President of British Pain Society is forced from office after refusing to denounce NICE guidance on low back pain

The president of the British Pain Society was forced to resign on 21 July after a campaign from members who were unhappy with guidelines on the management of low back pain from the National Institute for Health and Clinical Excellence (NICE), which he helped develop.

In a letter to the BMJ this week Michael Rawlins, chairman of NICE, and Peter Littlejohns, the institute’s clinical and public health director, called the move to oust Paul Watson as “shameful” and “professional victimisation of the worst kind” (BMJ 2009:339:b3028, doi:10.1136/bmj.b3028).

Professor Watson, who has been president of the society since April, said he was “very disappointed” about what had happened. “It gives the wrong impression of how the British Pain Society conducts its business, and that distresses me quite a lot,” he said.

Some members of the society called an emergency general meeting on 21 July because they were not satisfied with a statement the society put out about its opposition to NICE guidelines. In addition, they wanted Professor Watson to repudiate the guidelines or resign.

The main sticking point was the recommendation in the guidelines that injections of therapeutic substances into the back for non-specific low back pain should not be offered, as the evidence of effectiveness is lacking.

But the society said that NICE’s guideline development group was “misguided” for not considering evidence from cohort studies and clinical case series in its deliberations on this and other treatments. “Although NICE has recommended further research into these procedures, we are most concerned that a significant number of patients will be denied this choice of treatment in the interim,” says the statement.

When Professor Watson refused to denounce the guidelines, members of the society voted for his resignation, by 186 to 179.

Professor Rawlins called the situation “absurd.” He said, “I would have thought that a profession would want their clinical practice supported by good evidence.”

He said he was surprised that members of the society themselves had not conducted some randomised controlled trials on the effectiveness of injections into the spine. “They [RCTs] would be inexpensive and easy to organise,” he said.

In their letter Sir Michael and Professor Littlejohns say that the British Pain Society’s action conflicts with a recommendation of the judicial review of NICE’s guidelines on chronic fatigue syndrome in March (BMJ 2009;338:b1110, doi:10.1136/bmj.b1110). The High Court judge who reviewed the case dismissed all challenges of the guidelines and said that “health experts must be able to express their opinions without fear of retribution,” say the professors.

The Council of the British Pain Society said that it was saddened at the loss of an excellent president. It a statement the society said that as a limited company it had acted within the law when it considered that its president had a conflict of interest in drawing up the NICE guidance. “One could argue at length about the guidelines on such a difficult subject as low back pain. Council of The Society stands by its beliefs that the guidelines are inadequate. However, this in no way is a reflection of Professor Watson, but of the conclusions reached by the NICE guideline committee and the dogmatic way in which they were presented,” it said.