NICE drops acupuncture from back pain guidelines

By Selina McKee

Cost regulators for the NHS in England and Wales are planning to significantly reduce the treatment options for patients with lower back pain and sciatica, dropping acupuncture from the list and pushing back paracetamol to the second-line setting.

In draft guidelines, the National Institute for Heath and Care Excellence is recommending that, in the first instance, patients with lower back pain with or without sciatica are sent into exercise programmes or treated with non steroidal anti-inflammatories (NSAIDs). 

 

If first-line strategies are ineffective or not tolerated, patients can be prescribed a weak opioid such as codeine, with or without paracetamol.

However, the Institute is no longer advocating the use of acupuncture, “because there is not enough evidence to show that it is more effective than sham treatment,” according to Mark Baker, clinical practice director for NICE. Under previous guidelines, doctors were able to prescribe 10 sessions of acupuncture to patients.

 

Also crossed off the list are electrotherapies, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, anticonvulsants, and spinal injections, and NICE is now advising that massage and manipulation should only be offered to patients alongside exercise.

 

"Our aim with this draft guideline is to give clarity and set out the most clinical and cost effective ways to treat low back pain and sciatica based on the best available evidence,” said Professor Baker, explaining the move.

 

In the UK it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in women, with a total cost to the economy estimated to be over £12 billion per year.

http://www.pharmatimes.com/Article/16-03-29/NICE_drops_acupuncture_from_back_pain_guidelines.aspx

Exercise not acupuncture for people with low back pain says NICE in draft guidance

NICE is updating its 2009 guidance on the early management of low back pain and has today published draft recommendations for public consultation.

The draft guideline recommends exercise, in all its forms (for example, stretching, strengthening, aerobic or yoga), as the first step in managing low back pain.

Massage and manipulation by a physiotherapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone.

The draft guideline also recommends encouraging people to continue with normal activities as far as possible.

The draft guideline no longer recommends acupuncture for treating low back pain because evidence shows it is not better than sham treatment ⁱ. Paracetamol on its own is no longer the first option for managing low back pain. Instead, the draft guideline recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Weak opioids, such as codeine, are now only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable.

Combined physical and psychological treatments (talking therapies) are recommended for people who have not seen an improvement in their pain on previous treatments or who have significant psychological and social barriers to recovery.

The updated draft guideline has been expanded to include people with sciatica, a painful condition typically caused by irritation or compression of the nerves which run from the lower back, through the legs and down to the feet.

Unlike the previous guideline, which only covered the management of low back pain that had lasted between 6 weeks and 12 months, the updated guideline covers people with low back pain or sciatica irrespective of how long they have had the condition

Professor Mark Baker, clinical practice director for NICE, said: “Millions of people are affected every year by these often debilitating and distressing conditions. For most their symptoms improve in days or weeks. However for some, the pain can be distressing and persist for a long time.

“Regrettably there is a lack of convincing evidence of effectiveness for some widely used treatments. For example acupuncture is no longer recommended for managing low back pain with or without sciatica. This is because there is not enough evidence to show that it is more effective than sham treatment.”

Professor Baker continued: “It is possible to reduce the impact that low back pain and sciatica can have on people’s lives. The draft guideline continues to recommend a stepped care approach and means people whose pain or function are not improving despite initial treatment should have access to a choice of further therapies.

“Our aim with this draft guideline is to give clarity and set out the most clinical and cost effective ways to treat low back pain and sciatica based on the best available evidence. We now want to hear from all those who provide care for people with these conditions in the NHS, as well as from people with the conditions and their carers, to ensure all relevant views are considered for the final guideline.”

According to musculoskeletal physician and GP Dr Ian Bernstein*, who is on the group developing the guideline: “The diagnosis of back pain includes a variety of patterns of symptoms. This means that one approach to treatment doesn’t fit all. Therefore the draft guidance promotes combinations of treatments such as exercise with manual therapy or combining physical and psychological treatments. The draft guideline also promotes flexibility about the content and duration of treatments, and the choices made should take into account people’s preferences as well as clinical considerations.” 

