Management of back pain and sciatica

21st September 2020 by Louise Hudman

Management of back pain and sciatica

This is an updated guideline from NICE on the management of low back pain and sciatica. There is quite a bit that is new in this guideline, but it probably doesn’t really add much to our current management. The biggest change is that they don’t advise the use of paracetamol on its own.

Risk stratify patients

  • Use a tool like the STarT Back tool.
  • Low risk – less intensive support (eg advice on return to activities, reassurance, self-management).
  • Higher risk – more intensive support (eg exercise as below).

Non-Invasive Treatments


They advise a group exercise programme referral. Looking at the full guideline, this is because it is cheaper than individual exercise. There is no evidence that one form of exercise is more effective than another.

Manual therapies

Consider a referral for this alongside exercise, with or without psychological therapy (see below). This includes massage and spinal manipulation. Again the full guideline advises that there is no evidence that massage is effective, but acknowledges that there is a placebo effect. There may be limited clinical benefit from manipulation. Hence the advice not to refer to these on their own.

Psychological therapies

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