Quality standard
Quality statement 4: Gabapentinoids, antiepileptics, antidepressants and paracetamol for low back pain without sciatica
Quality statement 4: Gabapentinoids, antiepileptics, antidepressants and paracetamol for low back pain without sciatica
Quality statement
Young people and adults are not given paracetamol alone, gabapentinoids, antiepileptics or antidepressants to treat low back pain without sciatica.
Rationale
The use of medicines without a significant clinical benefit in managing low back pain with or without sciatica can lead to unnecessary side effects for the person, risk of dependency and inappropriate use of resources.
Quality measures
Structure
Evidence of local arrangements to ensure that no GP prescriptions include paracetamol alone, gabapentinoids, antiepileptics or antidepressants to treat young people and adults with low back pain without sciatica unless the young person or adult has other indications for those medicines.
Data source: Local data collection, for example, service protocols.
Process
a) Proportion of young people and adults with low back pain without sciatica, who are given gabapentinoids or antiepileptics and have no other indications for them.
Numerator – the number in the denominator who are given gabapentinoids or antiepileptics.
Denominator – the number of young people and adults with low back pain without sciatica and no other indications for gabapentinoids or antiepileptics.
Data source: Local data collection, for example, GP prescribing audits.
b) Proportion of young people and adults with low back pain without sciatica, who are given antidepressants and have no other indications for them.
Numerator – the number in the denominator who are given antidepressants.
Denominator – the number of young people and adults with low back pain without sciatica and no other indications for antidepressants.
Data source: Local data collection, for example, GP prescribing audits.
c) Proportion of young people and adults with low back pain without sciatica, who are given paracetamol alone and have no other indications for it.
Numerator – the number in the denominator who are given paracetamol alone.
Denominator – the number of young people and adults with low back pain without sciatica and no other indications for paracetamol.
Data source: Local data collection, for example, GP prescribing audits.
What the quality statement means for different audiences
Service providers (such as GP practices) have systems in place to make staff aware that they should not give paracetamol alone, gabapentinoids, antiepileptics or antidepressants to treat low back pain without sciatica. Young people and adults should only be given these medicines if they have other indications for them.
Healthcare professionals (such as GPs and nurses) do not treat low back pain without sciatica with paracetamol alone, gabapentinoids, antiepileptics or antidepressants. They should only offer these medicines if there are other indications for them.
Commissioners (such as clinical commissioning groups and NHS England) ensure that they have agreed service specifications which state that services do not treat low back pain without sciatica with paracetamol alone, gabapentinoids, antiepileptics or antidepressants.
Young people and adults with low back pain without sciatica are not given paracetamol alone, gabapentinoids, antiepileptics or antidepressants unless they need them for other conditions. This is because these medicines are not effective in either easing back pain or restoring function such as walking and doing daily tasks.
Source guidance
Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59 (2016, updated 2020), recommendations 1.2.26, 1.2.29 and 1.2.30