Nice focus: low back pain

by Gary Shield

13 October 2020

Back pain causes more disability than any other condition across the globe. New guidance from the National Institute for Health and Care Excellence should support the delivery of patient benefits and savings.

NICE guidance pWhat’s the guidance?

NG59: Low back pain and sciatica in over 16s: assessment and management. Published in September 2020.

Does it replace earlier guidance?

Yes, this update replaces the previous guidance published in 2016

What does it cover?

This guideline covers assessing and managing low back pain and sciatica in people aged 16 and over. It outlines physical, psychological, pharmacological and surgical treatments to help people manage their low back pain and sciatica in their daily life. The guideline aims to improve people’s quality of life by promoting the most effective forms of care for low back pain and sciatica.

The guideline includes new and updated recommendations on: pharmacological management of sciatica. In particular it updates guidance around the use of non-steroidal anti-inflammatory drugs (NSAIDS), including taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity and using the lowest effective dose for the shortest possible period of time. It also underlines that opioids should not be offered for managing chronic sciatica.

These supplement the existing recommendations on:

Who is it for?
  • Healthcare professionals
  • Commissioners and providers of healthcare
  • People with low back pain or sciatica, and their families and carers
Who is affected by the condition?

Worldwide, low back pain causes more disability than any other condition. Episodes of back pain usually do not last long, with rapid improvements in pain and disability seen within a few weeks to a few months. Most back pain episodes get better with initial primary care management, without the need for investigations or referral to specialist services. However, up to one-third of people say they have persistent back pain of at least moderate intensity a year after an acute episode needing care, and episodes of back pain often recur.

What are the benefits for patients?

Implementing the guideline is expected to lead to a reduction in use of gabapentinoids and opioids for people with severe sciatica. Long term use of gabapentinoids and opioids can lead to dependency. Reduced use of these treatments may therefore lead to reduced cases of dependency. Public Health England reviewed the use of these treatments and the difficulties of dependency and withdrawal in 2019.

What are the financial implications?

The estimated net financial impact of implementing this guideline for the population of England in the next five years is a saving of around £220,000 in 2021/22 rising to a saving of around £1.1m per year from 2025/26. This is equivalent to a saving of around £2,000 per 100,000 population. This takes account of: savings related to reduced drug use and increased costs from higher use of epidurals for people with acute severe sciatica; and savings related to reduced drug use for people with chronic severe sciatica. Further information can be found in the resource impact tools that support the guideline.

Gary Shield is resource impact assessment manager at Nice