Quality statement 4: Anticonvulsants, antidepressants and paracetamol for low back pain without sciatica

Quality statement 4: Anticonvulsants, antidepressants and paracetamol for low back pain without sciatica

Quality statement

Young people and adults are not given paracetamol alone, anticonvulsants 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, anticonvulsants 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 anticonvulsants and have no other indications for them.

Numerator – the number in the denominator who are given anticonvulsants.

Denominator – the number of young people and adults with low back pain without sciatica and no other indications for anticonvulsants.

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.

Outcome

Number of medicines-related adverse events for young people and adults with low back pain without sciatica.

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, anticonvulsants 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, anticonvulsants 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, anticonvulsants or antidepressants.

Young people and adults with low back pain without sciatica are not given paracetamol alone, anticonvulsants 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 (2016) NICE guideline NG59, recommendations 1.2.21 and 1.2.24–25.