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British Pain Society, which represents specialists in the field, has written to NICE calling for the guidelines to be withdrawn after its members warned that they would lead to many patients having to undergo unnecessary and high-risk spinal surgery.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".