If you’re going to suffer, please do so quietly

The UK’s National Institute of Health and Clinical Excellence (NICE) is ordering doctors to reduce the number of steroid injections to treat chronic back pain for which the cause is not known. The reason? NICE hopes that the new policy will help get health care costs in its public system under control.

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

Doctors are outraged. They believe that under the new policy, thousands will suffer needlessly, seek more dangerous treatments such as opiates and spinal surgery (as opposed to the acupuncture and osteopathy NICE would like them to use), or be forced to pay £500 for private treatments after a lifetime of payments into the National Health Service.

It seems strange that NICE would recommend less-tested methods such as acupuncture and osteotherapy over steroid injections to deal with pain, but such is the way when government bureaucrats are making health care decisions rather than doctors and patients: Special interests always find a way into the decision-making process.

The NICE guidelines admit that evidence was limited for many back pain treatments, including those it recommended. Where scientific proof was lacking, advice was instead taken from its expert group. But specialists are furious that while the group included practitioners of alternative therapies, there was no one with expertise in conventional pain relief medicine to argue against a decision to significantly restrict its use.

It’s no surprise that alternative treatment providers would encourage greater reliance on their services. What’s interesting is that no specialist representing the service NICE wished to save money on was at the table to offer an opposing point of view.

NICE defended its policy by stressing that there is no desire to eliminate injections, only those administered to patients who have been in pain for less than a year and before the cause is diagnosed. Waiting lines to see a specialist are long, and so are waits for diagnoses, ensuring that this group of patients is large enough that NICE believes it will cut 57,000 injections per year — and, unfortunately, leave the patients who would have received those 57,000 injections to suffer for the sake of cost savings.

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