Back pain: injections might not be the solution, say Lancashire medics

Lancashire patients with some types of back pain will no longer be prescribed injections
Lancashire patients with some types of back pain will no longer be prescribed injections
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Patients with lower back pain in Lancashire and South Cumbria will see limits placed on the number of spinal injections they receive as part of their treatment.

The change will standardise the procedures offered to patients no matter where they live in the region, after it emerged that several areas have historically had no policy in place to guide clinicians. Some types of back pain will no longer be treated with injections at all.

A meeting of the Joint Committee of Clinical Commissioning Groups (JCCCG) heard that spinal injections were a commonplace and costly treatment for back complaints - but not necessarily in a sufferer’s best interests.

“We had some patients receiving these injections where the evidence is they wouldn’t have been receiving a net benefit,” Elaine Johnstone, chair of the commissioning policy group, told members.

The new policy - which is expected to save around £300,000 per year - will mean access to the injections is determined by the type of pain an individual is experiencing.

So-called non-specific back pain, where a cause cannot be identified, will no longer be treated by the jabs, because they are not deemed effective by the NHS.

Patients with specific and so-called radicular back pain, resulting in acute or severe sciatica, will be allowed two injections prior to being referred to a consultant and a further two under the care of that specialist - in advance of either surgery or discharge.

Other eligibility criteria, including prior appropriate self-management of the pain, will also apply.

Mark Youlton, chief officer of East Lancashire CCG, said some specialists might refuse to be bound by the changes.

“There are some consultants who will say, ‘I don’t care, I’m carrying on [giving the injections]’,” he said.

“Don’t underestimate the power of not paying [a provider] for something,” Amanda Doyle, chief officer for the region’s Integrated Care System, replied.

The NHS needed to establish the “what’s safe and what’s going to make people better,” she added. “Let’s do the things that are going to do that and stop the things that aren’t.”

The meeting heard that even some GPs were surprised by the rigour of the process which had been undertaken to arrive at the new policy.

“We shouldn’t be injecting people where there’s not clinical evidence that it’s right to do so - that’s the most important thing,” Anthony Gardner, Director of Planning and Performance at Morecambe Bay CCG, said.