A recent studyⁱⁱ found that lower back pain caused more disability than any other condition, affecting 1 in 10 people and becoming more common with increasing age. 

In the UK it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in womenⁱⁱⁱ and the total cost of low back pain to the UK economy is reckoned to be over £12 billion per year^iv.

Sciatica is also a relatively common condition, with estimates suggesting that as many as 40% of people will experience it at some point in their lives.

 

https://www.nice.org.uk/news/press-and-media/exercise-not-acupuncture-for-people-with-low-back-pain-says-nice-in-draft-guidance

The Differences Between Chiropractors And Osteopaths

By Anthony Holton

When the philosophies are your point of comparison, the differences between these two health practices are subtle. It only becomes obvious if you take a deeper look into their scope of practice and educational requirements. Both actually subscribe to the whole body concept of treatment. Osteopaths believe that lack of blood flow will lead to disease while chiropractors believe that nerve interference can result to diseases.
Osteopathy
This was founded in 1860s by a medical doctor and surgeon who served various military bases. In 1864, his 3 children died because of spinal meningitis so he began studying the relationship between the musculoskeletal system and disease.

It is further emphasized that this form of medical care has been founded on the philosophy that all body systems depend on one another to achieve good health. When it comes to the scope of practice of osteopathic physicians, they can already prescribe medicine and perform surgery whenever necessary. They strongly believe in the philosophy of treating the whole person as one rather than treating just the symptoms. Today, the number of professionals performing manipulation has decreased as more and more of them are required to train in hospitals in different disciplines. The good side though of this is that they can specialize in various types of medical practice.
Chiropractic Care
This was founded in 1895. A chiropractor is dedicated to paying careful attention to the function, biomechanics, and structure of the spine. They also take into account the spine's effects on the musculoskeletal and neurological systems. These professionals strongly believe that the body will heal itself when the function and structure are corrected.
As for their scope of practice, they limit to treating low back pain, headaches, joint problems, sciatica, and other related issues. Apart from that, they can also treat spinal disc conditions, osteoarthritis, carpal tunnel syndrome, and other ligament and tendon issues like strains and sprains. Be reminded that they don't administer medications but recommend herbal remedies and vitamins. Moreover, they don't perform invasive treatments. Rather, they employ physical therapy, spinal manipulation, and nutrition.

If you are deciding on which health provider is best for you, there are several things to consider. These include the nature and severity of your health condition, and your personal preference. Bear in mind that problems associated with the spine may be best treated by a chiropractor. On the other hand, illnesses like bacterial and viral infections and systemic diseases requiring medications and aggressive treatments are best treated by an osteopath.

http://ezinearticles.com/?The-Differences-Between-Chiropractors-And-Osteopaths&id=9336837

Self diagnosis explains that pain in the butt ... for me, not my wife

By Dick Sparrer

Oh, boy, am I ever suffering.

But at least I know why. You see, I've self-diagnosed my problem as an irritation of the sciatic nerve.

All right, I know what you're thinking--he who doctors himself has a fool for a doctor. But I came up with my diagnosis by using a very scientific approach: I looked up my symptoms in an old "Kaiser Permanente Healthwise Handbook: A Self-Care Guide For You and Your Family."

Still, knowing my problem doesn't keep it from hurting. It's painful, and I'm suffering. So I figure, as long as I'm suffering, everyone around me should be suffering, too, right?

To that end, when I arrived home the other night, I started to groan a little bit, just to see if I could evoke a little sympathy from my wife.

"Oooohhh," I murmured softly, but loud enough for my wife to hear.

Nothing.

