The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Peripheral nerve-field stimulation for chronic low back pain.
The lower back is commonly defined as the area between the bottom of the rib cage and the buttock creases. Chronic low back pain is tension, soreness and/or stiffness often worsened by movement lasting more than six weeks in the lower back region. Low back pain is a common disorder, affecting around one-third of the UK adult population each year. Peripheral nerve-field stimulation involves implanting electrodes in the back, connected to a neurostimulator under the skin. The aim is to mask the back pain by modulating the transmission of pain signals to the brain. The patient uses a remote control to deliver low voltage electrical stimulation to the subcutaneous tissue layers of the lower back. The stimulation causes a tingling sensation (paraesthesia) in the area of the body associated with the pain, easing the discomfort.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.