Chronic low back pain is an issue that many (if not most of us) will face in our lives - professionally and/or personally.
Several organizations around the world have established guidelines for treatment related to pain, and today we’ll look at an evidence based set of guidelines called the National Institute for Health and Care Excellence (NICE)guideline for low back pain.
Today's Paper (The Guideline)
Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59] Published date: November 2016.
NICE is an independent public body in England that provides evidence-based recommendations for their national health care service. Internationally it's one of the more respected set of evidence based guidelines, and their current version is being updated.
The most current version (2016) contains some evidence based recommendations that can support your practice.
We’ve included a simplified version below:
Stratify assessment and care based on presentation (for example usingSTarT back tool)
Imaging is not generally recommended - because it can often do more harm than good.
Provide patients with information on the nature of low back pain and sciatica. Ideally it should be non-threatening (non-iatrogenic) and provide positive expectations.
Encourage people to continue with normal activities and not to withdraw unnecessarily
Promote and facilitate return to work or normal activities of daily living if they aren’t
Rest more than a few days is not recommended
Consider exercise management, and some manual therapy
Don’t offer orthotics, belts or related equipment
Don’t offer traction, acupuncture, needling, PENS, TENS, ultrasound or interferential
Don’t offer opioids, antidepressants or anti-convulsants
Consider NSAIDs - but only in conjunction with exercise, activity and physical management.
Don’t offer injections, spinal surgery (including fusion or disc replacement) or ablations
Consider decompression only if other management strategies have failed.
Low back pain treatment has traditionally been dominated by physicians, specialists, physiotherapists and chiropractors. But, as can be seen in clinical practice and research, the pendulum continues to swing away from medications, surgery, modalities (and even manual therapy) and towards activity, exercise and movement.
Occupational Therapist (like you) have great skills to provide patient relevant treatment that includes to maintain or increase engagement in meaningful activity - all strongly supported by evidence and clinical guidelines.
Is the time is ripe for OTs to “reclaim” our place in low back pain treatment?