Therapeutic and diagnostic injections for the treatment of back pain

Please click here to view the full Therapeutic and diagnostic injections for the treatment of back pain Commissioning Statement.

Please click here to access the referral form.

Commissioning Position

NHS Vale of York CCG does NOT routinely commission therapeutic spinal injections for back pain. Therapeutic injections included in this policy are:

Epidural injections and nerve blocks
Facet joint injections (FJI)
Radiofrequency nerve denervation (rhizolysis/ medial branch block/ nerve root ablation)
Trigger point injections

There are three exceptions (but note that ALL requests now have to be made via a referral form for prior approval)

For the treatment of acute severe spinal pain or sciatica of up to 12 weeks duration, as part of the acute/subacute back pain pathway, to help with mobilisation

one epidural or transforaminal injection will be commissioned within an acute back pain service

Facet joint injections for diagnostic purposes:

Facet joint injections will NOT be commissioned for acute or acute on chronic spinal pain for therapeutic purposes

For patient with complex multi level disease requiring assessment for surgical intervention (via specialist MSK service; orthopaedic or neurosurgical services) the CCG will commission a maximum of two facet joint injections for diagnostic purposes to help localise the problem and define surgical management of chronic spinal pain (which has lasted more than 2 years, with nerve root involvement). These should be performed no more than 6 weeks apart, as part of pre-surgical work up.

Spinal injections required to treat cancer related spinal pain (eg epidural or intrathecal injections, nerve blocks eg coeliac) – if other analgesia (oral, topical) has failed

The CCG only considers spinal injections for patients with chronic spinal pain (>12 weeks) in clinically exceptional circumstances.

All patients with low back pain and/or sciatica should be assessed in line with NICE guidance NG59¹. This MUST initially include

Consider alternative diagnoses eg injury, malignancy
Risk assessment and risk stratification (eg STarT Back risk assessment tool at first point of contact with a healthcare processional).
Based on risk stratification, consider simpler support (eg self-management - exercise, weight loss etc) or more complex intensive support (eg pain management programmes (with physical and psychological elements), optimised pharmacological interventions

All requests for therapeutic injections for chronic back pain, on the grounds of clinical exceptionality, need to be made to the NHS Vale of York CCG Individual Funding Request Panel process, using the referral form.

Approval is required by the NHS Vale of York CCG for both new patients, and patients for whom a repeat therapeutic back pain injection is being considered.

General patient information is available at Back pain