Low back pain and sciatica: summary of NICE guidance

Bernstein, Ian A; Malik, Qudsia; Carville, Serena; Ward, Stephen

doi:10.1136/bmj.i6748

Cited by 400Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPregnancy-related medical research

Low back pain and sciatica: summary of NICE guidance

Bernstein, Ian A, Malik, Qudsia, Carville, Serena, Ward, Stephen·2017·BMJ

DOI 10.1136/bmj.i6748

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Abstract

#### What you need to know Low back pain is the leading cause of long term disability worldwide.1 The lifetime incidence of low back pain is 58-84%,2 and 11% of men and 16% of women have chronic low back pain.3 Back pain accounts for 7% of GP consultations and results in the loss of 4.1 million working days a year.2 More than 30% of people still have clinically significant symptoms after a year after onset of sciatica.4 This guideline replaces the National Institute for Health and Care Excellence (NICE) guideline on early management of low back pain in adults (2009) and expands its remit. It summarises the updated recommendations from NICE for the assessment and management of low back pain and sciatica.5 For a visual summary, please see infographic. It is intended to overcome patchy commissioning of back pain pathways and pain management programmes6 and poor implementation due to clinicians’ beliefs that previous recommendations were constraining clinical practice.7 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence …

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CBT and multimodal approaches including psychological components improve CBP and associated long-term impairment.
“Cognitive behavioral therapy (CBT) and multimodal approaches including psychological components have been demonstrated to improve CBP and associated long-term impairment [11, 12].”
From EFFects of Exposure and Cognitive behavioral Therapy for chronic BACK pain (“EFFECT-BACK”): study protocol for a randomized controlled trial (2024) · cites this paper as [11]
NICE guidelines suggest using manual therapy as part of a broader package of treatments to help reduce LBP and co-morbid mental health conditions.
“One form of treatment for chronic pain, suggested by the recent guidelines by National Institute for Health and Care Excellence (NICE; Bernstein et al., 2017), is to use manual therapy as part of a broader package of treatments (e.g. in conjunction with exercise therapy and psychological treatment) to help reduce LBP and co-morbid mental health conditions.”
From An evaluation of osteopathic treatment on psychological outcomes with patients suffering from chronic pain: A prospective observational cohort study collected through a health and well-being academy (2018) · cites this paper as Bernstein et al., 2017

A Heavy Burden: the occurrence and impact of musculoskeletal conditions in the United Kingdom today.
Parsons, S., Ingram, M., Clarke-Cornwell, A. M., & Symmons, D. P. M. (2011) · Cited by 27 · see citing works

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Method
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Authors: Bernstein, I. A., Malik, Q., Carville, S., & Ward, S.
Affiliations: London North West Healthcare NHS Trust (GB)
Royal College of Physicians (GB)
Brighton and Sussex University Hospitals NHS Trust (GB)
ORCID: Bernstein, Ian A
Carville, Serena
Ward, Stephen
Venue: BMJ
Publisher: BMJ
Published: 2017-01-06
Volume: 356
Pages: i6748
ISSN: 1756-1833 (ISSN-L)
0959-8138
DOI: 10.1136/bmj.i6748
OpenAlex: W2568605285
Cited by: 399
References: 2
Citations by year: 2026: 23 · 2025: 35 · 2024: 45 · 2023: 60 · 2022: 47 · 2021: 52 · 2020: 48 · 2019: 43 · 2018: 35 · 2017: 9
FWCI: 26.02
Type: journal article
Language: en
Update notices: correction (2021-07-14)
Open access: closed
Licence: www.bmj.org/licenses/tdm/1.0/terms-and-conditions.html (tdm)
Locations: BMJ (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
Keywords: low back pain, sciatica, NICE guidelines, chronic back pain, back pain management, clinical evaluation, pain management program, implementation of clinical recommendations, cost-effectiveness
MeSH terms: Humans, Sciatica, Randomized Controlled Trials as Topic, Low Back Pain, Practice Guidelines as Topic

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Low back pain and sciatica: summary of NICE guidance

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