"OOOOhhhh," I moaned just a little louder.
Still nothing.
Then, "OOOOOHHHH," I wailed with all the volume of an expectant mother in the throes of delivery.
"OK, I heard you the first time," she said, making no attempt at all to hide her disgust. "If you're in that much pain, why don't you just call the doctor?"
"I don't have to," I said, happy that she was finally showing some interest in my suffering, albeit casual interest at best. "I know what it is."
"So now you're a doctor all of a sudden?" she snapped. "How do you know what's wrong?"
"Because I looked it up," I said with a certain pride in my diagnosis. "It's sciatica all right. Listen to this."
And I went on to read from the handbook: "Sciatica is an irritation of the sciatic nerve, which runs from the lower back down through the buttocks and to the feet. It can result when an injured disc presses against the nerve. Its main symptom is radiating pain, numbness, or weakness that be worse in the leg than in the back."
I looked up for some sign of approval. Nothing.
"Don't you see?" I said. "That explains why I have this terrible pain in the butt."
"Well, then what's the explanation for the terrible pain in my butt?" she asked.
"Very funny," I whined. "I don't know why you can't be more sympathetic."
"Because you're so pathetic!" she exclaimed. "You complain constantly. You moan and groan, you wiggle and squirm. You slather on so much Ben Gay every night that the neighbors are starting to complain about the fumes. And still you won't call the doctor!"
"I don't have to," I muttered. "I know what it is."

"Oh, that's right, I forgot ... you looked it up in your book!" she cried. "You know, that book's really, really old. We don't even belong to Kaiser anymore."
"So you mean I should have looked it up on the Internet instead?" I asked.
"You're incredible," she said (and I don't think she meant that in a good way). "Maybe, just maybe, if you called the doctor, he could give you something for the pain, it would start feeling better and you'd stop bugging me so much!"
"Hmmm, I hadn't thought about that," I admitted.
"Men!" she said, trying to describe my pitiful display in just a single word. "Men are such babies. Now leave me alone for a while, you've given me a headache."
"Wait!" I exclaimed. "I think I can help. "Hay fever ... head lice ... headaches. Here it is, page 125 ... "
"Oh, please!"
OK, so maybe it isn't a how-to guide to open heart surgery. But my "Healthwise Handbook" is pretty handy nonetheless. After all, it did help me diagnose my sciatica.
Now as for curing my problem, where the heck is Dr. Oba's phone number?

http://www.mercurynews.com/ci_29617940/los-gatos-saratoga-self-diagnosis-explains-that-pain

 

The Differences Between Chiropractors And Osteopaths

By Anthony Holton

When the philosophies are your point of comparison, the differences between these two health practices are subtle. It only becomes obvious if you take a deeper look into their scope of practice and educational requirements. Both actually subscribe to the whole body concept of treatment. Osteopaths believe that lack of blood flow will lead to disease while chiropractors believe that nerve interference can result to diseases.
Osteopathy
This was founded in 1860s by a medical doctor and surgeon who served various military bases. In 1864, his 3 children died because of spinal meningitis so he began studying the relationship between the musculoskeletal system and disease.

It is further emphasized that this form of medical care has been founded on the philosophy that all body systems depend on one another to achieve good health. When it comes to the scope of practice of osteopathic physicians, they can already prescribe medicine and perform surgery whenever necessary. They strongly believe in the philosophy of treating the whole person as one rather than treating just the symptoms. Today, the number of professionals performing manipulation has decreased as more and more of them are required to train in hospitals in different disciplines. The good side though of this is that they can specialize in various types of medical practice.
Chiropractic Care
This was founded in 1895. A chiropractor is dedicated to paying careful attention to the function, biomechanics, and structure of the spine. They also take into account the spine's effects on the musculoskeletal and neurological systems. These professionals strongly believe that the body will heal itself when the function and structure are corrected.
As for their scope of practice, they limit to treating low back pain, headaches, joint problems, sciatica, and other related issues. Apart from that, they can also treat spinal disc conditions, osteoarthritis, carpal tunnel syndrome, and other ligament and tendon issues like strains and sprains. Be reminded that they don't administer medications but recommend herbal remedies and vitamins. Moreover, they don't perform invasive treatments. Rather, they employ physical therapy, spinal manipulation, and nutrition.

