Acupuncture is no longer recommended as a treatment for low back pain on the NHS, according to new draft guidelines released today by the National Institute for Health and Care Excellence (Nice).

The u-turn comes after a review of scientific evidence found that the practice was no better than a placebo in treating those living with low back pain and sciatica.

The draft guidelines report that there have now been a large number of scientific trials looking into the effectiveness of acupuncture but that, “there was still not compelling and consistent evidence of a treatment-specific effect for acupuncture.”

Low back pain is thought affect one in 10 people, while its cost to the UK economy is estimated to exceed £12 billion a year in lost productivity.

Nice guidelines from 2009 on the early management of low back pain recommended that healthcare providers “consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.”

But the new draft guidelines, now covering sciatica as well as low back pain, contain an unequivocal volte-face, stating: “Do not offer acupuncture for managing non-specific low back pain with or without sciatica.”

Professor Mark Baker, clinical practice director for Nice, said: “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.”

Edzard Ernst, emeritus professor of complementary medicine at the Peninsula School of Medicine, University of Exeter, welcomed the new guidelines. “The previous Nice guidelines for low back pain were seriously out of touch with the reliable evidence. What is worse, they were used by alternative therapists to justify unproven practice,” he said. “ It is good to see that Nice have now caught up with the evidence. Neither spinal manipulation nor acupuncture are supported by good science when it comes to treating low back pain.”

After examining a large number of studies, including 30 randomised control trials that looked at the use of acupuncture without any other treatment, the authors of the draft guidelines concluded that although acupuncture could appear to be effective, the evidence overall demonstrated that it was no better than a placebo. “Although comparison of acupuncture with usual care demonstrated improvements in pain, function and quality of life in the short term, comparison with sham acupuncture showed no consistent clinically important effect.”

They also emphasise the use of tailored exercise for treating low back pain and sciatica, adding that psychological therapies and massage should only be used alongside exercise.



The draft guidelines also reveal that paracetamol is no longer recommended as “the first medical option” and should not be used on its own. Instead, they advise that non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen should be considered. Codeine and other weak opioids are only recommend in acute cases and only if other anti-inflammatories cannot be taken or if they are not found to help. Electrotherapies such as ultrasound remain on the list of procedures to be avoided.

“I have to be disappointed because I think acupuncture is a useful technique that we should be using as much as possible,” said Dr Mike Cummings, medical director of the British Medical Acupuncture Society. “It’s unfortunate that the methods used on this occasion have led to a negative recommendation.” He believes there are problems with the way the studies were assessed. “It is partly to do with the decision to put the biggest emphasis on the difference over sham,” he said. “That is a problem for all physical therapies because physical therapy shams tend to be active - because you have to touch patients.”

Open for consultation until 5 May, the final version of the guidelines is expected to be published in September.