THE PROPOSALS

Alternative cure promoted by NHS for the first time The NHS last week unveiled new guidelines for treating back pain, which included the use of acupuncture and spinal manipulation. This was the first time that the National Institute for Health and Clinical Excellence (Nice), the health service rationing body, had recommended alternative therapies. The guidance says GPs should give patients the choice of a course of 10 acupuncture sessions over 12 weeks as part of their treatment. The advice was based on seven studies that tested acupuncture’s efficacy and compared it with traditional treatments for lower-back pain. Nice concluded that acupuncture was just as effective at curing such pain, at least on a short-term basis, as the methods currently used.

THE PROBLEM

70% of Britons suffer back pain at some time Back pain is the biggest cause of work-related absence in Britain. Lower-back pain is particularly prevalent, affecting 70% of people at some stage in their life, according to NHS statistics. Traditional treatments rely on a combination of exercise and chemical pain relief, but advocates of complementary medicine believe that acupuncture can help release endorphins, which act as natural painkillers. Professor Steve Field, chairman of the Royal College of General Practitioners, welcomed the new guidelines. “I have found osteopathy and chiropracty helpful with some patients, and become more convinced about acupuncture, having previously been sceptical,” he said.

REASON FOR DOUBT

‘Sham’ therapy may work as well as real thing The studies used by Nice were not unequivocal in their results. One found there was no significant difference in pain between patients who had had a full course of acupuncture and those who had had only a minimal one. Another found no difference in effect between “sham” acupuncture – using needles without back stimulation and avoiding traditional acupuncture points – and the real thing. Some critics concluded that the theatre of acupuncture and the associated psychosomatic effects were more important than accurately followed procedures. Others were concerned about the cost implications. Nice calculated that the average cost for a group undergoing acupuncture was 25% more than for those who received traditional care.

DOCTORS’ PROTESTS

Specialists in pain relief say clinical methods work Specialists from the Interventional Pain Medicine Group of the British Pain Society said last week they would write to Nice claiming that the new guidance did not take into account the use of spinal injections, which have been shown to give good relief for chronic back pain. Ron Cooper, former chairman of the group, said: “Nice made it difficult for us to submit evidence to a committee on which there was not one experienced pain physician.” Doctors also wondered if there was an ulterior motive. Raj Munglani, consultant on pain medicine at West Suffolk hospital, said: “There is a lot of concern that this is actually a way of banishing waiting lists for some procedures, because they will no longer be available.”