In order for to properly understand the relevance of the newly published guideline on chronic pain in the right context, I need to explain the status of Complementary and Alternative Medicine (CAM) in Scotland, the role of SIGN and of guidelines in general first.  The people who already know this, please bear with me.

The purpose of SIGN guidelines is to inform health professionals in Scotland of best practices and provide recommendations for effective practice in the management of clinical conditions based on the best available evidence. They are not proposals.

In the case of chronic pain, SIGN recommends (as did NICE in 2009 for non-specific low back pain) what is considered ‘Alternative and Complementary Therapies’. In this case the recommendation is for using manual therapies and manipulation (including massage and acupuncture) for low back pain, neck pain and osteoarthritis.  The reason why your GP friend hasn’t heard about it yet may be because the guidelines were only launched on the 12th December.  Also, the guidelines are for the whole of chronic pain management including medication dosages, Chronic Pain Service Model etc - not just regarding CAM.  Your friend would benefit from visiting the new chronic pain support website on .

GPs are encouraged to be aware of and follow all guidelines.  Patients are also entitled to ask for and to expect the best recommended treatments for their condition in the NHS.

In the case of the use of complementary therapies in the NHS, even though they are recommended for the conditions above, as it stands right now, GPs are unable to refer patients for those therapies as they won't know who to refer to and how to refer.  According to the BMA ( ) and the Scottish Government ( , GPs remain responsible for the patients they refer to CAM therapists so they are expected to assess therapists' qualifications, insurance status, etc which is absurd.  I’m currently discussing this with NHS Lanarkshire.

As detailed on the links above, the Scottish Government has made quite clear that it's up to individual Health Boards to decide what treatments there are available in the NHS and this includes CAM.  (you'll be able to find all my activities - and MSPs supporters) on this on www.

In order for GPs to be able to refer chronic pain patients to the recommended therapies in the same way that they refer to physio, for instance, two things need to be put in place ASAP: CAM regulation and a referral pathway. My main focus is to argue the urgent need for those two things to happen (through Parliament questions, correspondence with NHS Lanarkshire and through the Cross-party Group on Chronic Pain of which I'm a founder member).

The Dept of Health in Whitehall have already helped create and funded an organisation to regulate CAM (the CNHC) THROUGHOUT THE UK but the Scottish Government has refused to acknowledge them until now (when Nicola Sturgeon was the Health Secretary). Having a regulatory body means that GPs can be confident that therapists a suitably qualified and conform to standards - that's how it currently works in England and Wales.

I'm in direct contact with the CNHC and with Scottish therapists registers in Scotland. (I’m told that there are over 100 CNHC-registered therapists here).

So, regulation would be very simple and quickly set up in Scotland through the CNHC - it's just a matter of the Government recognising the organisation as a UK-wide regulatory body (in the same way that the BMA regulates GPs throughout the UK).

Referral pathway is straight forward enough to set up.

So, in summary, although the mechanisms to make CAM available through the NHS haven't been set up, this doesn't mean that patients shouldn't demand CAM therapies when they are clinically recommended as best interventions for their chronic pain.

Patients AND GPs should be encouraged to ask for those therapies so that Health Boards understand that they need to do something about it (or even that they risk being sued under a few ‘headings’ – including breach of human rights).

As some of you will know, I’ve been in touch with Dr  Kohli – NHS Lanarkshire’s Director of Public Health, to try to find a way to progress on the issues of  patients’ right to equal access to the guideline recommendations in Lanarkshire.  Some local GPs have started recommending patients for CAM pain management but only those who can pay – a situation that is not acceptable.

At the launch of the SIGN guideline, I was also invited to join NHS Lanarkshire’s Service Improvement Group (SIG) which I have accepted.  I’ll report on developments there as well as necessary.  It’s good to bear in mind that any patients can apply to join their local SIG.

Things move faster and get done when users lead.  So, the more patients declare that they want drug-free treatments and demand it from their health service, the better the chance that it will happen and quickly.

Please get in touch with me if you need to clarify anything or need any assistance on this, including access to the Parliament’s Cross-party Group on Chronic Pain  (chronic pain patients are most welcome)

Your GP might be interested in learning the content of this email – he/she would be very welcome to contact me too regarding this issue.

I have added some more new people to this mailing list to make it less time consuming for me (but, of course, I’ll contact you individually when necessary).  Do let me know if you would like me to remove your address from this list.

Contact Paulo at This email address is being protected from spambots. You need JavaScript enabled to view it.  or by calling 0845 053 3149


Congratulations to Ruth Duncan who was presented with an Oustanding Achievement Award at CamExpo by Leon Chaitow.

ruth2             ruth1

Not only has Ruth been busy voluteering at the Commonwealth Games this summer but she has written her first book – MYOFASCIAL RELEASE - available now!

She is in practice in Milngavie, Glasgow and can be contacted at The Natural Therapy Centre on 0141 956 4174 or by email at This email address is being protected from spambots. You need JavaScript enabled to view it.

Ruth also has an article in this month's OTMS (Issue 59) on the 'Psoas'.


There is currently no statutory regulation as yet in Complementary Medicine in this country – the UK – but the Complementary and Natural Healthcare Council are the voluntary regulatory body and its register is now open. There are representatives from 12 Complementary Therapies working together and most are now part of this regulatory register. You can visit the website on .

The General Council for Massage Therapies is the regulatory body for Massage Therapy after working with a Federal Working Group under the guidance of the Prince’s Foundation for Integrated Health. The GCMT is now the voice of Massage Therapy and is working with the regulatory body (CNHC). Members of the GCMT Council are members of the Profession Specific Boards which advises the CNHC. The Professional Standards Authority has now formed to be the super-regulator.

The Scottish Massage Therapists Organisation was one of the founder organisations of the General Council for Massage Therapies and we follow their guidelines in regard to codes of conduct, standards of education and so on.

You can visit the websites on and

If you have decided to relocate, and wish to join the Scottish Massage Therapists Organisation, we welcome applications from ALL massage therapists NOT just home-grown Scottish ones! We have an arrangement with an insurance company who offer discounted insurance to our members. You will need to give us information on your course – a course transcript would be great along with copies of your diplomas and details of your assessments – details on what we require can be provided along with our Non-Affiliated School download.

We cannot give you any advice in regard to visas – if you are not from an EU country you would have to apply to work in the UK, as for any work.

Therapists are listed on the SMTO website. Some are working in clinics, health and fitness clubs, spas while others are working part time or full time as self-employed therapists from home – and of course, some do home visits. The National Health Service exists here so people are not used to paying for healthcare but Massage Therapy, Remedial and Sports Massage Therapy, Advanced Remedial Massage and Reflexology are becoming more and more popular – as has happened in Canada, USA and Australia – people vote with their feet!

If you require any further information then please don’t hesitate to contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. or telephone the office on +44 (0)8454 638852.

Thank you for your interest in the SMTO, and good luck!


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