Important Changes to NICE Guidance (NG59): NSN Response

NG59 Nice Guidance: https://www.nice.org.uk/guidance/ng59

NICE has recently removed the recommendation for CPPP interventions for persistent low back pain, following the withdrawal of some key studies and a review of the available evidence. We recognise NICE’s responsibility to ensure that clinical recommendations are based on robust and current evidence, and understand that the withdrawal of studies underpinning previous recommendations may require their reconsideration.

The NSN has concerns about the implications of this change for patients, clinicians and NHS services, where CPPP approaches are embedded within many spinal and MSK pathways, including the National Low Back and Radicular Pain Pathway (2017). We recognise combined physical and psychologically informed approaches, including psychological therapies and models such as Cognitive Functional Therapy (CFT), are now embedded within many NHS Musculoskeletal and Pain Services and form an important part of contemporary biopsychosocial care for people with persistent low back pain.

It is also important to note that NICE guidance on chronic pain (NG193) continues to support a combination of physical and psychological therapies as part of the management of chronic primary pain. This provides relevant guidance for clinicians when considering a broader, person-centred approach to managing persistent pain.

The NSN Executive has written to NICE to seek clarification on the evidence, the implications for clinical practice and whether a formal review of the guidance will take place. The NSN remains committed to evidence-informed, person-centred spinal care and has offered its expertise to support any future review or stakeholder discussions.

We will continue to engage constructively with NICE and will update NSN members as further information becomes available. Please feel free to inform us of any concerns regarding impact on local services.

Posted on behalf of the NSN Executive Committee