injections of steroids, such as cortisone, which are used to reduce
inflammation, should no longer be offered to patients suffering from
persistent lower back pain when the cause is not known.
Instead the National Institute of Health and Clinical Excellence
(NICE) is ordering doctors to offer patients remedies like
acupuncture and osteopathy.
Specialists fear tens of thousands of people, mainly the elderly and
frail, will be left to suffer excruciating levels of pain or pay as
much as £500 each for private treatment.
The NHS currently issues more than 60,000 treatments of steroid
injections every year. NICE said in its guidance it wants to cut this
to just 3,000 treatments a year, a move which would save the NHS £33
But the British Pain Society, which represents specialists in the
field, has written to NICE calling for the guidelines to be withdrawn
after its members warned that they would lead to many patients having
to undergo unnecessary and high-risk spinal surgery.
Dr Christopher Wells, a leading specialist in pain relief medicine
and the founder of the NHS' first specialist pain clinic, said it was
"entirely unacceptable" that conventional treatments used by
thousands of patients would be stopped.
"I don't mind whether some people want to try acupuncture, or
osteopathy. What concerns me is that to pay for these treatments,
specialist clinics which offer vital services are going to be forced
to close, leaving patients in significant pain, with nowhere to go,"
The NICE guidelines admit that evidence was limited for many back
pain treatments, including those it recommended. Where scientific
proof was lacking, advice was instead taken from its expert group.
But specialists are furious that while the group included
practitioners of alternative therapies, there was no one with
expertise in conventional pain relief medicine to argue against a
decision to significantly restrict its use.
Dr Jonathan Richardson, a consultant pain specialist from Bradford
Hospitals Trust, is among more than 50 medics who have written to
NICE urging the body to reconsider its decision, which was taken in May.
He said: "The consequences of the NICE decision will be devastating
for thousands of patients. It will mean more people on opiates, which
are addictive, and kill 2,000 a year. It will mean more people having
spinal surgery, which is incredibly risky, and has a 50 per cent
One in three people are estimated to suffer from lower back pain
every year, while one in 15 consult their GP about it. Specialists
say therapeutic injections using steroids to reduce inflammation and
other injections which can deaden nerve endings, can provide months
or even years of respite from pain.
Experts said that if funding was stopped for the injections, many
clinics would also struggle to offer other vital services, such as
pain management programmes and psychotherapy which is used to manage
Anger among medics has reached such levels that Dr Paul Watson, a
physiotherapist who helped draft the guidelines, was last week forced
to resign as President of the British Pain Society.
Doctors said he had failed to represent their views when the
guidelines were drawn up and refused to support the letter by more
than 50 of the group's members which called for the guidelines to be
In response, NICE chairman Professor Sir Michael Rawlins expressed
outrage over the vote that forced Dr Watson from his position,
describing the actions of the society as "shameful". He accused pain
specialists of refusing to accept that there was insufficient
scientific evidence to support their practices.
A spokesman for NICE said its guidance did not recommend that
injections were stopped for all patients, but only for those who had
been in pain for less than a year, where the cause was not known.
Iris Watkins, 80 from Appleton, in Cheshire said her life had been
"transformed" by the use of therapeutic injections every two years.
The pensioner began to suffer back pain in her 70s. Four years ago,
despite physiotherapy treatment and the use of medication, she had
reached a stage where she could barely walk.
"It was horrendous, I was spending hours lying on the sofa, or in
bed, I couldn't spend a whole evening out. I was referred to a
specialist, who decided to give me a set of injections. The
difference was tremendous",
Within days, she was able to return to her old life, gardening,
caring for her husband Herbert, and enjoying social occasions.
"I just felt fabulous – almost immediately, there was not a twinge. I
only had an injection every two years, but it really has transformed
my life; if I couldn't have them I would be in despair".