Practice Guidelines

Low back pain and sciatica: summary of NICE guidance

BMJ 2017; 356 doi: (Published 06 January 2017) Cite this as: BMJ 2017;356:i6748
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Infographic available

Click here for a visual overview of assessment and management for those with low back pain and/or sciatica.

Low back pain/sciatica and acupuncture: the international bazaar

Bernstein et al provide us a clear summary of the National Institute for Health and Care Excellence (NICE) guidance about low back pain/sciatica, stating in the main box “acupuncture or electrotherapies should not be recommended”.(1) Indeed, NICE guidance specifically recommends acupuncture NOT be used for managing low back pain and sciatica. (

There have been more than 3000 studies for acupuncture and the majority of them were unreliable, inconclusive or generated insufficient evidence to make recommendations. For pain, the effect is weak, and evidence of clinical efficacy (restoring normal function and removing the need for other health care) is lacking. If patients believe in acupuncture, the effectiveness is marginally greater: Expectation Based Medicine is not Evidence Based Medicine.

France is a weird example (an understatement for dissociative disorder): the High Authority for Health (HAS, NICE counterpart) states for acupuncture: “efficacy has not been demonstrated” and “may be prescribed” ( Maybe HAS will wait until November 2018 (Next NICE review) to update its 2000 recommendation as NICE may change its mind or possibly it has no concerns for updating its recommendation yet? (2)

In the USA, according to the American Academy of Family Physicians: “Acupuncture is effective in the management of chronic low back pain.”(3)

In Australia, in a review, endorsed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (4), FSM (Friends of Science in Medicine) recommended that the use of acupuncture be discontinued from all medical practice. FSM have just published a complaint, addressed to the UK Committee of Advertising Practice, the body with responsibility for the regulation of UK-based online advertisements, against the British Acupuncture Council & over 400 UK acupuncture websites for misleading advertising claims.(5)

Recommending acupuncture undermines patient trust, as recommendations should be based on evidence. In a publicly funded system, use of resources should be directed to interventions that work. Other harms are related to inconvenience, and opportunity cost, specifically in delay in diagnosis and in effective treatment.

1 Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ 2017;356:i6748

2 Braillon A, Gignon M, Dubois G. G-I-N must adopt the WHISKY statement. Qual Saf Health Care 2005;14:391.

3 Kligler B, Teets R, Quick M. Acupuncture is effective in the management of chronic low back pain Complementary/Integrative Therapies That Work: A Review of the Evidence. Am Fam Physician 2016 1;94:369-74.

4 Friends of Science in Medicine. Is there any place for acupuncture in 21st century medical practice? 29 July 2016.

5. Marron L. Complaint against British Acupuncture Council & 400+ acupuncture Websites. 22 December 2015.

Competing interests: FSM was formed "to emphasise the importance of having health care in Australia based upon evidence, scientifically sound research and established scientific knowledge. (

11 January 2017
alain braillon
senior consultant
Loretta MARRON Chief Executive Officer, Friends of Science in Medicine (FSM), Australia
University Hospital. 80000 Amiens. France