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NICE recommends complementary therapies for back pain

By Nigel Praities

GPs have been urged by NICE to make greater use of complementary therapies such as acupuncture and spinal manipulation for treating back pain.

New guidance from the institute recommends GPs consider a list of conventional or other therapies, such as spinal manipulation or a 12-week course of acupuncture, in patients with persistent low back pain.

The advice - described as ‘puzzling' by some experts – follows a major US study earlier this month showing 60% of patients receiving both sham or real acupuncture had clinically meaningful improvements in their level of functioning.

Professor Martin Underwood, chair of the guideline development group and a GP with special interest in back pain, said the guidance would change the way GPs treat back pain: ‘This guideline heralds a sea-change. I am delighted now I'll be able to offer my patients a choice of therapies for that have been shown to work.'

But Professor Edzard Ernst, professor of complementary medicine at Peninsula Medical School in Exeter, said the guidelines ignored clear evidence of harm – such as stroke or even death – from chiropractic treatment.

‘The guidelines are puzzling. There have been trials that show promising results for chiropractic, but the totality is not as strong as the guidelines seem to imply.'

The guidelines also recommend GPs advise patients to keep physically active and offer regular paracetamol as an initial treatment, followed by NSAIDs or weak opioids.

Dr Louise Warburton, a musculoskeletal GPSI who works in Shropshire, welcomed the guidance but was concerned over use of opiods beyond the acute phase of pain.

‘I would be slightly worried about patients being on opioids long-term. This has to be interpreted with some caution,' she advised.

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