NICE guidelines - Recommended treatment for lower back pain

NICE have published new guidelines(1) discussing  treatment for lower back pain in people who have had back pain for more than one week but less than one year.  This section outlines the advice and recommended treatments from the guidelines.

In this article

Try and self manage the problem

If you have back pain you should be encouraged to manage it yourself and try and continue with normal life.

Keep active and stay as normal as possible

Physiotherapists and doctors should reassure you and advise you to keep active and carry on as normally as possible. 

Education about back pain

You should find as much information as you can about non-specific back pain so you understand what it is. My web site here has a lot of useful information that may help you with this.

Get some simple pain relief so you can stay active

The guidelines suggest that if pain relief is needed, paracetamol is a good option, followed by non-steroidal anti-inflammatory drugs (NSAIDs) or weak opioid drugs (e.g. codeine). These are UK drug names but I'm sure the equivalents are available in other countries.

They also suggest that you could try these one of these treatments for back pain in addition to the advice above

A supervised lower back exercise programme

This should be tailored to you as an individual and can be either in a group or a one-to-one supervised lower back pain exercise programme.

Spinal manipulation or mobilisation

This is a controversial treatment for lower back pain as the evidence for either is pretty weak.  This has caused a lot of heated debate as there are many people who do not think spinal manipulation is that effective. Nonetheless the guidelines suggest trying up to 9 sessions for up to 12 weeks.

Massage for pain relief

I'm not surprised about this one. I have a section on back massage therapy and the evidence shows that it can be helpful.

Acupuncture

The recommendations suggest a course of acupuncture a maximum of 10 sessions over a 12-week period.

What if none of this works?

The guidelines suggest that you combine physical and psychological treatment (100 hours over a maximum of eight weeks is suggested) if you have had at least one of the treatments above and it has not been effective, or if you have significant disability or psychological distress. I have written a section on how unhelpful thoughts and beliefs can affect your back pain. You can read more about the biopsychosocial management of back pain here.

References

1.         NICE Low back pain.<http://guidance.nice.org.uk/CG88>

Lower back pain treatment hub page

Lower Back Pain Toolkit Home Page

September 24, 2012