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NICE’s back pain guidance is a pain in the…



So, on the same day I finally get round to reading the NICE draft guidance on back pain, something ironic happens. No, ha ha, I don’t pop a disc. And a good job too, because if I had, and followed NICE’s advice, I’d have been stumped. Paracetamol is a no-no, apparently – though try telling that to the thousands who self-medicate – and if NSAIDs don’t help, it’s co-codamol, but that’s only for three days, of course, (says so on the box), so after that, you’re on your own, mate.

NICE has to realise that in back pain, our management will be a pragmatic compromise

No, the irony is that I read a survey demonstrating that a third of back pain sufferers feel their GP doesn’t take their problem seriously. As in, (I’m guessing here, but I know I’m right), not seriously enough to arrange an immediate X-ray or scan, and/or not seriously enough to be able to wave a magic wand over their symptoms.

So there we are, neatly between the rock of NICE saying there’s sod all you can do and the hard place of the public wanting us to do more. I’m all for EBM, but NICE has to realise that in something as common as back pain, unless we can educate the punters to stay away completely, our management will be a pragmatic compromise – because it’s not about the appliance of science, necessarily, it’s about keeping patients with bad backs off ours while we let nature do its thing. So it’s all very well NICE trying to justify narrowing our options, but the public wants them widened, at least by the time they’ve negotiated an appointment with us. Under these circumstances, withdrawing a standard painkiller from standard care sure won’t have us scoring any better in ‘How seriously does your GP take you?’ surveys.

Funnily enough, being between that rock and hard place really is playing my back up. I need to take something, so pass me that guidance, will you? Actually, don’t bother.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield