The National Institute for Health and Care Excellence (NICE) recently updated its guideline, Low Back Pain and Sciatica in Over 16s. The guideline features recommendations on imaging, exercise, orthotics, pharmacological management of sciatica, invasive treatments for low back pain and sciatica, and more.
The July 2026 update to Low Back Pain and Sciatica in Over 16s saw a few key changes. The recommendations on psychological therapy for low back pain with or without sciatica, and combined physical and psychological programmes for low back pain or sciatica were withdrawn. Those recommendations were partly based on evidence that was retracted since publication. The guideline board decided not to update the recommendations because it believed that doing so would be unlikely to notably impact clinical practice, so they were withdrawn.
NICE also removed references to psychological therapy in recommendation 1.1.3 and 1.2.7. Below, we compare the 2026 guideline update alongside the previous 2020 version. For the complete look at the NICE guideline, Low Back Pain and Sciatica in Over 16s, view the full-text version.
Key Elements of the 2026 Update:
| Recommendation | 2020 | 2026 |
|---|---|---|
| 1.1.3 | Based on risk stratification, consider: simpler and less intensive support for people with low back pain with or without sciatica likely to improve quickly and have a good outcome (for example reassurance, advice to keep active and guidance on self-management); more complex and intensive support for people with low back pain with or without sciatica at higher risk of a poor outcome (for example, exercise programmes with or without manual therapy or using a psychological approach). | Based on risk stratification, consider: simpler and less intensive support for people with low back pain with or without sciatica likely to improve quickly and have a good outcome (for example reassurance, advice to keep active and guidance on self-management); more complex and intensive support for people with low back pain with or without sciatica at higher risk of a poor outcome (for example, exercise programmes with or without manual therapy). |
| 1.2.7 | Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy. | Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package that includes exercise. |
| 1.2.13 | Consider psychological therapies using a cognitive behavioural approach for managing low back pain with or without sciatica but only as part of a treatment package including exercise, with or without manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage). | This recommendation has been deleted. |
| 1.2.14 | Consider a combined physical and psychological programme, incorporating a cognitive behavioural approach (preferably in a group context that takes into account a person's specific needs and capabilities), for people with persistent low back pain or sciatica: | This recommendation has been deleted. |
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