A Critical Look into the 2016 NICE Guidelines: Acupuncture for Low-Back Pain and Sciatica

In November of 2016, the National Institute for Health and Care Excellence (NICE) Guidelines for low-back pain (LBP) and sciatica were published. According to the NICE Guidelines Development Group (GDG), acupuncture is no longer a recommended treatment for LBP and sciatica, while other therapies including nonsteroidal anti-inflammatory drugs, exercise, epidurals, and manual therapy are recommended as treatments. The aim of this article is to discuss how the GDG decision-making process behind the recommendations against acupuncture—while supporting common conventional treatments for LBP and sciatica—is inconsistent and lacks sufficient evidence-based justification. The evidence used to develop the 2016 NICE Guidelines for LBP and sciatica were critically appraised using the Grading of Recommendations, Assessment, Development, and Evaluation framework, and examined for their limitations. There is predominantly moderate-quality evidence favoring acupuncture over sham, suggesting that the GDG's conclusion that acupuncture works through nonspecific effects is inconsistent with the NICE evidence. The NICE evidence comparing acupuncture to usual care (or wait-list) also demonstrates acupuncture's effectiveness. The GDG's analyses excluded non-English language studies, and evaluated acupuncture by different standards, compared to other recommendations. Acupuncture demonstrates efficacy and effectiveness in the treatment of LBP and sciatica. Each of the GDG's recommendations for treatment of LBP and sciatica should be reevaluated as consistently as possible by the same standards to mitigate any inconsistencies. Analyses of acupuncture should include studies without language restrictions and factor in acupuncture dose and types of sham devices to reduce potential bias in conclusions drawn.