Physiotherapy Q&A: why won’t my physiotherapist recommend a TENS machine?

I had a course of private physiotherapy 2 years ago for back pain and it was great. A combination of exercise, painkillers, acupuncture and a TENS machine helped get rid of my pain. However, my back pain returned a few months ago and I am now seeing a NHS physiotherapist who does not recommend acupuncture or a TENS machine. Why would they advise against these when they worked so well last time?

It sounds as though your physiotherapist is very aware of the new guidelines on the management of low back pain and sciatica that were recently published in November 2016. The National Institute for Health and Care Excellence, otherwise known as NICE, regularly review all the available research for specific health problems affecting the general population. An expert panel work through this research and put together a guide to make it clear which treatments have strong evidence that they are effective and also identify which treatment options do not have sufficient evidence to support their use.

The most recent guidelines on back pain and sciatica state that exercise and certain painkillers are effective in the treatment for your back pain but concluded that there is currently not enough evidence to show that acupuncture and TENS will help with your pain. This is not to say these treatments do not help specific people, just that when looking at the available evidence, it does not show that these are consistently effective for the general population.

Providers of physiotherapy services to the NHS, such as Horder Healthcare, have to demonstrate to the commissioners who pay for these services that they are following such guidelines and are not using public funds to offer patients treatments that do not have strong evidence around their effectiveness. Therefore you may find that what you are offered in an NHS service may vary from what you may find in a private service. The NHS does test the effectiveness of unproven treatments in clinical trials and when they have been proven to be beneficial for the general population, they are then included in revised guidelines.