I am incredulous and very gravely concerned at the level of
misunderstanding of current models of back care management propounded in
this document. I would be grateful if any of the experts who prepared
could answer my 3 biggest concerns.
(1) I agree with the statement that back pain sufferers should be
encouraged and empowered to 'self-manage' their condition. How is this to
be achieved by recommending that they seek passive, hands-on treatment
such as manual therapy, or even more mystifyingly, acupuncture ?
(2)How can the committee of experts (all of them honourable men, as Mark
Anthony might have said) recommend with a straight face non-evidence-based
treatments like manual therapy, acupuncture and spinal fusion whilst
ignoring the weight of evidence which supports interventional pain
management and CBT as more than valid treatments of first resort ? The
committee's statements about interventional pain management are frankly
ignorant and embarrassing to NICE.
(3) Where is the evidence-based advice to reassure and encourage back pain
sufferers to think of their condition as time-limited and likely to settle
without the need for complicated interventions or passive treatment ?
It seems to me that this guideline has been used as a propaganda vehicle
to allow cherry-picked evidence to be enshrined as doctrine. This is an
abuse of the guideline development process, as we should remember that
medicine is not just evidence-based but science-based as well.
Competing interests:
Specialist in Rehabilitation and Pain Medicine
Rapid Response:
NICE Misguidance
I am incredulous and very gravely concerned at the level of
misunderstanding of current models of back care management propounded in
this document. I would be grateful if any of the experts who prepared
could answer my 3 biggest concerns.
(1) I agree with the statement that back pain sufferers should be
encouraged and empowered to 'self-manage' their condition. How is this to
be achieved by recommending that they seek passive, hands-on treatment
such as manual therapy, or even more mystifyingly, acupuncture ?
(2)How can the committee of experts (all of them honourable men, as Mark
Anthony might have said) recommend with a straight face non-evidence-based
treatments like manual therapy, acupuncture and spinal fusion whilst
ignoring the weight of evidence which supports interventional pain
management and CBT as more than valid treatments of first resort ? The
committee's statements about interventional pain management are frankly
ignorant and embarrassing to NICE.
(3) Where is the evidence-based advice to reassure and encourage back pain
sufferers to think of their condition as time-limited and likely to settle
without the need for complicated interventions or passive treatment ?
It seems to me that this guideline has been used as a propaganda vehicle
to allow cherry-picked evidence to be enshrined as doctrine. This is an
abuse of the guideline development process, as we should remember that
medicine is not just evidence-based but science-based as well.
Competing interests:
Specialist in Rehabilitation and Pain Medicine
Competing interests: No competing interests