Every three to five years, NHS Lancashire and South Cumbria ICB review its clinical policies to ensure they reflect the latest evidence-based guidance and best practice. We are currently reviewing the following policies and would welcome your views on the proposed changes.
Please share your feedback by completing the short questionnaire.
This policy relates to procedures to relieve low back pain by injecting medication into the spine or using radiofrequency energy to disrupt nerve function. The proposed changes broaden the definition of spinal injections that are not routinely commissioned and introduces exclusion criteria. This is based on National Institute for Health and Care Excellence (NICE) guidance on out of scope criteria for this procedure. The changes may mean fewer people are eligible for the criteria. The proposed policy wording includes two options (A or B below) which will be decided based on feedback received from the public.
The wording is as follows:
1. Spinal injections for non-specific low back pain are not routinely commissioned (this includes all injections such as facet joint injections, therapeutic medial branch blocks and intradiscal therapy together with prolotherapy and trigger point injections e.g. botulinum toxin – this list is not exclusive).
2. Epidural injections for neurogenic claudication in people with central spinal canal stenosis are not routinely commissioned.
3. Caudal Epidural / selective nerve root block only under ultrasound or Xray guidance are routinely commissioned for people with acute and severe sciatica. Blind spinal injections are not recommended by NICE.
4. Radiofrequency denervation of the facet joint for a person with chronic low back pain is routinely commissioned in the following circumstances:
a. non-surgical treatment has not worked for them
b. the main source of pain is thought to come from structures supplied by the medial branch nerve, as confirmed by a positive response to a diagnostic medial branch block within the last 6 months
c. they have moderate or severe levels of localised back pain (rated as 5 or more on a visual analogue scale, or equivalent).
5. Ensure all patients undergoing radiofrequency denervation have received a rehabilitation programme tailored to their needs and continue to commit to long term self-management of their rehabilitation.
Option A: 6. A repeat denervation procedure is allowed at a frequency of not less than two years.
OR Option B: 6. A repeat denervation procedure is allowed at a frequency of 18 months since the first denervation if clinically indicated.
Please note this survey closes at midnight on Friday 26 December 2025.