New cost-cutting NHS guidelines on back pain 'will lead to more surgery'

By Jenny Hope

Sore point: Back pain suffers could face surgery due to fewer spine injections

Thousands of patients could undergo unnecessary spinal operations because of new NHS guidelines on treatments for lower back pain, warn experts.

Dozens of hospital consultants say the ‘cost- cutting’ restrictions mean more patients will end up having major surgery.

They claim less risky procedures using spinal injections have been wrongly dismissed as ineffective, even though they help hundreds of thousands of patients with chronic back pain each year.

Guidelines issued earlier this week by the National Institute for Health and Clinical Excellence (NICE) set out permitted treatments for patients whose back pain has lasted for at least six weeks but less than a year.

They endorsed widespread use of ‘alternative’ therapy, letting patients opt for a three-month course of acupuncture, manual therapy such as physiotherapy, or exercise.

Described as a ‘sea-change’ for back pain sufferers, the guidelines also told doctors not to recommend therapies with ‘little evidence’ to support them, controversially including injections of small amounts of steroids into the back, MRI scans, X-rays and ultrasound.

Now, many patients who fail to respond to initial treatment could miss out this intermediate stage and proceed straight to risky spinal fusion operations.
NICE estimates the NHS will make annual savings of £33million on back injections and £11million on MRI scans.

However, it will spend £24million extra on acupuncture and £16million extra on manual therapy, making the cost-cutting aspect negligible.

Around 50 specialists belonging to the Interventional Pain Medicine Group of the British Pain Society are writing to NICE, claiming it has dismissed good evidence about spinal injections, which do not cure pack pain but give a period of relief from chronic pain.

Guidelines: Doctors have been told not to recommend treatments like injections of steroids and X-rays 

Dr Ron Cooper, past chairman of the group and a consultant pain specialist in Northern Ireland, said: ‘I have never known so many pain medicine specialists to be so furious. More patients will end up having more expensive surgery, which is unnecessary, risky and has worse results.

‘NICE made it difficult for us to submit evidence to a committee on which there was not one experienced pain physician.

‘The guidelines will make us the laughing stock of Europe, Australia and the U.S. where pain specialists will continue to have full access to a wide range of treatments.’

Dr Raj Munglani, a consultant in pain medicine at West Suffolk Hospital, Bury St Edmunds, said: ‘There could be as many as 400,000 patients (a year) who will be eligible for spinal fusion – when it should be a last resort.

‘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.’

Dr Serge Nikolic, a chronic pain specialist at Bart’s hospital in London, said any savings made from the guidelines would be a false economy if they led to more spinal surgery.

A NICE spokesman said: ‘The guideline sets out... those approaches which either don’t work as well as alternatives, or for which there is little evidence of benefit.

‘The guideline recommends that new research is needed to decide if injections into the back are, or are not, effective.’

New cost-cutting NHS guidelines on back pain 'will lead to more surgery'