TNRF2: Pain Management

Overview

Lumbar Facet Joint injections consists of an anaesthetic with a long-lasting steroid injected into the facet joint itself. This reduces the inflammation in the joint space. This can reduce 
pain and other symptoms caused by inflammation such as nerve irritation. 

Thresholds and eligibility 

Facet joint injections are NOT routinely funded for patients with chronic non-specific low back pain and those with sciatica.

NHS Surrey Heartlands will fund medial branch blocks for the diagnosis of lumbar back pain to establish whether the main source of pain is thought to come from structures supplied by the medial branch as follows:

• The patient is part of a comprehensive pain management programme.

AND

• All non-surgical and conservative management options (physiotherapy treatments and guided exercise programmes, pharmacotherapy including analgesia and muscle relaxants) have been tried and failed. 
  • Please provide evidence of robust conservative therapy (e.g., physiotherapy report) within the last 12 months.

AND

• The pain has resulted in moderate to significant impact on daily functioning (rated as 5 or more on a visual analogue scale, or equivalent) at the time of referral with no evidence of other pathology.
  • No evidence of contraindications is present for the needle placement and injection of local anaesthetics.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

A spinal epidural injection contains a steroid medicine, usually together with a local anaesthetic. The liquid is injected into a gap called the epidural space, which surrounds your spinal cord. The steroid reduces inflammation around your spinal cord, while the local anaesthetic provides faster pain relief.

Thresholds and eligibility 

Epidural injections of local anaesthetic and steroid will only be funded for people with acute and severe sciatica.

Epidural injections will not be funded for neurogenic claudication in people who have central spinal canal stenosis.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.

Overview

Radiofrequency facet denervation is a minimally invasive procedure used to treat central neck or back pain caused by arthritis or injury to the facet joints. 

Thresholds and eligibility 

Radiofrequency denervation can be offered according to NICE guideline (NG59) if all non-surgical and alternative treatments have been tried and there is moderate to severe chronic pain that has improved in response to diagnostic medical branch block.  Consider referral for assessment for radiofrequency denervation for people with non-specific low back pain when:

• Non-surgical treatment has not worked for them, and the main source of pain is thought to come from structures supplied by the medial branch nerve, and they have moderate or severe levels of localised back pain (rated as 5 or more on a visual analogue scale, or equivalent) at the time of referral.

AND

• Only perform radiofrequency denervation in people with non-specific low back pain after a positive response to a diagnostic medial branch block.

AND

• Do not offer imaging for people with non-specific low back pain with specific facet joint pain as a prerequisite for radiofrequency denervation.

Resources

Treatments not routinely published policy (TNRF2)

Additional information

Assuming patients meet the criteria for this procedure, the consultant can provide the treatment.  

However, if the patients does not meet the criteria, the consultant has the option of submitting an Individual Funding Request (IFR) application to the Effective Commissioning Initiative Team at NHS Surrey Heartlands via the Blueteq database if they consider them to be clinically exceptional.