If you are deciding on which health provider is best for you, there are several things to consider. These include the nature and severity of your health condition, and your personal preference. Bear in mind that problems associated with the spine may be best treated by a chiropractor. On the other hand, illnesses like bacterial and viral infections and systemic diseases requiring medications and aggressive treatments are best treated by an osteopath.

http://ezinearticles.com/?The-Differences-Between-Chiropractors-And-Osteopaths&id=9336837

Sciatica nerve pain prevention and exercises for pain relief

By Devon Andre

Sciatica nerve pain, or sciatica leg pain, occurs when a person experiences feelings of numbness or tingling, which begins in the lower back region through the buttocks and runs down the leg – the sciatic nerve.
Sciatica nerve pain is a symptom related to an underlying condition that affects the sciatica nerve. Conditions that can lead to sciatica nerve pain are a lumbar herniated disc, degenerative disc disease, and spinal stenosis.
Fortunately, physical therapy and exercises can help relive sciatica nerve pain and improve the condition by increasing strength through stretching and aerobic techniques.

Sciatica nerve pain stretches

Sciatica nerve pain stretches aim to target the muscles that lead to pain. These muscles are often tight and inflexible, so stretching can loosen the tightness and minimize pain.
Stretching the hamstring is best when dealing with sciatica nerve pain as the sciatic nerve runs through the hamstring – this is the area behind the quadriceps, underneath your buttocks.
Here are some examples of sciatica nerve pain stretches:
Towel hamstring stretch: Lay on your back with a towel wrapped around your thigh. With your leg up in the air and your hands grasping the towel, begin to straighten the knee until a stretch is felt at the back of the thigh. Hold the position for 10 seconds and gradually begin to increase the duration of the hold over time.
Wall hamstring stretch: Once again, lay on the floor with your buttocks up against a wall. With one leg stretched out in front and the other up against the wall, push the knee straight until a stretch is felt.
Hamstring stretch while sitting: Sit at the edge of a chair and have one leg straight out in front of you with your heel on the floor, toes pointing upward. Sit up straight while pushing your navel towards your thigh without actually leaning over. Hold the stretch for 30 seconds and repeat three times for each leg.

Sciatica exercises

Exercising for sciatica nerve pain has been found to be more effective than simply staying in bed. Strengthening and low aerobic exercises should be your go-to, as they offer the most relief from sciatica nerve pain.
Strengthening exercises should work to strengthen the spinal column and the supporting muscles, tendons, and ligaments. This includes targeting the lower back, abdomen, glutes, and hip muscles.
Low aerobic exercises consist of walking, swimming, and pool therapies. They aim to increase fluid and nutrient exchange in order to promote a healthy environment for healing. Furthermore, low aerobic exercises work as a natural painkiller, as exercise has been shown to help alleviate pain by increasing endorphins in the body.
Speak to your physical therapist or trainer with regards to appropriate exercises to help strengthen your muscles in order to reduce sciatica nerve pain.

Other tips to relieve sciatica nerve pain

 Along with stretches and exercises, there are other home remedies you can utilize in order to alleviate sciatica nerve pain. Other tips to improve sciatica nerve pain include:

• Take over-the-counter anti-inflammatory medications
• Apply hot and cold packs
• Wear a supporting lower back brace
• Get proper sleep
• Try yoga
• Quit smoking – smokers have higher incidences of back pain
• Maintain a healthy weight
• Practice maintaining proper posture
• Ensure you lift and carry objects properly
• If you are on a long driving trip or flight, ensure you take plenty of moments to move around as much as possible, i.e., make stops, get up from your seat

By practicing these tips as well, you can help improve sciatica nerve pain and prevent future injury.

http://www.belmarrahealth.com/sciatica-nerve-pain-prevention-and-exercises-for-pain-relief/

