Faculty of Pain Medicine and British Pain Society express concern over recently published NICE guidance on ‘Managing low back pain and sciatica’

The Faculty of Pain Medicine (FPM) and British Pain Society (BPS) have very significant concerns regarding the updated guidelines on ‘Managing low back pain and sciatica’ published on 22 September 2020 by the National Institute for Health and Care Excellence (NICE).

For severe and long-term back pain and sciatica, NICE is indicating that no other pharmacological agents beyond anti-inflammatory drugs and/or codeine are to be considered in the management of these patients.

The FPM and BPS’s key points are:

• The NICE guidance has huge potential impact on and negative implications for patients suffering with chronic pain who would derive significant individual benefit from pharmacological treatments. There is the potential for harm to patients by omitting treatments that are valuable in the context in which they are used, namely to enable rehabilitation and an improved quality of life.
• Both FPM and BPS recognise the importance of considerable caution and care with any medications that have tolerance, dependence, withdrawal and abuse potential.  Clear guidance on evaluation of benefit, harm and of a time limited approach to stopping medications that have not achieved significant benefit is a safer, more humane and appropriate response to current concerns rather than a blanket ban on individual assessment.
• The FPM and BPS have concerns regarding the methodology of the guideline, which is deficient when considering complex patients where patient-centred care is paramount.
• The FPM and BPS remind their Fellows and members that NICE guidance is not mandatory. As Professor Mike Baker, Chair of NICE in 2017 stated: NICE is there to support decisions and not dictate them. Indeed, NICE’s terms and conditions specifically state that they are not mandatory.

The FPM and BPS are fully supportive of evidence-based pain management of all conditions and continues to promote the development of high-quality guidance to support patient management. Fellows and members are reminded of the Core Standards for Pain Management Services (CSPMS)– a collaborative multidisciplinary publication providing a robust reference source for the planning and delivery of Pain Management Services in the United Kingdom. 

These are designed to provide a framework for standard setting in the provision of Pain Management Services for Healthcare professionals, commissioners and other stakeholders to optimise the care of our patients.

It is important to note that these guidelines have been issued with a review of NICE guidelines on the management of neuropathic pain which address other neuropathic pains.

The FPM’s full response to the consultation draft of this guideline can be downloaded below and the full set of consultation responses is available here.