Active Chiropractic

NICE Guidelines for Low Back Pain 22 July 2009

Assessing the low back

The publication of the National Institute for Clinical Excellence (NICE) Guidelines for ‘Early management of persistent non-specific low back pain’ in May 2009 caused something of a stir in medical circles. For the first time, treatments like chiropractic, osteopathy and acupuncture, are included in the recommended approach for tackling low back pain within the National Health Service. I’ve been banging on about the importance of these guidelines to anyone within earshot since they came out.

Who produced these Guidelines?

The NICE Development Group responsible for the Low Back Pain Guidelines was chaired by Professor of Primary Care Research, Martin Underwood, and included various medical doctors, a professor of pain management, a spine surgeon, a physiotherapist, a nurse clinician, a psychologist, patient representatives, an osteopath and a chiropractor.

What are the Guidelines based on?

The Development Group reviewed the available published evidence – randomized controlled trials and other studies that have shown the effectiveness of chiropractic for low back pain. The UK Back Pain Exercise and Manipulation Trial (2004) (‘UK BEAM’ Trial), a large well-organized trial which demonstrated the efficacy and cost-effectiveness of manipulation treatment, was particularly influential.

What is ‘non-specific’ low back pain?

“Non-specific low back pain is tension, soreness and/or stiffness in the lower back region for which it is not possible to identify a specific cause of the pain. Several structures in the back, including the joints, discs and connective tissues, may contribute to the symptoms.” This is precisely the sort of pain that chiropractors spend a lot of their time dealing with.

So what is specific back pain?

Specific causes of low back pain include “malignancy, infection, fracture, ankylosing spondylitis and other inflammatory disorders”. If a chiropractor suspected one of these conditions (and a lot of chiropractic training is about identifying such conditions) he would refer the patient back to their doctor for further investigation.

What do the Guidelines actually say about chiropractic?

Paragraph 1.4.1 of the Guidelines tells doctors that they can “Consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks.” Some chiropractors have commented that this is not enough but I disagree. A lot of people would get a lot of benefit from nine sessions of chiropractic.

Does this mean I can get chiropractic on the NHS?

Hopefully yes – but not yet. How the guidelines are implemented is up to the local commissioners and providers. Quite how chiropractic care will be provided within the NHS in Peterborough is yet to be worked out. It’s worth asking your doctor if chiropractic is available as this will help to remind the professionals involved of the public demand for chiropractic services.

References

The full guideline, with details of the methods and evidence used to develop it, can be viewed at www.nice.org.uk/CG88fullguideline. A quick reference version is viewable at http://guidance.nice.org.uk/CG88/QuickRefGuide/pdf/English.