NICE Standard for low back pain and sciatica needs urgent revision

Abstract

Low back pain is the leading cause of years lived with disability, imposing an enormous economic burden on society. In the UK, the cost of treating low back pain in general practice alone was estimated to be £3.2 billion in 2015, with 80% of these costs attributed to healthcare consultations.1 The healthcare costs of low back pain and neck pain were estimated to be US$134.5 billion in the USA in 2016.2 In 2016, the National Institute for Health and Care Excellence (NICE) released a guideline containing evidence-based recommendations for the management of low back pain and sciatica.3 Subsequently, NICE published the Clinical Care Standard in 2017 focusing on priority areas for healthcare quality improvement for the management of low back pain and sciatica.4 The NICE Standard is composed of a set of ‘quality statements’ describing the high quality care that should be provided and ‘quality measures’ to assess the care specified in the statement.5 Our view, however, is that health service planners, clinicians and patients are not well served by the 2017 NICE Standard.4 In this viewpoint, we discuss the problems with the 2017 NICE Standard and suggest how the Standard could be revised so that it better reflects the current evidence and provides more helpful guidance for clinicians. The evidence of the effectiveness of the interventions discussed in this viewpoint is provided in online supplemental file 1. ### Supplementary data [bjsports-2025-109817supp001.pdf] The recommendations in the 2017 NICE Standard are underpinned by the 2016 NICE guideline for the management of low back pain and sciatica.3 4 As the NICE guideline was issued nearly 10 years ago, some of the recommendations and, consequently, the NICE Standard are not in line with the most recent evidence. Three interventions that are recommended in the Standard (risk stratification, self-management and radiofrequency denervation) …