By
Laura Donnelly, Health Correspondent
Published: 7:45AM BST 02 Aug 2009
The Government's drug rationing
watchdog says "therapeutic" 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 million.
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guidelines to be withdrawn after its members warned that they would lead to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 failure rate."
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 chronic pain.
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 withdrawn.
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
"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".