Exercise should be the main treatment for low back pain, according to new guidance in England.
Acupuncture is not effective and physiotherapy only works with a programme of exercise, according to the National Institute for Health and Care Excellence.
NICE says exercise in all its forms is the first step in managing low back pain. This can be yoga, aerobic exercise or just stretching and strengthening.
Patients should also continue with normal activities so far as possible.
The recommendations are contained in draft guidance to be finalised in September.
Patients should try non-steroidal anti-inflammatory drugs such as ibuprofen or aspirin as their first medication, it says. Weak opioids such as codeine should only be used when NSAIDs are ineffective or unsuitable, it says.
Doctors should consider suggesting psychological therapies for patients with persistent problems, NICE says.
Professor Mark Baker, from NICE, said: “Regrettably there is a lack of convincing evidence of effectiveness for some widely used treatments. For example, acupuncture is no longer recommended for managing low back pain with or without sciatica. This is because there is not enough evidence to show that it is more effective than sham treatment.
“It is possible to reduce the impact that low back pain and sciatica can have on people’s lives. The draft guideline continues to recommend a stepped care approach and means people whose pain or function are not improving despite initial treatment should have access to a choice of further therapies."
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