UK no longer recommends Acupuncture for back pain; will Australia be next?
“Our aim with this draft guideline is to give clarity and set out the most clinical and cost effective ways to treat low back pain and sciatica based on the best available evidence,” said Professor Mark Baker, clinical practice director NICE (National Institute for Health and Care Excellence).
If you suffer from back pain, this is what you need to know:
Acupuncture
For many years now, acupuncture has been a recommended treatment for managing non specific low back pain in the UK. GPs in the four countries of the United Kingdom were actively encouraged to recommend it as a treatment for their patients. However, the NHS has done an about-turn in regards to acupuncture. It is no longer deemed a treatment for back pain as comparative studies from NICE (the National Institute for Health Care and Excellence) have shown that it is no more effective than placebos.
It is interesting to note a blog by Brent A. Bauer M.D. on the US based Mayo Clinic website, “in several studies, both sham acupuncture and real acupuncture relieved low back pain better than having no treatment at all.” He agrees that acupuncture is unlikely to have any ‘real’ benefits to the body however perhaps the psychological element is playing a role in reducing pain regardless. Going forward, be wary of someone claiming to be a professional who recommends acupuncture for back pain as evidence based studies determined that it doesn’t work.
A thorough search of Australian Government websites has revealed that neither our federal or state medical bodies have suggested to the public that acupuncture is good treatment for back pain. In fact, the Medical Journal of Australia is very clear that they disassociate from unproven therapies:
“Traction, acupuncture, magnet therapy, injections into trigger points,and hydrotherapy are no more effective than sham treatment, placebo, or being put on a waiting list.”
In Australia, guidance from government instead recommends evidence-based treatment for dealing with back pain including exercise, manual therapy (i.e. physiotherapy and remedial massage), pain relief medication, counselling on strategies for managing pain or even hot and cold compresses for short-term relief.
Exercise and physiotherapy
The NHS guidelines are telling doctors to get their patients exercising as the first step towards recovery. Australia is giving doctors the same advice. Although there was no single cure for back pain, there is clear and convincing evidence that continued movement is essential for improving health results and returning to normal activities.
No single form of exercise is suggested as better than any other. Walking, yoga, stretches and aerobic movement are all fine. This particular guideline is about keeping people active (despite the back pain) and helping them to stay active in their usual daily activities as much as possible to prevent deterioration.
The UK guidelines are now align with Australian guidelines. They say nothing to detract from the manual manipulations performed by qualified massage therapists and physiotherapists, however, their treatment is only recommended in conjunction with exercise. Manual manipulations on their own are not enough to stop back pain.
Pain Relief Medication
The UK has also changed their recommendations in regards to over the counter drugs commonly used to treat back pain.
Traditionally, paracetamol is used to counteract pain but this medicine is best used to relieve pain associated with temperature and fever. On the other hand, the drug ibuprofen (commonly sold under the brand name Nurofen) reduces pain and underlying inflammation. There have studies in the past year or so that found low back pain may often be caused by inflammation of herniated discs where ibuprofen can work more effectively. In the UK, they have also taken steps so that codeine (a low level opioid) can only be administered in severe cases.
The laws in Australia are on a slightly different page when it comes to pain relief medication. Paracetamol is still recommended for low pain, ibuprofen for moderate pain and codeine and prescription medication for severe pain, however the administration of higher level drugs may be restricted. See HealthDirect for more information.
