommendations are interesting – for example Acupuncture for back pain is NOT recommended, this is of interest, as in 2009 Acupuncture was included. This decision appears to have been made upon a single study that stated “Sham” (fake) acupuncture was no more effective that actual acupuncture. The major issue with this paper is that the sham needles were still placed over acupuncture points, so there still could have been an effect from this. The body of evidence for acupuncture in low back pain is overwhelmingly positive, although the mechanisms by which it works is up for debate. And just for complete transparency here I do not use acupuncture to treat back pain although I can see the merits of it as a treatment and have seen the positive effects it has for some patients.
Another recommendation is not to seek intervention until you have been experiencing back pain for a minimum of 6 weeks – To me, this is completely ludicrous, I mean 6 weeks, come on. I’m not sure about you, but put up with pain for 6 weeks? Not happening. If your cars warning light came on would you continue to drive it for 6 weeks and hope that the light would turn itself off? Of course not. You would take it to the car dealer and get it sorted. Equally if your iphone or ipad broke would you wait 6 weeks in the hope it would magically start working again? No. So why apply this theory to help with your back health, it makes no sense, no sense at all.
Another “concerning” recommendation is the prescription of opioids and Anti-inflammatory drugs for low back pain – we know from the research that the presence of inflammatory cells in low back pain is exceptionally rare, so it defies logic to think that anti-inflammatory drugs will be of benefit.
So why these recommendations? Well… remember I said earlier that NICE is funded by the government, to advise the government about cost effectiveness? What does removing acupuncture from the recommendations and the prescription of NSAIDs have in common? They are both cost saving. NSAIDS are cheap, like really cheap pence in fact, x6 treatments of acupuncture and physiotherapy however are expensive, in comparison if you are determining cost by purely financial means and not looking at the quality of life and care of your patients.
It leads to the question, why then is it that manual therapy; whether it is administered by a physiotherapist, osteopath or chiropractor, and has been proven to be effective in the treatment of low back pain, that only 7% of all people presenting to their GP with low back pain receive a referral on to see a manual therapist? Furthermore, those lucky 7% then usually face at least a 12 if not 18 week wait to see a therapist and often receive a poor service and only a single session.
It all boils down to two things COST and TIME. Pills are cheap and quick. But they solve literally NOTHING. In fact they routinely cause more problems than they solve, and are in part the reason why so many people go on to develop chronic back pain.
This reminded me of one of our patients Chris – he was in pain with his back – he saw his GP 4 times in the space of six weeks, he was given progressively more and more painkillers – by the time he came to see us he was struggling to stand up straight, was off work and taking 8 – 10 pills per day. He had not been offered anything other than pills from his GP. We listened to Chris and quickly got to work on a management plan, some manual therapy, home exercises and a course on our IDD spinal decompression unit, and within 6 weeks Chris had come off all his meds, returned to work and was feeling much better about life in general. We are continuing to work with Chris to help him understand what he can do to prevent this from happening again.
So who do you trust to give you the best advice on your back pain – an agency that contradicts itself and is funded by the government, who’s main aim seems to be to cut costs and services within the NHS or a therapist who listens to you, incorporates your goals and aligns their care with your expectations to achieve the best possible outcome?