Yoga for sciatica and low back pain relief

By Johanna Steinfeld

Sciatica and pain in our low backs is almost an epidemic in our society.
For the most part we have lost the connection of walking in balance and our backs bear the brunt of our anatomical misalignments. Add to this held tensions and stress, and our poor bodies are overwhelmed with how to properly support us.
Yoga practice guides our awareness more deeply through our body and through the koshas/layers of the body. We move through the physical layer to the energetic layer to the intellectual layer to the subtle layer. It is this pathway in that teaches you how to listen and connect more deeply with what’s happening inside your body.
By practising the following series, you will discover weaknesses through places of discomfort. With practice and over time, you will learn how to strengthen and engage the muscles that support your hips, back, knees and ankles. If these movements are very uncomfortable for you, don’t despair. That means the poses are working and continue to practise them. It takes commitment to practice and patience of time for things to change.
Whether you are just beginning your yoga practice or have been practising for a long time, Supta Padagusthasana is a series of postures we consistently practise. ‘Supta’ means lying down, ‘pada’ is your foot and ‘gusthas’ big toe. This pose is translated as lying-down-hand-to-big-toe pose. Eventually, once things have opened, you will be able to wrap your index and middle fingers around your big toe as you stretch your leg straight overhead. In the meantime, we practise these postures with the assistance of a strap, or you can use a men’s tie as I am doing here.

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The benefit to this series of poses is that since you are lying on your back, your back is safely supported by the floor. The correct actions in this pose help create traction in the lower back while the stretch of the legs will help to balance tension and any distortions on the two sides of your back.
Try these poses anytime during your day and commit to practicing this series everyday for one week. You will notice a difference in how you feel and everyday will be a little more.
Follow along with this months video for a mini yoga practice with guided instruction
Remember that practising Yoga under the watchful eye of a skilled teacher is the best way to refine and build your practice.

Supta Padagusthasana
Begin lying on your back. Check in with your breath and your body. If your back feels tight here, keep your extended leg bent, foot on the floor, while you do these stretches.
If you find your head arching back so your chin is higher than your forehead, place a folded blanket under your head, and draw your chin down to lengthen the back of your neck.

Supta padagusthasana A
Hug your right knee into your chest and extend your left leg long on the floor. Breathe here and give your body permission to relax and lengthen.
Place the strap over the sole of your right foot and work the strap up to the balls of your foot.
Press your foot into the strap and straighten your leg.
Relax your shoulders and your face. Breathe normally.
Bring your attention to extending your right leg up and your left leg strongly along the floor and away from you. Stabilize yourself by engaging your abdominals all around.
Notice if your right hip is hiking up and draw your right hip away from your head.
Work the actions of the pose and stay here for 10 breaths.

Supta padagusthasana B
Place both ends of your strap into your right hand. Place your left hand on your left thigh as a reminder to keep your left thigh and hip grounded to the floor for stability. Extend your right leg strongly and as you exhale, open the right leg out to the right side. Move slowly so you can feel how you engage the muscles in your legs and how you use your abdominal muscles to help stabilize the pose.
Once you have reached the full expression of the pose, extend both legs strongly by pressing out through your heels.
Breathe here for five full breaths. Engage your abdominal muscles to help you bring your leg back upright.

Supta padagusthasana C
Place both ends of the strap into your left hand. Open your right arm out to the side at shoulder height.
Inhale and extend your leg strongly up. As you exhale, slowly lower your leg out to the left side. Draw your right hip down toward the end of your mat and turn your head to the right. Press out through both heels to energize the pose.
Breathe here for five full breaths. Engage your abdominal muscles to help you bring your leg back upright.
Rest in savasana for a few breaths before you switch legs and repeat the above sequence on the left side.
The following two poses are designed to open your hips and help invite in relaxation and ease of breath.

Sucirandrasana/Thread the Needle Pose
Bend your knees and place your feet on the floor. Hug your right knee into your chest then cross your right ankle over your left knee. Flex your right foot strongly. If you are feeling an opening through your right hip, stay here. If you can move more deeply, bring your left thigh into your chest and interlace your fingers behind your left thigh.
Keep your breath, face and shoulders relaxed.
Stay here for five — 10 breaths
Release and switch sides.

Supta Baddha Konasana
Release your knees out to the sides and bring the soles of your feet together. You can place some rolled up blankets or blocks under your knees to support your inner thighs and encourage relaxation. Rest your hands on your belly and close your eyes.
Rest here for as long as you feel comfortable. Keep your awareness on your breath and relax the muscles of your face and your shoulders.
Stretch your legs out and rest in savasana for 5 — 10 minutes.

Enjoy your practice
Namaste and Happy Yoga

http://calgaryherald.com/health/diet-fitness/yoga-for-sciatica-and-low-back-pain-relief