General Wellbeing - NHS clinical guidelines on early management of non-specific low back pain
As I've mentioned in a previous newsletter, there is a body called the 'National Institute for Clinical Excellence' (NICE) that provides the NHS with various guideline notices in regard how to treat patients with different ailments, diseases, viruses etc. Curiously though, and you'll see the relevance of this statement as we go on, there is no mandatory requirement for NHS trusts to follow these guidelines, unless the Secretary of State for Health intervenes.
What is good news for the complementary therapy industry, which traditionally suffers from lack of modern clinical approval, is that in Clinical Guideline 88 (click here to read it), it states that for *early management of non-specific low back pain 'manual therapy' (including massage, spinal manipulation and mobilisation) is one of the preferred non-invasive treatment methods.
*early in this instance means low back pain which has persisted for 6 weeks or more, but less than 12 months
What surprised me as a therapist, is that this guidance was issued in 2009 and until last month I'd never heard of it. Especially when massage therapy is still not ordinarily available on the NHS (unless you are lucky enough to be referred to a physiotherapist who happens to have done some extra training in this field).
Which begs these 2 questions: 'Why are we, as therapists, not utilised by the NHS?' and secondly, 'Why as an industry are we not using this NICE guideline to promote ourselves'. I think the answer to the first question can be partly answered by my statement in the first paragraph, and the answer to the second question may be because the guideline note is not widely known outside of the NHS.
However, what's important for you to know as patients and clients, is that under the changes being adopted by the NHS at the moment, the NHS will be run by 'GP commissioning groups' and provided a therapist can meet the 'any qualified provider' rules then they can apply for a contract to provide a service to the NHS. Obviously what needs to happen is for GPs to realise there is a real need for different manual therapies to be made available on the NHS...but here's the challenge, only you can make that happen.
Other interesting information from guideline 88:
-Low back pain affects around 1/3rd of the population
-For manual therapy treatment, it recommends a maximum of 9 sessions over 12 weeks
-For Acupuncture (the only recommended 'invasive' procedure) a maximum of 10 sessions over 12 weeks
-It does not recommend sending patients for x-rays of the lumbar spine for non-specific low back pain, rather it suggests an MRI (in the context of a referral for an opinion on spinal fusion)