With thanks to the BBC:

Patients with persistent low back pain should be offered acupuncture, massages or exercises on the NHS, says guidance.

It is the first time the National Institute for Health and Clinical Excellence has explicitly backed the use of complementary therapies. The rationing watchdog said evidence suggests they help and will be cost effective if doctors stop providing less proven back services like X-rays.

The move was welcomed by some charities and experts but criticised by others.

Low back pain is a very common problem affecting one in three adults in the UK each year, with an estimated 2.5 million people seeking help from their GP.

For many people the pain goes away in days or weeks. But for some, the pain can persist for a long time and become debilitating.

NICE says anyone whose pain persists for more than six weeks and up to a year should be given a choice of several treatments, because the evidence about which works best is uncertain.

Complementary therapies

In addition to painkillers and regular advice to stay active and carry on with normal activities as much as possible, patients, together with their doctor, can decide to opt one of three complementary treatments.

This includes up to eight exercise sessions or 10 sessions of acupuncture over 12 weeks, or a course of manual therapy, which includes up to nine sessions of spinal manipulation, mobilisation or massage. Professor Peter Littlejohns, NICE Clinical and Public Health Director said NHS providers now had the opportunity to look at the services they provide and decide what changes are needed.

He said: “There is variation in current clinical practice, so this new NICE guideline means that for the first time we now have the means for a consistent national approach to managing low back pain.

“Importantly, patients whose pain is not improving should have access to a choice of different therapies including acupuncture, structured exercise and manual therapy.”

Patients who fail to benefit from their first choice may be offered another of these options, he said.

If that doesn’t work, they can try an intensive treatment programme combining exercise and psychological therapy.

Contentious

He said the costs to the NHS would be minimal – in the order of £77,000 – because they are offset by the savings in terms of reducing future disability and healthcare needs and moving away from treatments with little supportive evidence.

The guidelines, which apply to England and Wales, say doctors should no longer offer spinal x-rays or MRI scans or injections of therapeutic substances into the back for non-specific low back pain.

The Chartered Society of Physiotherapy welcomed the guidelines, as did Dr Dries Hettinga of the charity BackCare.

He said: “This offers a real choice for patients.

“This guideline will help patients understand what treatment and care can help them with their back pain and shows that there can be a positive outlook for treating this condition.”

But others were critical of the recommendations.

Professor Edzard Ernst, an expert in complementary medicine at Peninsula Medical School, said he was surprised by the guidance and particularly by NICE’s recommendation of spinal manipulation.

“It feels as though the panel was biased in favour of this approach thus over-rating its effectiveness and under-estimating its risks which can be considerable. In my view, a critical risk benefit analysis of the most reliable data fails to come out in favour of chiropractic.

“We must remember that no optimally effective treatment for back pain exists.”

With thanks to the Prince’s Foundation for Integrated Health:

The first and only dedicated NHS Medical & Clinical Hypnosis Service is run by Dr Raj Sharma and Rieko Ito, a nurse therapist at the Royal London Homeopathic Hospital.  Here, Dr Sharma tells us about his work.
FIH: Can you tell us a bit about how the service works?

RS: We operate from the Royal London Homeopathic Hospital.  We get referrals from GPs from across the UK through the NHS Choose and Book system, as well as referrals from doctors, psychologists and others working within University College London Hospitals.

We can treat people individually or in groups.  We run a Cognitive Behavioural Therapy (CBT) unit in conjunction with the Hypnosis unit – and sometimes use both together to treat patients.

The aim of both hypnosis and CBT is to equip the patients with the tools to manage their condition.

FIH: What is hypnosis used for?

RS: We treat a wide spectrum of medical, psychological and dental conditions – from phobias and anxiety disorders, to chronic pain and gut disorders.

We run group programmes for conditions such as Fibromyalgia Syndrome, Temporomandibular Joint Disorders, and Irritable Bowel Syndrome.

FIH: What does your research show about using hypnosis in these conditions?

RS: Research shows that hypnotic techniques reduce the perception of chronic pain, especially in lessening the intensity and emotional aspects of pain.

There’s strong evidence for the use of hypnosis in Irritable Bowel Syndrome. It was recommended by the National Institute for Clinical Excellence (NICE) in February 2007.

The hypnotic technique used is Gut Directed Imagery in hypnosis, where hypnotic suggestions and imagery are used to alleviate pain and bloating, and improve bowel function.

A recent audit from the Unit showed that 70% of patients referred had a clinically significant improvement in their symptoms.

For our group sessions, the research shows that using hypnosis with CBT enhances the effects of CBT by 70%.  A recent audit of the Integrated TMD groups showed that patients on average found a 57% relief from the combined approach of hypnosis and CBT.

FIH: What’s it like running such an unusual service within the NHS?

RS: I find my job extremely satisfying. It’s an honour to run such a unique service for the NHS. As a medical doctor, I’m helping patients to manage their condition and resolve their problems through psychological techniques, and not only relying on medications.

Being medically trained, I have the added advantage of understanding a patient’s medical, psychological or dental problem in both biological and psychological terms.

FIH: What are the limits of hypnosis?

RS: What can limit hypnosis is the varying degree of susceptibility to hypnotic suggestions among the population. However, only a small percentage of the population are low in susceptibility, and there are validated tools from Harvard and Stanford Universities to measure one’s susceptibility.

Since we’re also using CBT,  we can also draw from that to help low susceptibility patients manage their condition.

Anniek Verholt is an Dutch holistic Art Therapist who uses techniques based on the therapeutic philosophy of Rudolf Steiner.

Anniek has recently arrived in Britain and will be working at the Hale Clinic in Regents Park where she will work mainly with cancer patients and ex-cancer patients.

Patients could benefit greatly from working intensely with colour, metaphors and other media to express their emotions, open up blockages, overcome depression, breathing problems, gain new energy, find out more about themselves, their illness and their life-journey.

For more information, Anniek has a web site here.